UPDATES IN MANAGEMENT OF CHILDHOOD EPILEPSY; best treatment of children with epilepsy in Dubai
Epilepsy is common in childhood. Febrile seizures (with fever) are an especially common seizure type. It is one of the more common seizure types across the entire paediatric age spectrum. Connect for Best neurologist Dubai for Epilepsy treatment.
Let’s first look at what’s the impact if we can’t control the seizures, and then we’ll get into how do we treat them to do this. Parents always worry about the deleterious scholastic effect of ongoing seizures, if children are struggling in school. Beyond the cognitive worries is what I would call physical effects of the seizure. So, if a child is standing and has a convulsive seizure ( sudden stiffness ,jerking of body with loss of consciousness and fall /atonic seizure (abrupt loss of postural tone and fall), there may occur serious physical injuries .
The ultimate injury is death. Children with convulsive seizures can have sudden unexpected death in epilepsy, therefore our impetus and consistent goal is to get seizures controlled. Aside from that, we know there are other kind of social stigmata associated with epilepsy that can affect the child as well. Even if the seizures are totally controlled, we know that some of the breakthrough ones can still occur, but they’re worse in children with poorly controlled seizures. Call us for Seizure treatment in Dubai.
Reasonable assumption is that if we can diagnose the child’s seizure type correctly, see if they have an epilepsy syndrome, if they do, diagnose that correctly and that will allow us to select appropriate treatment for the seizure type and syndrome, and thereby attaining the optimal seizure control.
A proper developmental history , a knowledge of adverse factors indicating perinatal brain injury and Electroencephalogram (EEG) can help guide us to how we can classify the seizure type and syndromes.
We’ve got a lot of medicines, that have been approved by the US Food and Drug Administration (FDA) over the last 30-plus years. By classifying the child’s seizures and syndrome can shrink this list from over 20 down to a handful.
When we select antiseizure medication, or the ASM, for our patient, there are a host of variables that require thinking through, of course the first being the efficacy for the particular seizure type and epilepsy syndrome. Other factors are timing of the initiation of medication, duration of treatment ,EEG findings, possible side effects of a particular medication and its convenience of administration. Febrile seizures and the first afebrile seizure are largely not treated with a regular anti-seizure medication unless a comprehensive neurological assessment indicates otherwise with due judging of the pros and cons of the contemplated medication. We are renowned for Neurophysiology Diagnostics for Patients in Dubai .
Some universally acknowledged professional organizations use the hierarchies of evidence, like the American Academy of Neurology, and the American Academy of Paediatrics, to make decisions about treatment- guidelines .
If we look at the generalized epilepsy, one of the more common ones is childhood absence epilepsy. We have class I evidence that ethosuximide and valproate are our drugs of choice. Ethosuximide, because of lack of side effects, is usually initiated first. Lamotrigine is a slightly "lower-tiered" class I in that it is not quite as effective.
Another common epilepsy syndrome across the entire spectrum of childhood is focal seizures (arising from one particular area of brain ). We know in childhood from birth up till, say, 18 or age 21, focal seizures represent about half or slightly over half of all seizures . As we move into adulthood, it’s probably three-fourths to 80%. So, across the age spectrum, this is the most predominant seizure type. There are a lot of medicines approved for focal seizures. All of our medicines work for focal seizures by themselves. If we combine it with another focal seizure medicine, they can all work together, too. The preferred medicines are Levetiracetam ,Lamotrigine ,Sodium Valproate and Oxcarbazepine, in that order. If you are searching for the best doctor for vertigo treatment, consult Dr. Arun kumar Sharma in Dubai.
Let’s look at the opposite end of the spectrum. We go from a normal child with either a generalized epilepsy or focal seizures ,to one of the developmental and epileptic encephalopathies, which is Lennox-Gastaut syndrome. In these children, the seizures start in childhood, often in the preschool years with a background of delayed milestones and other developmental drawbacks . A common example is a condition called Tuberous Sclerosis. They have multiple seizure types infantile spasms (salaam attacks), atonic seizures, focal seizure and generalized epilepsy. This is a syndrome where characteristic EEG findings combined with the clinical manifestations help us to narrow our therapeutic choices to down to a few medications like Rufinamide ,Sodium valproate ,Vigabatrin ,ACTH hormone, and ketogenic diet.
Some newer drugs have been approved recently as broad spectrum antiepileptics for children. Perampanel ,Lacosamide and Brivaracetam are some of them. There are medicines in the pipeline that will be available down the road. We have a need for these because, as we know, about a third of our patients, give or take 30%, even with our best available treatments still have seizures. We have an ongoing need for more therapies.
Cenobamate and Ganaxolone are some promising medications in advanced Phase 3 trials for paediatric patients with focal seizures and may prove to be useful for other kind of epilepsies as well.
Summing up, a few words about the “rescue medicines (used to abort a seizure in a child with or without being on a regular antiseizure medication)”. A traditional recommendation has been rectal diazepam gel, for children ages 2 and up. Obviously, in our school-aged children, giving a medicine rectally has a kind of social stigma, and a lot of times they’re hesitant to use it. Luckily nowadays, we have other options, like intranasal Midazolam nose/orobuccal spray, easy to use and promptly effective.
In general, we aim for a complete control of seizures without causing significant side-effects, and yet probably about 30% of our children don’t achieve a complete seizure control .An ineluctable fact of brain biology, neuro-architectural ,neurochemical , lack of compliance ,parental ignorance coupled with ill-advised reluctance and human nature to be averse to any sort of medication . Call Dr. Arun kumar Sharma your best neurologist Dubai.
