Childhood Epilepsy

Clinical Description

Recurrent unprovoked seizures. Epilepsy is classified as generalised or focal.

Causes:

• Congenital brain malformation
• Neurologic sequelae of intracranial infections, trauma and hypoxic brain injury
• Idiopathic
• Syndromes: Lennox Gestaut, Sturge weber, beningn familial, myoclonic epilepsy of the infant
• Metabolic

Signs and Symptoms

• Tonic-clonic: sudden loss of consciousness (tonic phase) than rhythmic contractions of all four extremities. Afterwards postictal phase with headache, confusion and fatigue. Often tongue bite, enuresis, encopresis
• Absence: Impaired awareness and responsiveness. cannot be interrupted by tactile stimulation, often interrupt conversation or ongoing physical activity such as eating and play, usually occur multiple times during the day and last only a few seconds.
• Atonic: abrupt loss of muscle tone
• Myoclonic: repetitive muscle contractions

Investigations

• Electroencephalogram
• CT or MRI brain where available

Pharmacological

Generalized seizures

• Sodium Valproate 20-40 mg/kg/day in 2 to 3 divided doses (maximum 60mg/kg/day)

Alternatively

• Phenobarbitone 5mg/kg nocte

OR

• Phenytoin 3- 5mg/kg PO 12 hourly or
• Carbamazepine 2.5mg/kg per, dose 12 hourly,
• Increase the dose weekly by 5mg/kg until 20mg/kg is reached.
• Levetiracetam 30mg/kg PO loading dose then 40mg/kg 12 hourly

Focal seizures

• Carbamazepine 2.5mg/kg, dose 12 hourly,
• Increase the dose weekly by 5mg/kg until 20mg/kg is reached.

Alternatively

• Give Sodium Valproate 20-40 mg/kg/day in 2 to 3 divided doses (maximum 60mg/kg/day)

Absence seizures

• Never give carbamazepine
• Give Sodium Valproate 20-40 mg/kg/day in 2 to 3 divided doses (maximum 60mg/kg/day)
• Give Ethosuximide 15 mg/kg at night as a single dose increased gradually if necessary to 50 mg/kg daily in 2 divided doses