Epilepsy%20(pediatric) Signs and Symptoms

• Epilepsy is a disorder that is characterized by a persistent predisposition of the brain to generate epileptic seizures
• This condition may cause neurobiologic, cognitive, psychological and social disturbances

Seizure 

• Defined as a transient occurrence of signs and symptoms due to abnormally excessive or synchronous neuronal brain activity that results to abrupt and involuntary skeletal muscle activity
• Unprovoked seizures that occur without a potentially responsible clinical condition or beyond the interval estimated for the occurrence of acute symptomatic seizures
• Classified as either seizures of unknown etiology or seizures that occur due to preexisting brain lesion orprogressive nervous system disorder

Epilepsy 

• Epilepsy is a clinical multiaxial diagnosis
  • Epileptic seizure is a transient occurrence of signs/symptoms brought about by abnormal excessive or synchronous neuronal activity in the brain
  • An epileptic seizure represents a disruption in the normal balance between excitatory and inhibitory currents or neurotransmission in the brain
    • Drugs or pathogenic processes that augment excitation or impair inhibition tend to be epileptogenic, while anti-seizure drugs tend to facilitate inhibition and dampen excitation
  • It is a disorder of the brain characterized by enduring predisposition to generate epileptic seizures, and by the neurobiologic, cognitive, psychological, and social consequences of this condition
• Epilepsy may be defined by any of the following conditions:
  • At least two unprovoked (or reflex) seizures occurring >24 hours apart
  • One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years

• Determine the disease associated with the epileptic seizure or syndrome
  • Eg neurocutaneous diseases, malformations, tumors, chromosomal anomalies, monogenic Mendelian diseases, etc
• Seizures in neonates, infants and toddlers
  • Mostly associated with perinatal brain injury, congenital central nervous system (CNS) malformation and metabolic derangement
• Seizures in late childhood
  • Most frequently result from infection, genetic epilepsy, neurodegenerative disorders
• Genetic causes of epileptic seizures not causative of a brain structural or metabolic disorder other than the epilepsy should be considered (eg KCNT1, KCNQ2, CDKL5, SCN1A, SCN2A, STXBP1, GRIN2A)

During Seizure

• Sudden falls
• Involuntary jerky movements of limbs in an awake patient
• Blank spells
• Urine incontinence with loss of awareness, or during sleep
• Falls, jerky movements, automatisms during sleep
• Episodes of confused behavior with lack or loss of awareness and/or recollection

• Visual stimulation (eg photic stimulation), drug-induced (eg alcohol), sleep deprivation or metabolic causes (eg hyponatremia, hypoglycemia or hypocalcemia)