Epilepsy in Special Population: Clinical Pearls Rajiv Anand, Deepak Arjundas
INDEX
ABCEFGHILMNOPQRSTVZ
Page numbers followed by b refer to box, and t refer to table.
A
American Epilepsy Society Guidelines for Status Epilepticus 23t
Aminophylline 15t
Amnesia 26
Anticonvulsant drug levels 21
Antiepileptic drugs 2, 6, 8, 11, 16t, 18, 19, 19t, 22
specific 15
Arterial blood gas 21
Atazanavir 19t
Attention deficit hyperactivity disorder 2
B
Barbiturates 12
Benzodiazepine 12, 23
Beta-blockers 15t
Beta-lactam antibiotics isoniazid metronidazole 15t
Blood
cultures 21
urea nitrogen 14
Bone mineral density 10
Breast milk, concentrations in 11
Bupropion 15t
C
Calcium 13
Carbamazepine 16t, 19t, 26
Carotid doppler ultrasonography 14t
Catamenial epilepsy 9
Central nervous system 18
Centrotemporal spikes, benign childhood epilepsy with 2
Chlorpromazine 15t
Clobazam 19
Clomipramine 15t
Clozapine 15t
Cognitive impairment, migraine sleep problems 2
Complete blood count 13t
Continuous spike-and-wave during sleep 2
Cortical brain tumors 5, 6
Creatinine 14t
Cyclic antidepressants 15t
E
Efavirenz 19t
Electroencephalogram 22, 25
Electrolytes 13
Epilepsy 1, 4-6, 6t, 8, 13
diagnosis of 4t
juvenile
absence 4, 6
myoclonic 4, 6
photosensitive 5, 6
post-traumatic 25
prevalence of 13
reading 5, 6
surgery 16
syndromes 2t, 4t, 6t
treatment for 6
treatment for 6
types of 9
Eslicarbazepine 10t
F
Felbamate 12
Fosphenytoin 23
G
Gabapentin 10t, 11t, 16t, 20t
Glucose and electrolyte levels 21
Gonadotropin-releasing hormone analogs 9
H
Hepatic function 15
Highly active antiretroviral therapy 19t
Holter monitoring 14t
Hormone replacement therapy 10
Human immunodeficiency virus
antiepileptic drugs for 19t
infection, complications of 18
Hypoxia ischemia 1
I
Intracranial hematoma 26
L
Lacosamide 10t, 16t, 20t
Lamotrigine 8-11, 16, 19
Landau–Kleffner syndrome 2t
Levetiracetam 9, 10t, 11t, 16t, 19t, 23t
Life-threatening neurologic disorder 21
Liver function tests 14t, 21t
Lopinavir 19t
Lorazepam 23t
Lumbar puncture 14t
M
Magnesium 14t
Maprotiline 15t
Medroxyprogesterone 9
Methylphenidate 15t
Midazolam 19t
Monoamine oxidase inhibitors 15
N
New antiepileptic drugs
during pregnancy, serum concentrations of 10t
use of 26
Non-nucleoside reverse transcriptase inhibitor 19
O
Olanzapine 15t
Oxcarbazepine 8-11, 16t, 19t
active metabolite of 11
P
Panayiotopoulos syndrome 2
Perampanel 16
Pethidine 15t
Phenytoin 19t, 26
Phosphorus 14t
Plasma protein 15
Polycystic ovary syndrome 8
incidence of 8
Pregabalin 10t, 16t, 20t
Progesterone 9
Q
Quetiapine 15t
R
Raltegravir 19t
Risperidone 15t
Ritonavir 19t
S
Seizures 1, 18
benign partial 5, 6
incidence of 18
investigation 18
management of 18
neonatal 1
post-traumatic 25
brain injury, management of 25
type, diagnosis of 20
Selective serotonin reuptake inhibitors 15
Serologic tests 14t
Several epilepsy syndromes 1
Sex hormones 9
Sodium valproate 9
Status epilepticus 21
investigations of 21
management of 21, 22
nonconvulsive 23
Subacute sclerosing panencephalitis 5, 6
Synthetic hormones 9
T
Theophylline 15t
Topiramate 10t, 16t
Toxicological screening 21b
Tramadol 15t
Traumatic brain injury 25
V
Valproate 8, 16t, 26
Valproic acid 19t, 23t
Vigabatrin 12
Z
Zidovudine 19t
Zonisamide 9, 10t, 11t, 16t
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Chapter Notes

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Seizures in Neonates and ChildrenCHAPTER 1

 
NEONATAL SEIZURES
Neonatal seizures have an incidence of 1.8–3.5 per 1,000 live births. Neonatal seizures may exacerbate hypoxia ischemia induced brain injury. These changes in the brain may contribute to long-term neurological disability in some patients later in life.1
The challenge lies in differentiating neonatal seizures from several normal, poorly coordinated, neonatal movements.1,2 Besides, there is lack of good treatment options.

CLINICAL PEARLS

  • Neonatal seizures should be diagnosed accurately and treated aggressively.
  • A rigorous workup to determine an underlying etiologic cause should be initiated quickly.
  • When an inborn error of metabolism is suspected, discontinuing feeding may help improve the seizures and encephalopathy. Institute intravenous solutions and diet specifically indicated.
  • Patients with seizures resulting from intracranial hemorrhage should have head circumference measurements performed daily. A rapid increase in head circumference may indicate hydrocephalus.
 
SEIZURES IN CHILDREN
Epilepsy is a common neurological disorder affecting 0.5–1.0% of children younger than 16 years of age. Several epilepsy syndromes have been identified in children (Table 1).3
2Comorbid disorders in children with epilepsy are categorized as neurological (cognitive impairment, migraine sleep problems), psychological [attention deficit hyperactivity disorder (ADHD), anxiety and depressive disorders] and physical (bone loss, weight changes, immunological disorders, dyslipidemia, hypothyroidism).4
Table 1   Focal epilepsy syndromes of childhood.
Syndrome
Onset
EEG findings
Benign childhood epilepsywith centrotemporal spikes
Onset: 3–13 years
Peak: 7–8 years
Bilateral asynchronous high amplitude, sharp and slow-wave complexes, with horizontal dipole, negative in centrotemporal regions and positive in frontal regions
Landau–Kleffner syndrome
Onset: 3–10 years
Continuous diffuse slow spikes and waves at 1.5–2.5 Hz occurring at all slow-sleep stages
Continuous spike-and-wave during sleep (CSWS)
Onset: 2–4 years
Infrequent spikes and waves; continuous diffuse slow spikes and waves at 1.5–2.5 Hz occurring at all slow-sleep stages, electrical status epilepticus in sleep (ESES)
Panayiotopoulos syndrome
Onset: 1–14 years
Peak: 3–6 years
Interictal EEG with occipital spikes and multifocal, high amplitude, sharp slow wave complexes
Gastaut type
Peak: 8 years
Bilateral occipital spike-wave discharges that activate with eye closure and diminish upon eye opening
There is a paucity of clinical trials of antiepileptic drugs (AEDs) in children.5-7

CLINICAL PEARLS

  • Early and complete seizure control and EEG normalization is crucial for the prevention of developmental disablement in younger patients or of accelerated cognitive decline.
  • Focus not only on seizure control but also on early diagnosis and treatment of comorbid disorders.
  • Choose AEDs that best control seizures with minimal cognitive side-effects. AEDs such as levetiracetam and lamotrigine appear to have fewer cognitive side effects than old generation AEDs.
  • 3Slow titration and using the lowest effective dose of AEDs is critical.
  • Avoid polypharmacy.
  • Treat comorbid neuropsychiatric disorders. Medications for ADHD and AEDs have drug interactions, e.g., methylphenidate may increase phenytoin serum levels. Carbamazepine may reduce methylphenidate levels.
  • Because of the sedative effects of alpha adrenergics, cautious use is recommended in patients receiving sedating AEDs.
REFERENCES
  1. Chapman KE, Raol YH, Brooks-Kayal A. Neonatal seizures: controversies and challenges in translating new therapies from the lab to the isolette. Eur J Neurosci. 2012;35(12):1857–65.
  1. Panayiotopoulos CP. Neonatal Seizures and Neonatal Syndromes. In: The Epilepsies: Seizures, Syndromes and Management. Oxfordshire (UK): Bladon Medical Publishing;  2005.
  1. Delphi B, Anilkumar AC. Self-limited focal epilepsies in childhood. Pract Neurol. 2018:64–8.
  1. Wei SH, Lee WT. Comorbidity of childhood epilepsy. J Formos Med Assoc. 2015;114(11):1031–8.
  1. Kessler SK, McGinnis E. A practical guide to treatment of childhood absence epilepsy. Paediatr Drugs. 2019;21(1):15–24.
  1. Pellock JM, Carman WJ, Thyagarajan V, Daniels T, Morris DL, D'Cruz O. Efficacy of antiepileptic drugs in adults predicts efficacy in children: a systematic review. Neurology. 2012;79(14):1482–9.
  1. Kim EH, Ko TS. Cognitive impairment in childhood onset epilepsy: up-to-date information about its causes. Korean J Pediatr. 2016;59(4):155–64.