Atonic seizures in children

Atonic Seizures in children

1. ATONIC SEIZURES IN CHILDREN

2. Aminul Gazi , a 2 year boy came to our OPD on 9 th June,2012. Her mother told us that he often fell to the ground spontaneously. His mother catches him most of the time, and she said that the boy went limp, as if completely powerless during the fall. The episodes last for less than a minute. The boy remains conscious after the attack. Sometimes he also tells his mother that he is going to fall. The attacks started around 6 months ago, and occurs at 2-3 weeks interval. Aminul is diagnosed to be suffering from Atonic Seizures.

3. Uncontrolled electrical activity in the brain, which may produce a physical convulsion, minor physical signs, thought disturbances, or a combination of symptoms. What is a Seizure?

4. International Classification of Seizures I. Partial seizures II. Generalized seizures A. Simple partial seizures B. Complex partial seizures A. Absence seizures C. Partial seizures evolving to secondarily generalized seizures With motor signs 2. With somatosensory or special-sensory symptoms 3. With autonomic symptoms or signs 4. With psychic symptoms Simple partial seizures at onset, followed by impairment of consciousness 2. With impairment of consciousness at onset 1. Simple partial seizures evolving to generalized seizures 2. Complex partial seizures evolving to generalized seizures 3. Simple partial seizures evolving to complex partial seizures evolving to generalized seizures B. Myoclonic seizures C. Clonic seizures D. Tonic seizures E. Tonic- clonic seizures F. Atonic seizures

5. What are Atonic Seizures? Atonic seizures are a type of generalized seizure. It involves all of the brain. It involves a sudden loss of muscle tone, so that the person goes limp and falls to the ground. They are often present in children who also have other seizure types, such as tonic or myoclonic seizures. They occur in all age groups, but are more common in children. Consciousness is impaired during the fall, although the patient may regain alertness immediately upon striking the floor.

6. The eyelids may droop, the head may nod, and the person may drop things and often falls to the ground. Some atonic seizures may be fragmentary and lead to dropping of the head with slackening of the jaw or dropping of a limb. Atonic attacks are often associated with myoclonic jerks either before, during, or after the atonic seizure. This combination has been described as myoclonic-astatic seizures.

7. What are other terms for atonic seizures ? Astatic seizure Akinetic Seizure Drop Seizure Drop A ttack

8. Epidemiology: They occur in all age groups, but are more common in children. Approximately 1% to 3% of children with epilepsy have atonic seizures . Atonic seizures frequently occur in people with Lennox- Gastaut Syndrome, along with absence and tonic clonic seizures

9. What are they like? Here's a typical story: "When Bob has a 'drop' seizure, he falls to the ground and often hits his head and bruises his body. Even if I'm right next to him and prepared, I may not catch him. Even with carpet in the bedroom and mats in the bathroom, he gets hurt."

10. Possible signs and symptoms of an atonic seizure: sudden loss of muscle tone. the child goes limp and falls straight to the ground. the child remains conscious or has a brief loss of consciousness eyelids droop, head nods, jerking. In babies, who cannot stand up, atonic seizures most often appear as a head drop. the seizure usually lasts less than 15 seconds, although some may last several minutes, but not longer than 3 minutes. the child quickly becomes conscious and alert again after the seizure.

11. Diagnosis: Atonic seizures can be diagnosed by Electroencephalography(EEG). Atonic seizures are usually associated with rhythmic spike-and-wave complexes varying from slow (1 to 2 Hz) to more rapid, irregular spike- or multiple spike-and-wave activity. Other tests may include MRI, CT scan or PET scan of brain.

12. Differential Diagnosis: In case of tonic seizures, the child may also fall to the ground. But with atonic seizures, however, the child falls straight to the ground, and is not pushed forward or backward by muscle contractions as with tonic seizures.

13. Complications of Atonic Seizures: These are often due to the fall of the child, who injures his head or face.

14. Treatment of Atonic Seizures

15. 1. General: Keep a constant watch on the child. Try to catch him before he falls. Helmets should be worn before venturing to unsafe places.

16. 2. Medical: Atonic seizures are treated with anti-epileptic drugs, although they do not always respond well to the traditional ones like Carbamazepine or Phenytoin. Valproic acid with benzodiazepines can be started as a first-line treatment. Clonazepam and Levetiracetam can be the second-line combination AEDs, if necessary. Patients often improve significantly from a dose of hydrocortisone, but may relapse quickly after the effects end. According to International League Against Epilepsy(ILAE), Valproate in conjunction with Lamotrigine is the “Treatment of Choice” in Atonic Seizures. If one have Lennox- Gastaut syndrome, newer AEDs like F elbamate and Topiramate are useful.

17. 3 . Surgical: C orpus Callosotomy can be tried if there is no response to a battery of AEDs. During this procedure, the fibers connecting the brain hemispheres are cut, which prevents the spreading of seizure activity from one side of the brain to the other. There can still have partial seizures on one side of the brain, but the treatment could significantly reduce the number and severity of the episodes .

18. What to do during these attacks? It can be difficult or impossible to intervene in time, unless one is standing close to the child or keeping an eye on him. If the child often has seizures of this type, he may need to wear a helmet to protect his head from injury. No specific intervention is needed for one of these seizures, unless the child was injured in falling.

19. Prognosis: Some epilepsy syndromes will go away when the child gets older. In other cases, the child may need to keep taking anti-epileptic drugs all his life.

20. THANK YOU