Epilepsy in Children and Adolescents

383 Pages·2012·3.25 MB·English

Epilepsy in Children and Adolescents
Epilepsy in Children
and Adolescents
Edited by
James W. Wheless, MD
DepartmentofPediatricNeurology
UniversityofTennesseeHealthScienceCenter
LeBonheurComprehensiveEpilepsy
ProgramandNeuroscienceInstitute
LeBonheurChildren’sHospital
Memphis,TN,USA
A John Wiley & Sons, Ltd., Publication
Thiseditionfirstpublished2013(cid:1)C 2013byJohnWiley&Sons,Ltd
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LibraryofCongressCataloging-in-PublicationData
Epilepsyinchildrenandadolescents/[editedby]JamesW.Wheless.
p. ; cm.
Includesbibliographicalreferencesandindex.
ISBN978-0-470-74123-8(cloth)
I.Wheless,James.
[DNLM: 1.Epilepsy. 2.Adolescent. 3.Anticonvulsants–therapeuticuse. 4.Child.
5.Epilepsy–therapy. WL385]
616.85(cid:2)300835–dc23
2012024368
AcataloguerecordforthisbookisavailablefromtheBritishLibrary.
Wileyalsopublishesitsbooksinavarietyofelectronicformats.Somecontentthatappearsinprintmaynotbe
availableinelectronicbooks.
Coverimage:4yearoldwithLennox-GastautSyndrome,slowspikeandwavecomplexesinsleep,courtesyof
DrJamesW.Wheless.
Setin10/12ptTimesbyAptaraInc.,NewDelhi,India
FirstImpression2013
Contents
Listofcontributors xiii
Preface xvii
Section1 Epidemiologyandclassificationof
childhoodepilepsies 1
Sectioneditor:PhillipL.Pearl
1 Epidemiologyandcommoncomorbiditiesofepilepsyinchildhood 3
JaySalpekar,MatthewByrne,andGeorgannFerrone
1.1 Epidemiology 3
1.2 Incidenceandprevalence 4
1.3 Genderandage 4
1.4 Classification 5
1.5 Febrileseizures 6
1.6 Etiology 6
1.7 Psychiatriccomorbidity 7
1.8 Psychologicalandpsychosocialstressrelatedtochronicdisease 7
1.9 Psychiatricsymptomsrelatedtomedicationsideeffects 8
1.10 Psychiatriccomorbidityrelatedtoepilepsypathophysiology 8
1.11 Attention-deficit/hyperactivitydisorder(ADHD) 9
1.12 Anxiety 10
1.13 Depression 11
1.14 Intellectualanddevelopmentaldisabilities(IDD) 12
1.15 Conclusion 12
References 13
vi CONTENTS
2 Classificationanddefinitionofseizuresandepilepsy
syndromesinchildhood 17
SusanE.CombsandPhillipL.Pearl
2.1 Introduction 17
2.2 Purposeandgoalsofdefinitionsandclassification 17
2.3 Systemsofclassificationanddefinitions 18
2.4 Seizures 18
2.5 Generalizedseizures 19
2.6 Focalseizures 22
2.7 Syndromes 23
2.8 Specificage-relatedepilepsysyndromes 25
2.9 Futuredirections 34
Acknowledgements 34
References 34
3 Initiatingandwithdrawingmedicalmanagement 37
DavidT.HsiehandBhagwanIndurMoorjani
3.1 Initiatingmedicalmanagement 37
3.2 Thechancesofseizurerecurrenceafterthefirstunprovokedseizure 39
3.3 Seizurerecurrence 42
3.4 Thepossibleadverseeffectsofseizurerecurrence 42
3.5 Therisksofinitiatingantiepilepticdrugtherapy 44
3.6 Thebenefitsofinitiatingantiepilepticdrugtherapy 45
3.7 Howtoinitiatetreatmentwithantiepilepticdrugs 45
3.8 Specialcircumstances 48
3.9 Summary:initiatingmedicalmanagement 48
3.10 Withdrawingmedicalmanagement 49
3.11 Thelong-termprognosisofchildhood-onsetepilepsy 50
3.12 Whentoconsiderdiscontinuingantiepilepticdrugtherapy 51
3.13 Riskfactorsforseizurerecurrenceafterdiscontinuation 51
3.14 Therisksofdiscontinuingantiepilepticdrugtherapy 54
3.15 Thebenefitsofdiscontinuingantiepilepticdrugtherapy 55
3.16 Howtodiscontinueantiepilepticdrugs 55
3.17 Specialcircumstances 55
3.18 Summary:withdrawingmedicalmanagement 56
3.19 Disclaimer 57
References 57
4 Commongeneticandneurocutaneousdisordersin
childhoodepilepsy 59
DewiFrancesT.Depositario-Cabacar,WilliamMcClintock,
andTomReehal
4.1 Idiopathicepilepsies 60
4.2 Symptomaticepilepsies 63
4.3 Epilepsyincommonchromosomalabnormalities 63
CONTENTS vii
4.4 Epilepsyinmetabolicandmitochondrialdisorders 65
4.5 Epilepsyinmalformationsofcorticaldevelopment 66
4.6 Neurocutaneousdisorders 67
4.7 Summary 70
References 70
Section2 Diagnostic evaluationofchildhoodepilepsies 73
Sectioneditor:DavidF.Clarke
5 Evaluatingthechildwithseizures 75
KristenParkandSusanKoh
5.1 Emergentdiagnosisandmanagement 76
5.2 Subsequentevaluation 79
5.3 Additionalneurodiagnosticevaluation 84
References 87
6 TheuseofEEGinthediagnosisofchildhoodepilepsy 90
DavidF.Clarke
6.1 TechnicalaspectsoftheEEG 91
6.2 MethodsusedtoincreaseEEGyield 91
6.3 WhenshouldanEEGbeordered? 92
6.4 EEGfindingsinepilepsyandepilepsysyndromes 93
6.5 NeonatalEEGs 94
6.6 TheEEGinfocalepilepsy 96
6.7 TheEEGofgeneralizedepilepsy 99
6.8 Specificdisease-relatedepilepsysyndromes 104
6.9 Conclusion 105
References 105
7 Imagingofpediatricepilepsy 107
AsimF.Choudhri
7.1 Introduction 107
7.2 Imagingconsiderations 107
7.3 Congenitalmalformations 117
7.4 Neoplasms 124
7.5 Acquired/idiopathicabnormalities 126
References 127
8 Non-epilepticparoxysmaleventsofchildhood 129
SuchetaM.Joshi
8.1 Introduction 129
8.2 Breath-holdingspells 130
8.3 Parasomnias 131
viii CONTENTS
8.4 Benignparoxysmalpositionalvertigoofchildhood 133
8.5 Syncope 134
8.6 Paroxymalnon-epilepticevents(PNEs)withapsychiatricorbehavioral
basis 134
8.7 Hyperekplexia 136
8.8 Alternatinghemiplegiaofchildhood 136
8.9 Movementdisorders 137
8.10 Sandifersyndrome 138
8.11 Conclusion 138
References 139
Section3 Principlesoftreatment 143
Sectioneditor:JamesW.Wheless
9 Pharmacologyofantiepilepticdrugs 145
JamesW.Wheless
9.1 Pharmacokinetics 146
9.2 Pharmacogenomics 155
References 157
10 Therapeuticefficacyofantiepilepticdrugs 159
JamesW.Wheless
10.1 Efficacy-basedtreatmentguidelines 160
10.2 Antiepilepticdrugselectionbasedonspecificpediatric
epilepsysyndromes 164
10.3 Influenceofcomorbiditiesinchildrenwithepilepsy 171
10.4 Conclusions 172
References 172
11 Adverseeffectsofantiepilepticdrugs 175
JamesW.Wheless
11.1 Introduction 175
11.2 Specificdrugs 179
11.3 At-riskprofilesandmonitoring 189
References 191
12 Vagusnervestimulationtherapyandepilepsysurgery 193
KateVanPoppelandJamesW.Wheless
12.1 Vagusnervestimulation 195
12.2 Epilepsysurgery 203
12.3 Conclusions 215
References 215
CONTENTS ix
13 Dietarytherapiestotreatepilepsy 219
JamesW.Wheless
13.1 History 220
13.2 Efficacy 221
13.3 Mechanismofaction 228
13.4 Selectionofcandidatesforthediet 232
13.5 Initiationandmaintenance 234
13.6 Complications 236
13.7 Theketogenicdietinthetwenty-firstcentury 239
References 239
Resources 240
Websites 241
Section4 Generalizedseizuresandgeneralized
epilepsysyndromes 243
Sectioneditor:AmyL.McGregor
14 Idiopathicgeneralizedepilepsies 245
AmyL.McGregor
14.1 Clinicalfeatures 246
14.2 Naturalhistory 248
14.3 Genetics 248
14.4 Treatment 248
14.5 Classification 249
14.6 Myoclonicepilepsyininfancy 249
14.7 Childhoodabsenceepilepsy(CAE) 250
14.8 Juvenileabsenceepilepsy(JAE) 252
14.9 Juvenilemyoclonicepilepsy(JME) 254
14.10 Epilepsywithgeneralizedtonic-clonicseizuresalone(IGE-GTCs) 256
14.11 Epilepsywithmyoclonicabsence 257
14.12 Epilepsywithmyoclonic-atonicseizures/Doosesyndrome 258
14.13 Febrileseizuresplus(FS+) 259
14.14 Eyelidmyocloniawithabsences(EMA)/Jeavonssyndrome 260
14.15 Summary 262
References 264
15 Cryptogenicandsymptomaticgeneralizedepilepsies:
epilepsieswithencephalopathy 267
KarenKeough
15.1 Neonatal-onsetepilepsieswithencephalopathy 268
15.2 Infantile-onsetepilepsieswithencephalopathy 270
15.3 Epilepsieswithencephalopathywithonsetlaterininfancy 275
15.4 Epilepsieswithencephalopathywithonsetafterinfancy 277
x CONTENTS
15.5 Continuousspikewaveofsleep(CSWS)andLandau–Kleffner
syndrome(LKS) 279
References 280
Section5 Partial-onsetseizuresandlocalization-related
epilepsysyndromes 283
Sectioneditor:JamesW.Wheless
16 Idiopathicpartialepilepsies 285
FreedomF.PerkinsJr
16.1 Benigninfantileseizures 286
16.2 Benignchildhoodepilepsywithcentrotemporalspikes 287
16.3 Childhoodoccipitalepilepsy(Panayiotopoulostype) 289
16.4 Late-onsetchildhoodoccipitalepilepsy(Gastauttype) 292
References 294
17 Cryptogenicandsymptomaticpartialepilepsies 296
StephenFulton
17.1 Etiology 296
17.2 Seizurephenomena 297
17.3 Temporallobeepilepsy 297
17.4 Extratemporalepilepsy 303
17.5 Occipitallobeepilepsy 306
17.6 Parietallobeepilepsy 307
17.7 Hypothalamichamartoma 307
17.8 Otherlocalizingandlateralizingsigns 308
References 309
Section6 Epilepsiesrelativetoage, etiology, orduration 311
Sectioneditor:Yu-TzeNg
18 Neonatalseizures 313
EricV.Hastriter
18.1 Significanceofneonatalseizures 313
18.2 Pathophysiologyofneonatalseizures 314
18.3 Classificationandclinicalfeaturesofneonatalseizures 316
18.4 Electrographicseizures 317
18.5 Monitoringandrecording 317
18.6 Etiologyofneonatalseizures 321
18.7 Metaboliccausesforneonatalseizures 323
18.8 Inbornerrorsofmetabolism 323
CONTENTS xi
18.9 Treatment 327
18.10 Chronicpostnatalepilepsyandtheneedforlong-termtreatment 328
18.11 PotentialadverseeffectsofantiepilepticdrugsontheimmatureCNS 329
18.12 Conclusion 329
References 330
19 Febrileseizures 333
MarieFranciscaGrill
19.1 Introduction 333
19.2 Definition 333
19.3 Incidenceandprevalence 334
19.4 Pathophysiology 334
19.5 Prognosis 334
19.6 Initialevaluationandmanagement 335
19.7 Long-termmanagement 338
19.8 Managementinpractice 341
19.9 Genetics 342
19.10 Parentcounseling 343
19.11 Conclusion 344
References 344
20 Statusepilepticusinchildhood 346
Yu-TzeNgandRamaMaganti
20.1 Definition 346
20.2 Epidemiology 349
20.3 Pathophysiology 349
20.4 Etiology 350
20.5 Diagnosisandinvestigations 351
20.6 EEGpatternsinstatusepilepticus 352
20.7 Treatment 356
20.8 Prognosis 359
References 359
Index 365