儿童原发性癫痫治疗指南(3)

儿童癫痫指南

Lumbar puncture should be done in children witha suspected meningitis, especially in infants(13).EEG and neuroimaging have no role in simplefebrile seizures(12).

Management includes definitive diagnosis,restraint in investigations, treatment of an acuteepisode, prophylaxis for future episodes and familycounseling(12). Role of defervescence in preventingfebrile seizures is questionable(13). Parents can betaught to use rectal liquid diazepam (0.5 mg/kg) orbuccal or nasal(12,15) midazolam (0.3 mg/kg) foracute termination of seizures that last for twominutes or more.

Any prophylaxis of febrile seizures reduces therecurrence of seizures but does not reduce the risk offuture epilepsy. Intermittent prophylaxis with oralclobazam in a dose of 0.75 mg/kg for 2-3 days in 2divided doses during fever is useful to preventrecurrence. Febrile status, complex and recurrentfebrile seizures (>6/year in spite of intermittentprophylaxis) may need EEG, neuroimaging andcontinuous prophylaxis with AED. Phenobarbitoneand valproate may be used in infants and olderchildren respectively, for 1-2 years(12). Carbama-zepine and phenytoin are not useful.4. Granuloma in Children

New-onset partial or generalized convulsive seizuresoccurring in clusters in an otherwise normal child isthe commonest presentation of single small contrastenhancing CT lesion (SSECTL); necessitatingneuroimaging, except when an idiopathic epilepsysyndrome is established with EEG(16). The com-monest etiology is neurocysticercosis (NCC) fol-lowed by tuberculomas. Parenchymal NCC cystsshould be classified as an active vesicular form (cys-tic, without enhancement or edema), a transitionalcolloidal/granular-nodular form (ring/disc enhance-ment with edema) or an inactive form (non-enhanc-ing calcified lesions without edema). Active lesionswhen accompanied by edema often produce a focalbackground asymmetry on the EEG(17).

NCC vs. tuberculoma: On neuroimagings thepresence of an eccentric scolex in a cystic lesion ispathognomonic of a NCC. Large (>2cm), oftenmultiple, isodense lesions with shaggy borders andlocation in the posterior fossa are likely to betuberculomas(18). MR Spectroscopy may helpdifferentiate the two(19).

Cysticidal treatment is beneficial andrecommended strongly in live NCC cysts andtransitional NCC granulomas(20). Albendazole for aperiod of 7(20,21) or 28(20) days in a dose of 15 mg/kg in 2 divided doses is the treatment of choice.Prednisone should be used at 1mg/kg/day, 3 daysbefore starting albendazole and continued for a totalof 7 days to reduce the risk of cerebral edema at thetime of cyst breakdown. A fundal examinationshould be performed before use of cysticidal drugs asophthalmic lesions are an absolute contraindicationfor medical therapy.

AEDs are given in acute symptomatic seizuresdue to active lesions (cystic lesions, granulomas) tillsuch time that they disappear or become inactive (noedema, no enhancement, calcified) – usually for aperiod of 6 months(22). Inactive calcified lesionspresenting with seizures either de novo or as relapsesshould be considered remote symptomatic andshould be treated till a 2 year seizure free period isachieved. Repeat imaging should be done to checkthe resolution of lesion after 6 month, if the child isclinically well or earlier, if the initial diagnosis wasinsecure or if the child is symptomatic.5. Idiopathic Partial Epilepsies in ChildhoodBenign epilepsy with cento-temporal spikes(Benign rolandic epilepsy, BECT)

This should be considered when a normal schoolaged child presents with brief and infrequent, partial,nocturnal, hemi-facial, sensory or motor seizures. Anawake-cum- sleep EEG is necessary, as it displays acharacteristic pattern of sleep activated runs ofcentro-temporal spikes or sharp waves. Thesyndrome has an excellent prognosis with remissionin most cases by the age of 15-16 years(23, 24).Panayiotopoulos syndrome (Early-onset childhoodepilepsy with occipital paroxysms, CEOPs)CEOP should be considered when a normal pre-school (3-5 yrs) child presents with severe nocturnalvomiting, followed by eye deviation and statusepilepticus, usually hemiclonic. This syndrome has

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