tailieunhanh - Ebook ABC of one to seven (5/E): Part 2

Part 2 book “ABC of one to seven” has contents: Febrile convulsions, recurrent headache, basic life support in the community, the child with fever, behaviour problems, children with special needs, school failure, minor orthopaedic problems, audit in primary care paediatrics, and other contents. | C H A P T E R 21 Epilepsy Bernard Valman Northwick Park Hospital and Imperial College London, UK OVER VIEW • Detailed observations of the episode by a witness are the most important guide to the diagnosis of a fit. • Recurrent attacks with similar features are essential for the diagnosis of epilepsy. • The attacks may cause changes of consciousness or mood or produce abnormal sensory, motor, or visceral symptoms or signs. These changes are caused by recurring excessive neuronal discharges in the brain, although the electroencephalogram (EEG) may be normal. • Investigations are no substitute for a history taken carefully from a witness and the EEG should not be used to determine whether an episode is caused by a fit. • Documented absence of fever is essential to exclude the more common problem of febrile convulsions (see Chapter 20). • See Chapter 20 for emergency management of a fit. The incidence of epilepsy is about 6 in 1000 schoolchildren whereas the incidence of children with febrile convulsions is about 30 in 1000 preschool children. A single seizure may need investigation but should not be called epilepsy and specific treatment is usually not indicated. When a second attack occurs within 1 month of the first, early treatment is mandatory and may influence long-term outcome. Disability depends partly on the frequency and severity of the fits but also on the presence or absence of developmental delay, cerebral palsy, or defects in the special senses that would suggest a structural brain abnormality (Box ). Most children with epilepsy attend normal schools, rarely have fits, and have no disability apart from the fits. Epileptic syndromes can be divided into those with no established aetiology but where there is a probability of genetic origin (idiopathic or primary) and those with a known aetiology (symptomatic or secondary) in which a structural brain lesion is suspected or can be shown. Epileptic fits can be divided into generalized or .