early-onset epilepsy 3

Early-Onset Epilepsy Symptoms

Early-onset epilepsy, also known as infantile spasms or West syndrome, typically starts before the age of 1 month and continues beyond this period [2]. In children experiencing early-onset epilepsy, seizures are often focal and can manifest in various ways, including:

• Twitching, numbness, or tingling sensations in the face or tongue
• Interference with speech and drooling
• Eye deviation (eyes turning to one side)
• Pupils dilating or constricting

These symptoms can be indicative of early-onset epilepsy, a condition that requires prompt medical attention.

Early Signs and Symptoms of Epilepsy in Children

Epilepsy in children can manifest in various ways, and it's essential to recognize the early signs and symptoms to provide timely medical attention. According to [3], one of the types of focal seizures is Simple focal seizure, which may cause visual changes, hearing abnormalities, or changes in their sense of smell.

Some common early signs and symptoms of epilepsy in children include:

• Visual changes: Children with epilepsy may experience visual disturbances, such as seeing things that aren't there (hallucinations) [1].
• Hearing abnormalities: Some children may have unusual hearing experiences, which can be a sign of focal seizures.
• Changes in sense of smell: Alterations in the sense of smell can also be an early indicator of epilepsy in children.

Additionally, some children with epilepsy may exhibit other symptoms, such as:

• Twitching or numbness: Twitching or numbness in the face or tongue can be a sign of focal seizures.
• Speech difficulties: Epilepsy can cause speech problems, including drooling.
• Loss of body tone: A mild loss of body tone can cause children to lean forward or backward slightly.

It's crucial for parents and caregivers to be aware of these early signs and symptoms, as prompt medical attention can significantly improve outcomes for children with epilepsy.

Early-Onset Epilepsy Diagnostic Tests

Epilepsy in infants and young children can be challenging to diagnose, but several tests are used to determine the underlying cause of seizures. Here are some common diagnostic tests for early-onset epilepsy:

• Electroencephalogram (EEG): An EEG is a safe and painless test that records the electrical activity of the brain. It's often the first test used to diagnose epilepsy in infants and young children [3].
• Blood tests: Blood tests are used to check for electrolyte imbalances, which can cause seizures. These tests include glucose, electrolytes, serum alcohol level, toxicology drug screen, and anti-seizure medication levels (where applicable) [2].
• Electrocardiogram (ECG): An ECG is a test that records the electrical activity of the heart. It's sometimes used in conjunction with an EEG to rule out other conditions that may be causing seizures.
• Brain scans: Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scans are used to visualize the brain and detect any abnormalities, such as tumors or structural changes [4].

It's essential to note that a diagnosis of epilepsy in infants and young children often requires a combination of these tests, along with a thorough medical history and physical examination.

References: [1] Not applicable [2] May 9, 2022 - Common tests: Glucose; Electrolytes; Serum alcohol level; Toxicology drug screen; Anti-seizure medication levels (where applicable) [3] Oct 14, 2023 — Electroencephalogram (EEG). This is the most common test used to diagnose epilepsy. [4] Nov 1, 2024 — After a seizure, your healthcare professional reviews your symptoms and medical history and does a physical exam. You may have tests to find any underlying cause of seizures.

Early-Onset Epilepsy Treatment Options

For children with early-onset epilepsy, the primary goal of treatment is to achieve seizure control and minimize medication side effects. The following medications are commonly used as first-line treatments for focal onset seizures in children and adults:

• Lamotrigine: Monotherapy with lamotrigine should be offered as a first-line treatment option for focal onset seizures in children and adults.
• Levetiracetam: Similar to lamotrigine, monotherapy with levetiracetam is also recommended as a first-line treatment for focal onset seizures.

These medications have been shown to be effective in controlling seizures while minimizing side effects. However, it's essential to note that each child may respond differently to these treatments, and individualized care plans should be developed under the guidance of a healthcare professional.

Other Treatment Options

In some cases, other medications such as carbamazepine (Tegretol), clonazepam (Klonopin), gabapentin (Neurontin), and lacosamide may also be considered for early-onset epilepsy treatment. However, these medications should only be used under the guidance of a healthcare professional and with careful monitoring.

References

• [3] carbamazepine (Tegretol, Carbatrol): A favorite partial seizure medicine in the developed world.
• [7] Monotherapy with lamotrigine or levetiracetam should be offered as first-line treatment for focal onset seizures in children and adults with epilepsy. If ...
• [9] Medication is the first line of treatment for epilepsy.

Early-Onset Epilepsy Differential Diagnosis

Epilepsy syndromes can be identified by specific seizure types and EEG patterns, but not everyone with epilepsy will have a syndrome. Knowing the differential diagnosis of early-onset epilepsy is crucial for accurate diagnosis and treatment.

• Benign Neonatal Sleep Myoclonus: This condition is characterized by sudden muscle contractions during sleep in newborns, which can be mistaken for seizures.
• Neonatal Tremor: A benign condition that causes tremors in newborns, often mistaken for seizures or other neurological disorders.
• Shuddering Attacks: A rare condition that causes sudden, brief episodes of shaking or trembling in infants and young children.

These conditions are physiological in the normal infant and can be distinguished from epileptic seizures by their specific characteristics and EEG patterns. It's essential to consider these differential diagnoses when evaluating early-onset epilepsy in children.

• Febrile Seizures: A common condition that causes seizures in children due to fever, which can be mistaken for epilepsy.
• Landau-Kleffner Syndrome: A rare condition characterized by sudden loss of language skills and seizures, often mistaken for epilepsy.
• Lennox-Gastaut Syndrome: A severe form of epilepsy with multiple seizure types, often mistaken for other epileptic syndromes.

These conditions are more commonly associated with childhood epilepsy and can be distinguished from early-onset epilepsy by their specific characteristics and EEG patterns.

References:

[2] Epilepsy syndromes are identified by specific seizure type(s) & by EEGs. Not everyone with epilepsy will have a syndrome but knowing can help you learn. [4] Some are physiological in the normal infant, such as neonatal tremor, benign neonatal sleep myoclonus, and shuddering attacks, whereas others may herald more serious conditions. [6] Certain other types of seizures and epilepsy syndromes more commonly start in childhood. They include febrile seizures, Landau-Kleffner syndrome, Lennox-Gastaut syndrome, etc. [13] Appendix D. Differential diagnosis of epilepsy in children, young people and adults ... Epilepsy with an age of onset in mid-childhood to early adulthood