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Neonatal Problems: Seizure Disorders

Description

Epilepsy represents the most common serious neurological problem affecting children, with an overall incidence approaching 2% for febrile seizures (due to fever) and 1% for idiopathic epilepsy (without an identifiable cause).
Classification of seizure disorders has evolved considerably over time and terms like grand mal or petit mal have largely been replaced by more detailed classifications based on specific clinical manifestations (symptoms), mode of onset (i.e. focal are or generalised, cf. International Classification below ) and discrete clinical syndromes.
At present, the epilepsies of childhood are most frequently classified using variations of the International Classification of Epileptic Seizures .

Symptoms and Signs

Childhood seizures are characterised by abnormal, excessive discharges originating from populations of cortical neurones (i.e. in the brain) and resulting in some clinically evident alteration of function or behaviour. Therefore, the symptoms of childhood seizures need not include recognisable motor activity such as tonic-clonic movement. Possible symptoms may include staring, drop attacks, behavioural changes, or even autonomic disturbances.
The causes of epilepsy in childhood vary in an age-dependent fashion. For example, seizures in neonates, infants, and toddlers most frequently result from perinatal brain injury, meningitis , congenital central nervous system malformations, and metabolic derangements ( low blood glucose or low blood calcium level ).
Conditions that cause seizures in newborns are often serious.
Central nervous system infection, genetic epilepsies, and neurodegenerative disorders are more likely to present with seizures beginning in later childhood.
These causes stand in stark contrast to the adult population, where traumatic brain injury, cerebrovascular disease, and neoplasms represent the most frequent causes of seizures.

Diagnosis and Treatment

Often brain-imaging techniques are employed to help in the diagnosis of epilepsy, e.g. ultrasound scanning , computed tomography (CT), magnetic resonance imaging (MRI) or an electroencephalogram (EEG).
Diagnosis is complicated by the fact that many symptoms are age-dependent and differ substantially from adult seizure disorders. For example, infantile spasms may be misinterpreted as a simple startle reflex and absence (petit mal) seizures are sometimes attributed to inattention or attention deficit .
Effective treatment depends largely on the physician's ability to establish an accurate diagnosis and choose appropriate therapy based on the likelihood of clinical benefit as well as potential side effects.
Determination of appropriate treatment for a child with epilepsy must be individualised based on the specific type(s) of seizure, the child's age, and the likelihood of significant side effects. Anticonvulsant monotherapy is preferred when possible and is effective in a majority of children.

For a more detailed table of treatment options depending on the type of epilepsy diagnosed, go here .

The information in this page is presented in summarised form and has been taken from the following source(s):
1. Loyola University Medical Education Network: http://www.meddean.luc.edu/lumen/index.html


Other HON resources 
   From MedHunt
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Epilepsy in Neonates
    From HONselect
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Epilepsy, Benign Neonatal

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Epilepsy, Benign Neonatal
 

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  http://www.hon.ch/Dossier/MotherChild/neonatal_problems/seizure_disorders.html Last modified: Jun 25 2002