User:Vbundang/Epilepsy in children

Education

Many variables of epilepsy may impact a child's education, resulting in low academic achievement. The disease itself has been associated with learning difficulties due to memory loss and decreased attention skill. Children with epilepsy may be absent from school more frequently than their peers due to frequency of seizures, seizure recovery and medical appointments.

Children with epilepsy may capable of functioning in a normal classroom environment, however some may be placed special education programs to ensure they are getting the educational support they need.

Higher achievement has been seen with small association in children with a positive attitude about their diagnosis, later age of diagnosis, and positive parental support.

Once treatment begins, these children often exhibit improved attention and grades.

Treatment

Surgery

Persistent, drug-resistant epilepsy may be treated with surgery. Surgical options include:

• Hemispherectomy: A surgical procedure in which one of the hemispheres of the brain is either partially or fully removed. The location of the brain from which the seizures originate, known as the epileptogenic zone, is disconnected to minimize, or even stop, occurrence of seizures and its complications. The effectiveness of this type of surgical treatment is unclear. Weak evidence suggests that over half of surgeries reduce seizures. The risk for series adverse effects including death, hydrocephalus, infection should be considered. This procedure may also be referred to as functional hemispherectomy, hemidecortication, or focal resection.

Systematic Review...

Potential Sources (Add Below)

• Management of Infantile Epilepsies (Systematic Review)
• Impact of ketogenic diet therapy on growth in children with epilepsy
• Academic attainment following pediatric epilepsy surgery: A systematic review
• Antiepileptic drug monotherapy for epilepsy: a network meta-analysis of individual participant data
• The management of epilepsy in children and adults (good read to get to know the classifications of epilepsy but its not a meta analysis or systemic review)
• The use of cannabinoids in children with epilepsy: a systematic review

Article Draft

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Diagnosis:

Two unprovoked seizures occurring at greater than 24 hours apart is important in the diagnosis. The time of the seizures occurring greater than 24 hours apart is necessary in the diagnosis parameters, but there is not specific timeframe that can be utilized to reset the clock. For example, a person who has their first unprovoked seizure at age 5 years and another seizure 20 years later would lead to them having a diagnosis of epilepsy. If the seizures are temporary, short-lived, or spontaneously occurring as a result of acute brain trauma, fever, alcohol withdrawal, low or high blood sugar then that would not lead to an epilepsy diagnosis. Seizures that occur due to a related known cause are considered provoked.

In terms of the second condition, high recurrence risk, it is when patient who already had developed one unprovoked seizure and is then labeled to have a greater than or equal to 60% risk of having another seizure within the next 10 years. Two factors must be considered to classify a patient as having a greater than or equal to 60% risk of having a second seizure in the next 10 years. The first factor is that brain imaging needs to performed where findings indicate there is a potential of the brain generating spontaneous and recurrent seizures. As for the second factor, it is performing an EEG test that shows abnormal electrical brain patters that are related to seizures which will indicate a high risk of recurrence of another seizure. If the neuroimaging and the EEG test show abnormal findings that does not have epileptiform potential meaning there is certain brain waves or activity that imply epilepsy or associated with epilepsy and they have experiences one unprovoked seizure then the patient would not be diagnosed with epilepsy. The consensus to set the percentage at greater than or equal to 60% is because it represents the minimum level confidence for someone who already experienced two unprovoked seizures is likely to have a third one.

Finally as for the third condition and that is a diagnosed epilepsy syndrome. The topic of epilepsy syndromes is complicated and is beyond the scope of this article, but essentially it is notably different than epilepsy types. It is identified by a combination of specific findings that come from clinical features, EEG, neuroimaging, genetic testing, and age dependent features. If there is evidence from the findings suggesting a specific epilepsy syndrome, then the patient is assumed to have epilepsy.

Classifications

An accurate way of classifying seizures and epilepsy types comes from obtaining a detailed patient history and performing appropriate tests as supporting data. As mentioned earlier, seizure types include focal, generalized, or unknown. The seizure classification initially starts with whether the seizures are focal or generalized. Focal seizures are ones that start from a specific focus limited to one hemisphere. As for generalized seizures, they originate at some area of the brain where both hemispheres are involved. If the onset of the seizure is unclear due to insufficient data from the patient's history as well as from the tests performed to classify it as focal or generalized, then the seizure will be classified of an unknown onset.

After classifying seizure types, the second part is classification of the epilepsy type. Classification of the epilepsy types assumes that the patient has epilepsy as defined by one of the three condition as detailed above in the diagnosis section. Epilepsy types as just with seizures types include focal, generalized, and unknown plus another category of combination of focal and generalized. To determine which of the four categories the patient belongs to, the seizure type of the patient must be defined. If a patient is classified to have focal (with awareness cognition to bilateral tonic-clonic) seizures that originate from both hemispheres they will be categorized to have focal epilepsy. If the patient has both focal and generalized seizures, they will be classified as having combined focal and generalized epilepsy.