Define Epilepsy in Children. Describe its classification, investigations and management.

Definition

• Epilepsy is a chronic disorder characterised by an enduring predisposition to recurrent, unprovoked seizures.
• It is diagnosed after ≥ 2 unprovoked seizures > 24 hours apart, or one unprovoked seizure with a high probability of recurrence.
• A seizure is a transient event due to abnormal, excessive neuronal discharge.

Classification of Seizures

• Focal seizures — arising in one part of the brain; with retained or impaired awareness (may become bilateral tonic-clonic).
• Generalised seizures — tonic-clonic, absence, myoclonic, atonic, tonic.
• Classified further by aetiology — structural, genetic, infectious, metabolic, immune or unknown.

Common Paediatric Epilepsy Syndromes

Clinical Evaluation

• A detailed eyewitness account is the cornerstone (semiology, triggers, duration, post-ictal state).
• Distinguish epileptic seizures from mimics — breath-holding spells, syncope, and non-epileptic events.
• Developmental and neurological assessment; look for underlying causes.

Investigations

• EEG — supports the diagnosis, classifies the seizure/syndrome, and identifies characteristic patterns (e.g. 3 Hz spike-wave, hypsarrhythmia).
• Neuroimaging (MRI) — for focal seizures, focal deficits, or drug-resistant epilepsy (to find a structural cause).
• Metabolic/genetic tests when indicated (especially in infants with regression).

Management — Principles

• Start an antiepileptic drug (AED) after a confirmed diagnosis, choosing by seizure type; use monotherapy at the lowest effective dose.
• Titrate gradually; add a second drug or switch if the first fails.
• Aim for seizure freedom with minimal side-effects.

Drug Choice BY Seizure Type

Seizure VS Epilepsy

A single provoked seizure (e.g. Febrile, hypoglycaemic) is not epilepsy. Epilepsy implies an enduring tendency to unprovoked seizures — the distinction determines whether long-term treatment is needed.

Precipitating / Trigger Factors

• Sleep deprivation, missed medication, intercurrent illness/fever.
• Flickering lights (photosensitivity), stress, and (in adolescents) alcohol.

Common Aed Side-effects (counsel About These)

Withdrawal of Therapy

AEDs can often be gradually withdrawn after a seizure-free period of about 2 years, taking into account the seizure type/syndrome, EEG and the family's wishes; tapering is done slowly to avoid withdrawal seizures.

Psychosocial Aspects

• Address stigma, schooling, and activity safety (swimming, cycling, heights).
• Screen for and manage associated learning and behavioural difficulties.