Childhood epilepsy is a common neurological syndrome of complex etiology, recurrent, paroxysmal, and temporary brain dysfunction during childhood time (0-18 years). The etiology is divided into primary and secondary. The etiology of childhood epilepsy is mostly caused by perinatal ischemia and hypoxia, cortical dysplasia, low-grade glioma, encephalitis, and trauma.
During the neonatal period until adolescence, the structure and function of the nervous system are in the process of rapid developmental shaping. Therefore, many aspects of epilepsy in different age groups are different from those in adults, from etiology, pathogenesis, clinical features performance to prognosis. Especially under the age of 6 years, which is a critical period of brain development, it is recommended to actively control seizures to facilitate the growth and development of the affected children.
1. Benign familial neonatal convulsions
Family history of neonatal convulsions, idiopathic epilepsy, 80% of convulsions appear 2-3 days after birth, seizure type is generalized seizures, good prognosis, normal psychomotor development, no secondary epilepsy, control drugs can choose phenobarbital and sodium propoxurate.
2, benign idiopathic neonatal convulsions
Benign idiopathic neonatal convulsions start 1-7 days after birth, mostly partial clonic or asphyxial seizures, with good prognosis.
3. Early-onset infantile epileptic encephalopathy (Ohtahara syndrome)
The first seizure is within 2-3 months after birth, usually within 1 month, mainly manifested as frequent spastic seizures, outbreak of inhibitory EEG, with poor prognosis.
4.Early onset myoclonic encephalopathy
It often develops in the neonatal period, mainly manifesting as partial or segmental multiple myoclonus, partial motor seizures. The later stage can be tonic spasms, and the EEG is mostly burst suppression type. The disease is severe and has a poor prognosis.
5.WEST syndrome
More than 60% of the children are symptomatic and 40% are idiopathic. The symptomatic cases are more common with perinatal hypoxia, tuberous sclerosis, multiple neurofibromas, cerebral hypoplasia, Sturge-Weber syndrome, various perinatal brain injuries, intracranial infections, etc.
6.Benign myoclonic epilepsy in infants
It is characterized by brief generalized myoclonic seizures without other types of seizures. The EEG shows extensive spikes and slow waves during seizures, mostly bilaterally synchronized. The interictal interval is normal. It should be treated as early as possible.
7.Dravet syndrome
It is also called severe myoclonic epilepsy in infants (severemyoclonic epilepsyinfancy, SMEI), with an overall incidence of about 1/20000-40000, male: female about 2:l. It accounts for about 29.5% of all types of myoclonic epilepsy in pediatrics and 7% of epilepsy in infants and children within 3 years of age.
8.LGS syndrome
Lennox-Gastaut syndrome (LGS), an age-related epilepsy syndrome, can be idiopathic or caused by certain etiologies, such as congenital developmental disorders, metabolic abnormalities, perinatal hypoxia, neurological infections, or cerebral hypoxia due to persistent epilepsy. The age of onset is 3-10 years, mostly at 3-5 years, and rarely secondary to other types of epilepsy such as WEST. The features of typical LGS syndrome include three: seizures manifesting as axial muscle tonicity, atonic seizures, and atypical aphasic seizures; EEG manifesting as diffuse – slow wave bursts in waking state, explosive rhythmic fast waves, multi-spike waves with slower wave rate, and eventually 10HZ all-around fast rhythm in sleep; intellectual developmental delay and concomitant personality disorder.
9.Febrile convulsions
Febrile convulsions, also known as hyperthermia, are common in children, and most of them have a good prognosis. The age of onset is from 3 months to 5 years old, and the convulsions are usually relieved after the age of 6 years due to perfect brain development. The cause of febrile convulsions is not fully understood and is thought to be related to immature brain tissue development, fever, and genetic susceptibility.
10. Epilepsy with central temporal spike waves (BECT)
This type of epilepsy is benign childhood epilepsy, with more males than females, and also has a significant correlation with age, with most seizures occurring between the ages of 2 and 14 years, more common between the ages of 6 and 10 years, and remission or disappearance by the age of 16 years, with a better prognosis. This symptom group manifests as brief, simple partial facial lateral motor episodes, such as brief tonic or clonic jerks of the unilateral facial muscles, oropharyngeal muscles, and mouth and lips. It is often accompanied by somatosensory symptoms, and some may progress to tonic or clonic seizures. Most of these seizures are sleep-related, with more than half of them occurring only during sleep, and most of them occurring during the daytime in the drowsy or resting state. During seizures, the EEG has high amplitude spikes and slow spikes in the central temporal region, which can be induced by sleep and easily spread. If the seizures are infrequent, it can be observed without drug treatment. If the seizures are frequent, the seizures can be controlled with drugs such as sodium propoxur and carbamazepine.
11.Children’s aphasic epilepsy
Childhood absence epilepsy (CAE) is one of the most common epilepsy syndromes that starts in childhood, typically at the age of 3 to 9 years old, with a peak at 6 to 7 years old. The EEG shows bilateral symmetric synchronous spikes and slow waves, usually 3 Hz, with normal background activity. The majority of children can gradually resolve or disappear with age, and good drug control is one of the factors of good prognosis.
12. Juvenile anhedonic epilepsy
The disease mostly develops between the ages of 7-17 years, with a peak age of 10-12 years. There is no significant gender difference. The prognosis is worse than that of children with athetoid epilepsy.
13. Juvenile myoclonic epilepsy
The typical presentation is a single or recurrent bilateral, non-rhythmic, irregular myoclonic jerking, mainly involving the upper limbs. It is genetically related, with no gender differences. Generalized tonic-clonic seizures are more common, and a few patients are seen to be disoriented, with epilepsy often occurring shortly after waking, usually without significant impairment of consciousness. Interictal and interictal EEGs have rapid, generally irregular spikes and multi-spikes. Sleep deprivation or light stimulation can often induce it. Pharmacological treatment is effective, and propoxur, phenobarbital, lamotrigine and levetiracetam are available.