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Frequently Asked Questions in Pediatric E pilepsy. Lorraine M. Lazar, MD, PhD Pediatric Epilepsy Northeast Regional Epilepsy Group. Individualized answers may differ based on patient diversity. “My child doesn’t have epilepsy , right?”. “Epilepsy”
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Frequently AskedQuestions in Pediatric Epilepsy Lorraine M. Lazar, MD, PhD Pediatric Epilepsy Northeast Regional Epilepsy Group
Individualized answers may differ based on patient diversity
“My child doesn’t have epilepsy, right?” • “Epilepsy” • Repeated episodes of spontaneous electrical misfiring in the brain • Not due to temporary brain irritation (ex. high blood pressure, uncontrolled diabetes, alcohol / drug intoxication) • Misconceptions • Not “Cerebral Palsy”, “Cognitive Disability / Mental Retardation”, Fragile / Sickly • Not uncommon • 326,000 children in the U.S. < 15 years old have epilepsy • 200,000 new cases diagnosed each year
“What caused my child’s epilepsy?” SYMPTOMATIC CAUSES IDIOPATHIC GENETIC
“Does my child need to see a geneticist?” • “Chromosomal Microarray (CGH microarray)” • Tests for larger pieces of missing or extra DNA • “Whole exome genetic testing” • Tests for smaller variations in DNA
“Why did the seizures start now?” Age Related Onset Of Childhood Epilepsy Syndromes JME Juvenile Absence GTC on awakening Childhood Absence Rolandic Lennox-Gastaut Febrile Seizures Benign Myoclonic Infantile Spasms Early Epil Encephalopathy Neonatal seizures Age (yrs) at Seizure Onset
“Will medication stop my child’s seizures?” ~70 % controlled with 1 med ~15 % controlled with >1 med ~15 % uncontrolled Best chance for seizure control is if medication well matched to seizure type(s) Other non-medicationtherapies available Increasing Medication Options
“Are the medications safe?” * * * * * * * * *
“Will my child have to take medication forever?” • ~ 65 % of children 2 years seizure-free on medication will remain seizure free when medication stopped • If seizures restart off medication, usually stop again on med • Seizures that don’t recur off medication: • Benign Rolandic • Childhood Absence • Seizures that commonly recur off medication: • Lennox-Gastaut syndrome • Juvenile Myoclonic Epilepsy**
Factors associated with a higher risk of seizure relapse if medication is discontinued * * *
Increased seizure recurrence risk if neurologic exam or EEG abnormal
“How do I keep my child safe?” • Medication Compliance • Regular doctor’s appointments • Pill Sorter • Inform doctor of insurance issues • Avoid seizure triggers • sleep deprivation • missing medication (forgetting, running out) • illness/fever (clean hands when eating a must!) • excessive alcohol use, illicit drug use • flashing lights • stress/anxiety
Know Basic Seizure First Aid (at Home and School): Stay calm Time the seizure Roll onto side Move objects away Don’t restrain Don’t put anything in the mouth Be reassuring as seizure stops
Water Safety – minimize drowning hazard • Bathe under constant supervision (unlocked bathroom door) • Consider shower (with clear drain) over bath • Never swim alone • Wear life vest in murky water • Sports Safety: • Always wear appropriate sports safety gear (helmets a must!) • Avoid climbing heights > 10 ft without a harness • Avoid bicycling in open traffic
Travel Safety: • Avoid sleep deprivation • Carry medications on trips • Have enough medication to last the trip • For older teens, follow DMV laws for driving • Medication Safety: • Inform your epilepsy doctor of other medications being taken, whether prescribed or over-the-counter • Benadryl – can lower seizure threshhold
“Can my child die from a seizure?” • SUDEP – Sudden Unexpected Death of someone with Epilepsy, who was otherwise healthy. • Most common with certain seizure types if uncontrolled • Rare in children, more common in adults • Cause of death in SUDEP unclear • irregular heart rhythm? • suffocation from impaired breathing, fluid in the lungs, being face down on bedding? • Best prevention is to follow treatment recommendations, including take anti-seizure medication regularly