儿童癫痫指南
diagnosis of seizure, help in the diagnosis of specificsyndromes and predict seizure recurrence(30); how-ever, a normal EEG does not rule out epilepsy. TheEEG interpretation is reliable only when it is wellrecorded and interpreted by an experienced EEGreader with at least one year of training in the same.In the child with uncontrolled epilepsy, a repeatEEG helps in reclassifying the syndrome. BeforeAED discontinuation, an EEG aids in predicting therisk of recurrence in most syndromes barring a fewe.g. BECTS.
In children with unexplained cognitive,neurobehavioral or scholastic deterioration; an EEGmay help in diagnosis of specific disorders likeSSPE, or epileptic encephalopathies like electricalstatus in slow wave sleep (ESES), and non-convulsive status epilepticus. There is no place forroutine follow-up EEGs in patients who are doingwell.
How should an EEG be done(31)?
EEG should be recorded 3-4 days after the lastseizure to avoid post-ictal slowing frominterfering with the interpretation.
A sleep EEG after deprivation should be part ofall routine recordings in children above the age ofthree years.
Minimum activation procedures likehyperventilation and photic stimulation shouldbe used.
Omission of AED prior to EEG recording is notrecommended.
Simultaneous video-EEG is useful indifferentiating non-epileptic events from trueseizures and for pre-surgical evaluation.
Neuroimaging
MRI is more sensitive than CT and is the modality ofchoice. CT retains a role in detecting calcificationand in acute situations like head trauma, statusepilepticus, and epilepsy, where granulomas are apossibility. MRI protocol should be adapted to theage of the child and the type of epilepsysyndrome(32). Neuroimaging is not recommendedin benign epilepsies. High resolution MRI withspecial techniques is recommended for delineatingthe epileptogenic zone and the eloquent cortex inpre-surgical evaluation. The preferred sequences areT1W (preferably, inversion recovery), T2W and PDfast spin echo, Fluid-Attenuated Inversion Recovery(FLAIR), 3D T1 acquisitions with 1-2 mm partitions(better anatomy and morphometry).
8. Management of First Unprovoked SeizureA good history is most important for diagnosis of aseizure. Open eyes, eye and head deviation,incontinence, tongue-bite are fairly specific for aseizure, whereas unresponsiveness, confusion,clonic/tonic movements are suggestive, though thesemay be prominent in non-epileptic events aswell(33). If the child is less than 6 months, admissionfor observation and evaluation is recommended.
EEG preferably 3-4 days after the seizure isrecommended in all cases(34).
Neuroimaging would be needed when there areseizure cluster, focal deficits, altered sensorium,focal EEG background change, etc(34).In the first seizure, AED should not berecommended, but a detailed discussion with theparents is necessary. Exceptions are statusepilepticus due to high rate of recurrence(35) orsevere parental anxiety. Home management ofseizures includes use of rectal diazepam/buccalor nasal midazolam(36) in seizures lasting formore than 2 minutes.
EEG in status epilepticus(SE):
A portable EEG can be done in children withconvulsive SE who do not regain consciousness asexpected, so as to exclude an ongoing nonconvulsivestatus epilepticus (NCSE). Continuous EEG moni-toring is desirable in refractory SE when pentothal orpropofol are being used for dose titration.9. Management of Newly Diagnosed Epilepsy
Long term AED treatment should be started aftersecond seizure(37). The aim of treatment iscomplete seizure control without significantadverse effects. AED is based on the predominant