Paediatric neurology

• Maintenance medicine treatment choices for different types of epileptic seizures:

  1st line:

  • Generalised tonic and/or clonic: Valproate OR Phenobarbital (<6 months old)
  • Levetiracetam* (if unable to swallow tablets)
  • Lamotrigine (if able to swallow tablets)

  2nd line (specialist advice):

  • Focal: Carbamazepine, Levetiracetam* (if unable to swallow tablets), Lamotrigine
  • Infantile epileptic spasms: Refer all
  • Absence: Valproate, Lamotrigine
  • Myoclonic: Refer all for specialist investigation and initiation of therapy with valproate
• Caution regarding AED choice for girls and women of childbearing potential:

  • Valproate should be avoided in adolescent women and preadolescent girls who are likely to remain on treatment into their childbearing years unless other treatment is ineffective or effective contraception is in place
  • Risk of adverse developmental outcomes to the fetus
  • Complete the 'Acknowledgement of Risk' form if using Valproate in this population
• Referral criteria:

  • Suspected but undiagnosed secondary cause for seizures
  • Focal seizures for neuroimaging (MRI preferred) if facilities or expertise not available
  • Seizures other than simple febrile convulsions in children <2 years
  • Seizures not controlled within 2 months on one agent with minimal side-effects
  • Neuroregression
  • Mixed seizure types in one patient
  • All myoclonic seizures and epileptic spasms at presentation
• West syndrome is a severe type of childhood epilepsy characterized by spasms, developmental delay and irregular distinctive brain wave activity.
• Benign rolandic epilepsy is a childhood epilepsy syndrome causing seizures that originate in the frontal or parietal cortex.
• Childhood absence epilepsy (CAE): Commonest generalized epilepsy in school aged children, characterized by brief episodes of staring and unresponsiveness.
• Childhood absence epilepsy is a common form of epilepsy in children aged 6-8 years old, characterized by brief episodes of staring and loss of awareness.
• Lennox Gastaut Syndrome: Generalised epilepsy characterised by multiple seizure types, cognitive impairment and slow background EEG abnormalities.
• Dravet Syndrome is an inherited disorder affecting infants and young children, characterized by prolonged febrile seizures and other seizure types.
• Lennox Gastaut Syndrome is a rare form of epilepsy characterized by multiple types of seizures, cognitive impairment, and slowing of EEG waves.
• West Syndrome is a severe neonatal epileptic encephalopathy characterized by spasms, developmental delay, and intellectual disability.
• Avoid prescribing carbamazepine, phenobarbital and phenytoin for patients receiving NNRTIs, PIs consider lamotrigine, valproate or levetiracetam.