Let's move on to generalized seizures.
In a patient with generalized seizures, i
it's important to control the seizure
but you probably got about five minutes
remember most pediatric seizures
will stop of their own accord
within five minutes.
An EEG after a seizure is done maybe useful
for identiyfing underlying seizure syndromes.
Let me give you an example.
Lennox Gastaut Syndrome
has an onset between typically three
and five years of age.
These patients have mixed varieties
and they may develop mental
And severe behavioral problems.
Lennox Gastaut has a very typical
<i>It is not so important for a medical
student or a resident</i>
a fellow would probably need to know it
if there is a neurology fellow.
But most of us don't really need
to know how to read EEGs
But we should be aware that there are
certain patterns in them
that give away certain diagnosis.
And Lennox Gastaut does have
a typical EEG appearance.
The reason why it is important to make
the diagnosis of Lennox Gustaut is because
it is a difficult to manage disease
and will require the guidance
of a pediatric neurologist.
Here is an example of an EEG.
What you see here is a patient
You can here that there are intermittent
periods of independent polywave spikes
lasting for roughly one to eight seconds.
And that is classic and emblematic
of that disease.
Ok, let's move on to anti-epileptic
Dilatin or Phenytoin
We've got Phenobarbital
and another that we might talk
about is Ethosuximide.
This are all drugs that we are going to use
to place a child on all the time
to help prevent them from
getting recurrent seizures,
when their seizures are frequent.
Dilantin is good for partial
or generalized seizures
The problem is you need to know
the serum drug levels of the patients
on this drug and over time
they can develop side effects.
The side effects that you are going to be
asked about on your tests
is probably Gingival hypertrophy.
They get excessively growing gums.
They also have
increased body hair. Usually in the arms
you can see it very easily.
And long term, they can have
with actually a loss of IQ points over time.
So we like to avoid the seizure
drugs unless we need them.
Phenobarbital generally used and better
on children under one year of age.
It is good for partial or generalized
and again, we are going to have to
follow drug levels.
Again, this can cause a loss of IQ points
It has a general sedating effect, which
mitigates somewhat over time
as they get used to the drug.
But be careful to warn the parents
that for the next week or two,
their child may be excessively
Ethosuximide is our first line
anti-seizure medicine for
children with absence seizures.
So, I threw it in here as an alternative
of a seizure medication that you will see
children being on.
The side effects of Ethosuximide is
behavioral changes, nausea
and they can get an Aplastic
anemia or a lupus-like syndrome.
The general principle here is that there are
lots of drugs we use in children
we need to know what the side effects are
and we need to know which drugs
are most effective
in which seizure syndromes.
It really a matter of what the
side effect profile
what are your monitoring needs
and what is the seizure type.
Let's switch goals to focal seizures.
only children with focal seizures are
going to have auras warning them
of an impending seizure.
Auras are unique things for each child.
Sometimes they will see certain colors
or just get a sense that a seizure is coming
Focal seizures usually affect one area of the
Let's say an arm or a face.
The child may be fully awake
during the event.
If we diagnose it with EEG,
but an MRI is absolutely indicated in
a child with a first time focal seizure
because we need to rule out
a focal abnormality in the brain.
We're going to treat focal seizures
with AEDs, implanted devices
and in bad cases, ketogenic
diet or surgercal removal of the lesion.
Infantile spasms are a severe and
very sad disease that happens
to infants and can have terrible progrnosis.
These look really unique.
And I urge you to go online and
get to Youtube
and find a video of infantile spasms.
They are all over the place.
It is important to be able to recognize them
It is important to make this
These children have generalized myoclonic
jerks of the neck, trunk and limbs.
It generally begins between 3
and 7 months of age.
The specific etiology of the majority
are unknown or they're genetic or syndromic.
Children who are not actively seizing
will start off with having a normal
neurologic exam and the typical
EEG finding is something called
You should probably remember that
that might show up on a test.
Infantile spasms have a very
And it is a very bad prognosis.
The death occurs for
about 1/3 within 3 years of diagnosis.
These children have profound cognitive
effects from their recurring seizures
These seizures are profoundly hard
and in survivors,
they gradually turn
into other types of seizures
which can persist into adulthood.
Another type of seizure that is much less
Benign Rolandic Epilepsy.
This is also called Benign Epilepsy with
Centrotemporal spikes or BECTS.
these patients tend to have
Centrotemporal spikes on their EEG.
This present as several partial seizures
usually in the face and in the hand.
It begins a little bit older
between 5 and 12 years of age.
And usually with normal children
who are developing normally.
What is key is they usually occur
or within an hour of falling asleep.
Almost all are outgrown during adolescence.
They have those specific EEG findings,
and treatment is optional because they
are asleep while having the problem.