Epilepsy is one of the most common disorders of the pediatric nervous system. The incidence of epilepsy in children is higher than that in adults, and the incidence of epilepsy in our survey population is 35/100,000/year, and the incidence of epilepsy in children is 151/100,000/year. Because children are in the growth and development stage, their epilepsy is different from adults in terms of etiology, clinical manifestations, diagnosis, treatment, and prognosis.
I. Age-specific features of the onset of pediatric epilepsy.
The onset of epilepsy is closely related to age, and most epilepsy syndromes are age-dependent. The first peak of epilepsy is during infancy and early childhood. 29.0% of all pediatric epilepsy cases start within 1 year of age, and 82.2% of all cases start within 7 years of age, indicating that most pediatric epilepsy occurs in preschool. Even in adult epilepsy, the age of onset of epilepsy under 15 years old is close to 50%.
Second, the etiological characteristics of pediatric epilepsy.
The main causes of epilepsy in children vary at different ages. It is important to understand the etiology and age distribution of pediatric epilepsy to guide the diagnosis and prevention of epilepsy. The brain development, genetics, metabolism, and midwifery techniques during the perinatal, neonatal, and infantile periods must be given adequate attention. The following etiologies are considered according to the age of onset of epilepsy in childhood.
(i) Epilepsy beginning in the neonatal period
1. birth injury, hypoxia, intracranial hemorrhage.
(2) Congenital malformations of brain development: hemimegalencephaly, focal cortical dysplasia, cerebral cleft malformation, gray matter heterotopia, synencephaly, and multi-cerebellar gyrus malformation, etc.
3, congenital metabolic abnormalities: hyperglycinemia, hyperammonemia, organic acidemia, galactosemia, etc.
(II) Epilepsy starting at 2-6 months of age
1.Inborn metabolic abnormalities: phenylketonuria, organic acidemia, etc.
2, birth injury
3, congenital malformation of brain development
4.Brain degeneration disease
(iii) Epilepsy starting between 7 months and 3 years of age
1.Intracranial infection
2. Congenital malformations of brain development, congenital metabolic abnormalities
3.Brain degenerative diseases
4, birth injury
5. Idiopathic epilepsy
(D) Epilepsy starting from the age of 3 years and above to school age
1.Idiopathic epilepsy
2.Intracranial infection
3.Brain tumor
4. Brain degenerative disease
C. Characteristics of pediatric seizures.
Age or brain maturity affects not only the susceptibility to seizures but also the type of seizures. Some seizure types are closely related to age development, especially in neonates and infants, which often have obvious age characteristics.
1. neonatal seizures present in a particular way, with their own specific classification of seizure forms
2. neonates and small infants do not have typical disoriented seizures and full blown tonic-clonic seizures are rare
3. spastic seizures are mainly seen in infants and young children up to 2 years of age
4. infants and young children lack good expressiveness and responsiveness, lack aura and complaints of sensory seizures during partial seizures, and state of consciousness is sometimes not easy to judge.
5. some infants and children with partial seizures lack focal signs and symptoms and need to rely on video EEG during the seizure period to determine the type of seizure.
6. typical disorientation seizures are mainly seen in preschool to adolescence
7. photosensitive reactions and photosensitive epilepsy are mainly seen in school age to adolescence.
IV. Epilepsy syndromes in the pediatric period
Epilepsy syndromes in children are more common than in adults, and most of them have age-dependent onset.
(a) Epilepsy syndromes in neonates and infants
(1) Otawara syndrome
2. Early myoclonic encephalopathy
3.Infantile spasms
4.Benign myoclonic epilepsy in infants
5.Dravet syndrome
6.Lateral convulsion-hemiparesis-epilepsy syndrome
(B) Epilepsy syndromes in early childhood and childhood
1.Lennox-Gastaut syndrome
2.Doose syndrome
3.Landau-Kleffner syndrome
4.Epilepsy with slow-wave sleep with continuous spikes and slow waves
5, Benign epilepsy with central temporal spike waves
6. Early-onset benign occipital lobe epilepsy in children
7.Late onset occipital lobe epilepsy in children
8.Children’s aphasic epilepsy
9, Myoclonic aphasic epilepsy
10.Rasmussen’s syndrome
(C) Epilepsy syndromes in adolescence
1. Juvenile akathisia epilepticus
2.Adolescent myoclonic epilepsy
3. Epilepsy with generalized tonic-clonic seizures only
V. Characteristics of pediatric epilepsy treatment.
The principles for the selection of antiepileptic drug therapy in children are basically the same as those for adults, but the following characteristics should be noted.
1. rapid growth and development in childhood, the daily dose should be calculated within the standard weight range by kilogram weight, for children whose weight is higher or lower than the standard weight, the dose should be given with reference to the standard weight, and the dose should be adjusted in combination with clinical efficacy and blood concentration.
1. Neonates and small infants have not yet fully developed liver and kidney functions and have poor metabolism and excretion ability of drugs, which have a long half-life in the body and are prone to accumulation of poisoning; infants to preschool age have a fast metabolism rate and short half-life, so the dose should be adjusted according to clinical efficacy under the monitoring of drug blood concentration.
2. pay attention to the monitoring of adverse drug reactions and regular liver function and blood tests, especially the increased risk of liver damage from valproic acid in children aged less than 2 years or with genetic metabolic diseases.
3. Whether to start antiepileptic drug therapy after the first seizure in children requires consideration of the etiology of epilepsy, seizure type, epilepsy syndrome, etc. For example, children with benign epilepsy with central temporal spikes and long intervals of recurrence are not necessarily treated urgently with antiepileptic drugs. However, if the cause of the seizure persists, AEDs should be given immediately after the first seizure.
Children are at an important stage of growth and development and learning. When choosing antiepileptic drugs, the effect on the cognitive function of the child should be fully considered and should be observed during the drug administration.
5. Although AEDs can usually be discontinued after 2-4 years of seizure control and normalization of EEG, children with epilepsy who have multiple seizure types, especially those with myoclonic seizures, atonic seizures and atypical aphasic seizures, should be on medication for a longer period of time; children with epilepsy with neurological disabilities such as cerebral palsy and mental retardation and/or abnormal neuroimaging manifestations are symptomatic epilepsy and should insist on taking medication for a long time; some adolescent idiopathic epilepsy requires long-term or even lifelong medication (e.g., juvenile myoclonic epilepsy).
6. some childhood specific epileptic encephalopathies (e.g. West syndrome, Lennox-Gastaut syndrome, Landau-Kleffner syndrome, etc.) can be treated with adrenocorticotropic hormones, ketogenic diet and other special treatment methods in addition to AEDs.
The indications for surgical treatment of pediatric refractory epilepsy are basically the same as those for adults, but attention should be paid to the characteristics of brain development in childhood. If Rasmussen syndrome is diagnosed, early consideration of surgery has a good long-term prognosis.
For children with epilepsy, the first dose of medication is very cautious: is it used? What medication to use? What dose? This is especially critical for control. If you listen to the prescriptions and choose an unreasonable treatment, it is likely to delay your child’s treatment.
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