Tokushukai Medical Group

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Pediatric Diseases:Epilepsy

About Epilepsy

Epilepsy is a disease which brain cell gets excited unrelated with one’s thought, then develops several symptoms like consciousness disturbance or spasm (they are called as seizure) are repeated. They are divided into “idiopathic” developed by unknown reason, and “symptomatic” accompanying with several brain disease or developed as after effect of the disease. Disease raised after the recovery of asphyxia neonatorum, inflammation of meninges, encephalitis, hemorrhage or brain damage, disease accompanied with congenital brain malformation, and disease which is developed by gene abnormality are divided into latter group.

Common age of pathogenesis

Disease is developed at early stage of childhood then decreased gradually afterwards, but it is focused since high-aged person development is increasing these days. Disease prevalence is roughly one in 100 persons, hence there are more than 1 million persons in Japan.

Symptom is divided into “partial seizure” and “general seizure”.

Cerebral figure:Symptoms are different depend on the brain area where seizure occur.

Symptoms are called as “seizure”, and repeated bout is its diagnostic. They are divided into “partial seizure” and “general seizure”.

Partial seizure is developed due to local brain nerve cell is over-excited, so that symptom such as, part of legs/hands become stiffed, twitched, eyes are flickering, see an unusual thing, smell abnormal odor, feel queasiness, stomachache, and/or headache, may be developed. Normally person’s consciousness is clear, but when consciousness is lost followed by these symptoms, it is called as “complex partial seizure”. Also, there is a “secondary general seizure” case which symptom changes to entire body seizure from partial seizure.

“General seizure” is the case which consciousness is lost from the beginning of seizure, suddenly entire body jerks, or entire body spasm occur. These symptoms are developed regardless the time and occasion like, at the onset of sleep, immediate after awakened, or during sleep or bathing. Also there are cases in several condition like, at the onset of fever or lack of sleep, or, being in bad physical condition.

Besides, symptoms of newborn infant are unusual movement of limbs, showing apnea symptom. For small children, it is difficult to identify whether the unusual movement during sleep is spasm. They laugh suddenly, cause fainting, or talk meaninglessly so that these are difficult to identify whether they are with psychiatric disease or not. To categorize aforementioned seizure type, epilepsy is divided as follows.

Cause Classification of epilepsy (Listed partially from 1989 International Epilepsy Federation classification)
Idiopathic General Epilepsy Localization-related epilepsy
Pediatric Absence Epilepsy
Juvenile Absence Epilepsy
Juvenile Miocroni Epilepsy
Epilepsy with spike on central and lateral sulcus
Epilepsy with paroxysm at occipital lobe
Symptomatic General Epilepsy Localization-related Epilepsy
West Syndrome
Lennox–Gastaut syndrome
Temporal lobe epilepsy
Frontal lobe epilepsy
Parietal lobe epilepsy
Occipital lobe epilepsy

General epilepsy occurs mainly from general seizure, and localization-related epilepsy occurs mainly from partial seizure. Each of them is divided into sporadic epilepsy of unknown cause, and symptomatic epilepsy which come along with several diseases or raised after the recovery.

Electroencephalographic examination is the must for diagnostic.

Several kinds of test are necessary since there are many diseases exist other than epilepsy which present with these symptoms. Tests like Brain Computer Tomography, MRI, Blood Test, Cerebrospinal Fluid Examination are conducted, but among these, Brain Computer Tomography is the must. In case abnormal wave (called as seizure wave) is recorded, provability of Epilepsy becomes higher, but seizure wave is merely recorded so that there may be a case where special test like, test is repeated, or brain wave is recorded whilst taking video image, becomes necessary. Other than these, nerve conduction velocity measurement, or development test or test for dementia, may be conducted.

Treatment with Antiepileptic drug is the most common.

First treatment for Epilepsy is taking “Anti-Epilepsy Agent” orally. Currently approximately 20 kinds of drug is used, further there are drugs under the development stage. Based on the aforementioned seizure type, drug is selected and start using with gradually increasing dosage volume. Taking drug periodically, one to three times a day. In case first drug shows no effect, change drug to the other one, or taking other drug together with current one.

For intractable epilepsy which is hard to control seizure, there is a case where several kinds of drugs are used together. Also, for epilepsia nutans (west syndrome) which is developed in infants, hormone agent called as “ACTH” is used, or ketogenic diet which contains fatty meal is used, as treatment.

In case internal medicine treatment cannot settle the symptom, surgical treatment may be considered. When the cause of pathological change of epilepsy is able to surgical cut off, cut-off surgery is conducted locally, or nerve path is cut. Surgical treatment may cause some effect to other functions of the brain so that careful approach, considering the balance of seizure and common social life, is necessary in consulting with specialist. Also, there is a method called as VNS which innervate parasympathetic nerve electrically, this method is an alternate option when internal medicine does not settle the symptom. So that consulting with epilepsy specialist is highly recommended.

Anti-Epilepsy Drug authorized in Japan
(Added recently authorized drug in Epilepsy Guideline 2010)
Generic Name Generic Name
Acetazolamide
Ethosuximide
Gabapentin
Carbamazepine
Clonazepam
Clobazam
Diazepam
Potassium bromide
Sultiam
Zonisamide
Topiramate
Nitrazepam
Valproic acid
Phenytoin
Phenobarbital
Primidone
Lamotrigine
Levetiracetam
Pelampanel
Lacosamide

How long period does oral usage take?

If effective, minimum 2 to 3 years internal usage is necessary. When there is no seizure in this period, and also no seizure wave is recorded in this period, it is able to stop taking internal drug with gradually decreasing drug amount. Symptom attack may re-develop during drug decrement period, so that careful proceeding is requested. When attack continues, internal drug taking may become necessary for one’s entire life.

Internal drug treatment can be done by periodic outpatient visit, but when fit occurs frequently, or seizure does not fit at all, called as “status epilepticus”, temporary hospitalized treatment is requested.

Objectives of the treatment is to control seizure 100%, but there may be a case where complete control is difficult with using several kinds of drug or utilizing several other methods available.

Points of attention on the treatment.

As mentioned before, seizure may occur during bathing or sleeping, or occur while going out or during a trip. The important thing is to take assigned drug promptly in schedule without fail. In case if this can not be kept, it may cause seizure again and may connect to traffic accident. For example, when “longer bathing”, become lack of sleep or overfatigue, it may be developed again. Also please avoid the situation where accident may occur as the effect of attack, by climbing up high, or diving into the sea.

Every single medicine has a side effect. Select the most appropriate and less side effect drug. Side effect, such as sleepiness, wobbling, poor appetite, rash, hepatic damage, or anemia may be different depend on the drug. When side effect is too strong, it is necessary to switch to the other medicine.

Burden on medical expense is reduced by public financial support.

Support program for infant stage may differ from local government, but generally speaking free or light individual payment up to junior high-school children by public financial support. For matured adults, there is a law which provides independence support, so that by making the registration, person may receive support depend on income condition.

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