Epilepsy in Children A Primary Care Perspective

Source: Landover, MD, Epilepsy Foundation of America, 22:47-minute VHS videotape, 1989.

Contact: Epilepsy Foundation of America, 4351 Garden City Drive, Landover, MD 20785. (301) 459-3700.

Summary: Epilepsy in Children: A Primary Care Perspective, a videotape, reviews the diagnosis and management of childhood seizures. Most childhood seizures can be successfully controlled; the keys are accurate diagnosis and administration of the most appropriate anticonvulsant medication. A seizure is a symptom of an underlying neurological disorder, which may be epilepsy or an epileptic syndrome. Syndromes are defined by the clinical event, electroencephalography (EEG) characteristics, age at onset, evolution and prognosis, family history, clinical history, and physical findings. Many conditions mimic epilepsy in children, including breath holding, pallid infantile syncope, night terrors, sleep walking, syncope, cardiac arrhythmia, and movement disorders. Once the physician has established that a seizure has occurred, it is important to take a clinical history, especially a detailed description of the event. Diagnosis is based on clinical, not EEG, data, but EEG's may suggest a seizure type. If possible, EEG's should be recorded with the child awake, asleep, hyperventilating, and with photic stimulation. When planning the management of a child with epilepsy, the physician should consider the certainty of the diagnosis, the nature of the lesion (if any), the child's age, and the risk of seizure recurrence. Video-EEG recordings of some of the most common seizure types in children are shown: Complex partial, absence, infantile spasms, tonic, and atonic. Commonly-used anticonvulsant drugs are carbamazepine, clonazepam, ethosuximide, phenobarbital, phenytoin, primidone, and valproic acid. The narrators explain which drugs are used for which types of seizures and discuss the danger of toxicity, which can change with age. The physician should prescribe the correct medication for the type of seizure, and refer children with epilepsy whose seizures are difficult to manage to a center specializing in epilepsy. Parents should be involved in the treatment plan, and encouraged to allow the child with epilepsy to participate in activities with other children.

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