5/22/2009
Outline
Pediatric Seizure
Semiology:
Role of video EEG
Joseph E. Sullivan, M.D.
Neonatal seizure
Infantile spasms
Myoclonic/astatic
Atonic/focal atonic
Eyelid myoclonia
Neonatal semiology
Clonic
Tonic
Myoclonic
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Subtle
May NOT have associated EEG
change
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Infant semiology
Limitations of the ILAE classification
Spasms
Different clinical expression
May be clinically asymmetric or be
followed by focal clonic seizure
typical behaviors, ie auras are absent
or unreliable
May be symmetric but still have focal
EEG features
symmetric tonic posturing or spasm
may be focal or generalized
Both may suggest an underlying focal
structural abnormality
Blinks, jerks, and falls
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Absence, myoclonic seizures, and
atonic seizures-are almost always
GENERALIZED
Further syndromic classification may be
possible
Help guide treatment strategies &
prognosis
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Pediatric Syndromes
Myoclonic/astatic epilepsy (Doose’s)
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Atypical benign partial epilepsy
Syndromes with eyelid myoclonia
Doose’s Syndrome
18 months-5 years (peak 3 years)
brief myoclonic/astatic seizures (<0.5
sec)
atypical, absence, GTC’s, later tonic
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Rx with valproate, levetiracetam,
clonazepam
Consider early referral for ketogenic
diet
Prognosis dependent on seizure control
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Atypical benign partial epilepsy
Children often have classic BRECT
phenotype
Then begin having “falls”=pseudoLennox syndrome
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This may be seen after treatment has
started specifically with CBZ/OXC.
Yang, Z, et al., Brain Dev 2009 Apr;31(4):274-81
Eyelid myoclonia
Part of absence “plus” sydromesJeavon’s syndrome
May lead to overestimation of true
absence burden
Often refractory to treatment and often
does not remit in later childhood
Fixation on/off sensitivity
Photosensitive
Conclusions
Video EEG is critical for semiologic
characterization of seizures in younger
children
May lead to more specific syndromic
diagnoses
Better management including guding
work-up, treatment, and possibly
prognosis
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