Cases of cns with EEG INTERPRETATION in paeds

Neurology cases with eeg as investigation

1. ABNORMAL EEG & CASE SCENARIOS DR LUBNA RIAZ ASSISTANT PROF OF PAEDIATRICS SZH, LHR

2. CASE- 01 Eight months old infant with recurrent episodes of flexor spasms involving neck, trunk and limbs followed by tonic sustained contraction for 2 to 10 seconds. Birth events were normal. He started sitting one month ago.

3. CASE- 01 Examination Microcephaly Café au lait spots Investigations EEG Hypsarrhythmia MRI Cortical dysplasia Diagnosis Infantile Spasms

4. HYPSARRHYTHMIA

5. CASE- 01 TREATMENT Medical Corticosteroids ACTH (gel, i.m. 75 U/m² for 2-6 weeks) Prednisolon (2 mg/kg/d for 2 weeks) Clonazepam/ Levetiracetam (safest alternatives) Valproate Although effective in 70% cases, but not safe in this age group. Required in high doses up to 100-300 mg/kg/d

6. CASE- 01 Vigabatrin In Tuberous sclerosis Sugical Removal of the dysplastic cortical tissue Prognosis is gaurded.

7. CASE- 02 A ten years boy presented in OPD with H/O of declining school performance for last 6 months. Very aggressive behavior towards his family and disturbed sleep. O/E, complete loss of short term memory, and infrequent abnormal movements of both arms.

8. CASE- 02 Past H/O measles Vaccination history No H/O Jaundice H/O joint pain and joint swelling

9. CASE- 02 Differentials Sub acute Sclerosing Panencephalitis (SSPE) Wilson disease Rheumatic chorea Likely diagnosis SSPE

10. PERIODIC SPIKE AND WAVE COMPLEXES IN SSPE

11. CASE- 02 Investigations EEG Characteristic pattern of Periodic bursts of spike-and-wave complexes CSF Elevated anti-measles Abs titer Elevated gamma globulin level Blood Elevated anti-measles Abs titer

12. CASE- 02 Treatment Periodic 6 weeks T/M of I/V α -interferon combined with oral Inosine Pranobex (Isoprinosine-100mg/kg/d) Repeated 6 times at 2-6 months interval Prognosis is worse.

13. CASE- 03 A 7 years old child with H/O right sided focal fits with twisting of mouth during sleep. He did not remember anything in the morning. Birth events normal, as was the school performance. CNS examination was unremarkable.

14. CASE- 03 Likely Diagnosis Benign Rolandic Epilepsy (benign childhood epilepsy) Investigations EEG Uni/bilateral spikes in central/centrotemporal region

15. SINGLE CENTROTEMPORAL SPIKE

16. SINGLE CENTROTEMPORAL SPIKE

17. CASE- 03 Treatment Reassurance Carbamazepine Prognosis Excellent

18. CASE- 04 A ten year old child, referred by school teacher that he often become motionless for 5-10 sec while attending the lecture. No H/O loss of consciousness and he could not recall anything. G.P started carbamazepine with no improvement.

19. CASE- 04 Further Examination Hyperventilation induced the absence seizures Investigations EEG Characteristic synchronous and symmetric 3cps spike-and-wave complexes, especially developed on frontal and central regions.

20. ABSENCE SEIZURES- 3CPS SPIKE AND WAVE ACTIVITY

21. ABSENCE SEIZURES- 3CPS SPIKE AND WAVE ACTIVITY

22. CASE- 04 Treatment Ethosuximide Drug of choice Valproate Alone/combination Clonazepam Refractory cases Carbamazepine Contraindicated

23. CASE- 05 A nine year old child with starring for 1-2 min and automatic movements of face and arms. H/O auditory hallucinations with postictal confusion. Physical examination was unremarkable

24. MULTIFOCAL SPIKE AND WAVE PATTERN IN COMPLEX PARTIAL SEIZURES

25. CASE- 05 Diagnosis Complex Partial Seizures was entertained. Investigations EEG Focal/multifocal slowing/spikes (usually in temporal and frontal regions) MRI SOL/Dysplastic tissue

26. CASE- 05 Treatment Carbamazepine/oxcarbazepine Phenytoin Valproate Newer Agents Topiramate Levetiracetam

27. CASE- 05 Surgical Glioma removal/ temporal lobe microsurgery

28. CASE- 06 A 12 years old child presented with recurrent episodes of flexor jerks of arms and legs, causing him to fall. Occurred in the early morning. No H/O disturbed consciousness. He was aware of the jerky movements. CNS examination was unremarkable.

29. JUVENILE MYOCLONIC EPILEPTIC DISCHARGE DURING PHOTIC STIMULATION

30. CASE- 06 Diagnosis Juvenile Myoclonic Epilepsy Precipitating Factors Sleep deprivation Awakening from sleep Alcoholism Investigation EEG Bilateral symmetrical spikes and spike-and-wave (3.6 to 6 Hz) discharges, dominantly over the frontal and central areas. Photic stimulation may provoke a discharge.

31. CASE- 06 Treatment Levitiracetam Drug of choice Others Valproate Lamotrigine Topiramate Treatment is life long

32. CASE 07 A four and half year old child, known case of epilepsy since age of 1 ½ year, on regular anticonvulsants, presented with sudden loss of consciousness . There was H/O of fever for one day. No H/O of head trauma or any other associated symptoms.

33. CASE 07 O/E GCS 9/15 Reflexes Normal Other systemic examination unremarkable INVESTIGATIONS EEG Generalized bursts and continuous runs of high voltage slow and sharp waves with spikes and polyspikes were seen.

34. CASE 07 CSF Normal findings. MRI BRAIN Normal

35. EPILEPTIC ENCEPHALOPATHY

36. EPILEPTIC ENCEPHALOPATHY

37. EPILEPTIC ENCEPHALOPATHY

38. CASE 07 TREATMENT Valproate infusion

39. THANK YOU