Epilepsy in children

Published on May 30, 2021   43 min

A selection of talks on Clinical Practice

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Hello, my name is Elaine Wirrell. I am the Director of Pediatric Epilepsy at Mayo Clinic and a professor of neurology there. I'm going to talk to you today on epilepsy in children.
Today we will review, first of all, how we make a diagnosis of epilepsy in children, specifically differentiating a seizure from a non-epileptic paroxysmal event. If it is a seizure, we'll talk about the importance of distinguishing between provoked versus unprovoked seizures. Also the importance of looking carefully for other seizures in a child who presents with an alleged first seizure, to determine if that child is actually presenting with epilepsy versus a single seizure. We'll talk about how we classify epilepsy, and why it is important to do so. We will address treatment of seizures in children, and finally, prognosis.
Epilepsy is a very common neurological disorder in children. This is work from Dr. Hauser, you can see that the incidence of epilepsy is U-shaped so it is highest at both ends of life, in childhood as well as in the elderly. This is a study that looked at the incidence of epilepsy in childhood, a population-based study. The incidence of epilepsy is significantly higher in the first year of life, specifically even in the first six months of life, than later on. Infancy is a very high-prevalence time for the diagnosis of epilepsy.
It's important to distinguish between a non-epileptic paroxysmal event and a seizure. Studies have shown that approximately one in four children who are referred with an alleged first seizure, did not have a seizure after they were seen by a neurologist. We do not have a gold-standard test, the most critical aspect in making a correct diagnosis of epilepsy is a detailed history. It's important to get that history from the child, many times children as young as 3 or 4 can give very important information that can help us in making a correct diagnosis. It's also very important to get that history from the witness to the event, which may or may not be the parent. If a child has had an event at school or an event at day-care, it's important to call the teacher or the day-care provider to elicit what they saw. The other thing that I find very helpful in making a correct diagnosis, in addition to having the parent or caregiver or witness describe to you what they saw, is asking them to mime the event. Oftentimes they'll do things like turn their head, or show some dystonic posturing that they may not be able to put into words.