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Overview of Seizures and Epilepsy

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Title: Overview of Seizures and Epilepsy


1
Overview of Seizures and Epilepsy
  • Lucyna Zawadzki, MD
  • Director of Pediatric Epilepsy Program
  • UWHC Madison

2
Learning Objectives
  • 1. After completing this activity, the learner
    will be able to define current prevalence and
    trends related to epilepsy and seizures.
  • 2. After completing this activity, the learner
    will be able to describe current
    treatments-including alternative care and new
    methods of drug delivery for children and
    adolescents with epilepsy.
  • 3. After completing this activity, the learner
    will be able to propose a plan of care for a
    student with epilepsy, including activity
    restrictions.
  • 4. After completing this activity, the learner
    will be able to describe and implement effective
    strategies for communicating and collaborating
    with health care providers around care for
    students with epilepsy.

3
Definitions
  • Epileptic seizure- a transient occurrence of
    signs and/or symptoms due to abnormal excessive
    pattern of excitability and synchrony among
    neurons in select brain areas.
  • Epilepsy- persistent epileptogenic abnormality
    of the brain that is able to spontaneously
    generate paroxysmal activity
  • Recurrent seizures (two or more)which are not
    provoked by systemic or acute neurologic insults
  • Epilepsy syndrome- complex of signs and symptoms
    that define a unique epileptic condition

4
Epilepsy Facts
  • 1 in 26 people will develop epilepsy during their
    lifetime
  • More common then autism, cerebral palsy, MS and
    Parkinsons disease combined
  • Epilepsy accounts for 1 of the global burden of
    disease ( WHO), equal to burden of lung ca in men
    and breast ca in women

5
Risk of Epilepsy
  • Highest at extremes of life ( 1st year of life
    and in elderly)
  • Risk of having at least 1 seizure in lifetime is
    10, and 1/3 will develop epilepsy
  • 2.2 mln of Americans
  • 65 mln people worldwide

6
Incidence and Prevalence in Pediatric Population
  • 5 per 1000 in school-aged children
  • 1.5 per 1000 in preschool-aged children
  • Affects more then 300,000 children under age 15
  • gt90,000 not adequately treated

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Seizure Classification
  • International League Against Epilepsy (ILAE) 2010
    revised classification
  • Based on known causes of epilepsy
  • Genetic
  • Structural/metabolic
  • Unknown cause

11
Generalized Seizures
  • Tonicclonic (in any combination)
  • Absence
  • Typical
  • Atypical
  • Absence with special features
  • Myoclonic absence
  • Eyelid myoclonia
  • Myoclonic
  • Myoclonic
  • Myoclonic atonic
  • Myoclonic tonic
  • Clonic
  • Tonic
  • Atonic

12
Focal Seizures
  • Without impairment of consciousness or awareness
  • With observable motor or autonomic components.
    This roughly corresponds to the concept of
    simple partial seizure.
  • Involving subjective sensory or psychic phenomena
    only. This corresponds to the concept of an aura.
  • With impairment of consciousness or awareness
    (dyscognitive). This roughly corresponds to the
    concept of complex partial seizure.
  • Evolving to a bilateral, convulsive seizure
    (involving tonic, clonic, or tonic and clonic
    components). This expression replaces the term
    secondarily generalized seizure.

13
Epileptic Syndromes
  • Defined by
  • Clinical features
  • Seizure type(s)
  • Age of onset
  • Family history
  • EEG findings
  • Diagnostic Investigations
  • Treatment
  • Prognosis

14
Electroclinical syndromes arranged by age at onset
  • Neonatal period
  • Benign familial neonatal epilepsy (BFNE)
  • Early myoclonic encephalopathy (EME)
  • Ohtahara syndrome
  • Infancy
  • Epilepsy of infancy with migrating focal
    seizures
  • West syndrome
  • Myoclonic epilepsy in infancy (MEI)
  • Benign infantile epilepsy
  • Benign familial infantile epilepsy
  • Dravet syndrome
  • Myoclonic encephalopathy in nonprogressive
    disorders

15
  • Childhood
  • Febrile seizures plus (FS) (can start in
    infancy)
  • Panayiotopoulos syndrome
  • Epilepsy with myoclonic atonic (previously
    astatic) seizures
  • Benign epilepsy with centrotemporal spikes
    (BECTS)
  • Autosomal-dominant nocturnal frontal lobe
    epilepsy (ADNFLE)
  • Late onset childhood occipital epilepsy
    (Gastaut type)
  • Epilepsy with myoclonic absences
  • Lennox-Gastaut syndrome
  • Epileptic encephalopathy with continuous
    spike-and-wave during sleep (CSWS)
  • Landau-Kleffner syndrome (LKS)
  • Childhood absence epilepsy (CAE)

16
  • Adolescence Adult
  • Juvenile absence epilepsy (JAE)
  • Juvenile myoclonic epilepsy (JME)
  • Epilepsy with generalized tonicclonic seizures
    alone
  • Progressive myoclonus epilepsies (PME)
  • Autosomal dominant epilepsy with auditory
    features (ADEAF)
  • Other familial temporal lobe epilepsies
  • Less specific age relationship
  • Familial focal epilepsy with variable foci
    (childhood to adult)
  • Reflex epilepsies

17
  • Distinctive constellations
  • Mesial temporal lobe epilepsy with hippocampal
    sclerosis (MTLE with HS)
  • Rasmussen syndrome
  • Gelastic seizures with hypothalamic hamartoma
  • Hemiconvulsionhemiplegiaepilepsy
  • Epilepsies that do not fit into any of these
    diagnostic categories can be distinguished first
    on the basis of the presence or absence of a
    known structural or metabolic condition (presumed
    cause) and then on the basis of the primary mode
    of seizure onset (generalized vs. focal)
  • Epilepsies attributed to and organized by
    structural-metabolic causes
  • Malformations of cortical development
    (hemimegalencephaly, heterotopias, etc.)
  • Neurocutaneous syndromes (tuberous sclerosis
    complex, Sturge-Weber, etc.)
  • Tumor
  • Infection
  • Trauma
  • Angioma
  • Perinatal insults
  • Stroke
  • Etc.
  • Epilepsies of unknown cause
  • Conditions with epileptic seizures that are
    traditionally not diagnosed as a form of epilepsy
    per se
  • Benign neonatal seizures (BNS)

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37
Not everything that looks like a seizure is a
seizure
  • Migraine headache
  • Syncope
  • Psychogenic seizure
  • Behavioral outbursts
  • Breath holding spells
  • Tics
  • Sleep disorders

38
Diagnosing Epilepsy
  • Detailed history and physical examination
  • EEG, video EEG
  • Imaging ( CT, MRI, PET)

39
History
  • Precipitating factors
  • Aura
  • Area of body first involved
  • Progression of activity
  • Specific activity observed (head or eye
    deviation, type of movement or posturing)
  • Level of consciousness
  • Incontinence
  • Apnea or cyanosis
  • Duration of seizure
  • Postictal symptoms ( confusion, hemiplegia,
    aphasia)

40
Seizure Triggers
  • Missed dose of medication
  • Sleep deprivation
  • Illness
  • Stress, anxiety, overstimulation
  • Hormonal changes
  • Alcohol and drugs of abuse
  • Hyperventilation
  • Flashing lights
  • Temperature extremes
  • dehydration

41
Spectrum of Severity
42
Psychosocial effects of epilepsy
  • Stigma of epilepsy
  • Compromised quality of life
  • Lower self-esteem
  • Vulnerable child
  • High incidence of depression, anxiety, ADHD and
    learning problems
  • Adverse effects of medications
  • Parental stress
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