15.5.5.2 Epilepsy

Question 1

Types of epileptic seizures

Answer 1

Epileptic seizures are usually divided into generalised and focal (previously called partial or localization-related) epileptic seizures

Question 2

Types of generalised epileptic seizures

Answer 2

• Generalised tonic clonic seizures
• Tonic seizures
• Clonic seizures
• Atonic seizures
• Myoclonic seizures
• Absence seizures (typical and atypical)
• Epileptic Spasms

Question 3

Focal epileptic seizures

Answer 3

Slide 6

Question 4

Epileptic spasms / Infantile spasm

Answer 4

• Age dependant syndrome
• West syndrome, infantile spasms or “Salaam or jack-knife attacks”.
• Occurs between 3 months to 1 year of age. (Age-dependant type of epilepsy)
• A specific type of fit consisting of sudden flexion (or rarely extension) of the head, trunk and extremities.
• A cry is often associated with the attack.
• The spasms are of a symmetrical nature and tend to occur in clusters.
• Developmental arrest usually accompanies seizure onset.

Divided in two groups:
- Symptomatic →Infants who have a definite history suggesting a pre peri or post natal insult. (85%)
- Idiopathic or cryptogenic →Infants who are healthy and Developmentally normal prior to the development of spasms and where no cause can be identified. (15%)

Outcome
- The major importance of this syndrome lies in it’s close association with intellectual dysfunction. (70-96%) -> ADHD
- The onset of spasms usually result in loss of previously acquired skills and social responsiveness.
- After 1 years may evolve into other intractable epilepsy syndromes such as Lennox Gestaut syndrome.

Question 5

Lennox-Gestaut syndrome

Answer 5

• Age 2-6 years.
• Mixture of seizure types. “ stare jerk and fall”
• Most frequently occurring are tonic, tonic-clonic, myoclonic, atypical absences and “head drops” (atonic drop attacks)
• Seizures are very frequent occurring numerous times a day.
• EEG shows irregular slow and spike wave activity.
• Mental deficiency in 80-90% of cases.
• Behavioural problems (hyperactivity autism etc ) also common.

Question 6

Childhood epilepsy with centrotemporal spikes

Answer 6

• the fact that child can tell you what they felt= focal seizure
• Rolandic epilepsy
• Age of onset 2-12 years, mostly between 4-10 years, peak 7-9 years. - Represents 16% of all epileptic seizures in children aged 0-15 years.
• Somatosensory stimulation of the oral-bucal cavity, speech arrest.
• Preservation of consciousness, excessive pooling of saliva and tonic or tonic-clonic activity in the face.
• Attacks most frequently involve the face, although the arm and leg can be involved.
• In most children they are common during sleep and of short duration.
• The frequency is typically low.
• Only happens few times: grows out of it
• Don’t give anti-epileptic meds
• EEG: High amplitude spike and sharp wave complexes in the left centrotemporal region.

Question 7

Childhood absence seizures

Answer 7

• Formerly termed petit mal epilepsy.
• Usually between 5 and 15 years. Very rare under 3 years of age.
• More commoner in girls than boys.
• Accounts for only about 2.5-5% of cases of childhood epilepsy.
• Sudden brief blank stare accompanied by unawareness.
• Sometimes accompanied by flickering of the eyelids and upward deviation of the eyes.
• The onset and termination of the absences are abrupt.
• Episodes are brief, usually lasting 5-15 seconds.
• No loss of body tone. Not associated with post-ictal state.
• Usually amnesia for the event. May interfere with school performance.
• An attack can often be provoked by over breathing.
• precipitate event by hyperventilating
• EEG: Generalized 3 per second spike- and slow wave complexes. Elicited by over breathing a cooperative child during the recording

Question 8

Status Epilepticus

Answer 8

• Continuous or recurrent seizures persisting for more than 30 minutes.
• More common in children below the age of 5 years (85%) and usually occurs after a febrile seizure or acute neurological event.
• Non compliance and changes in anticonvulsant therapy are common precipitants of SE in older patients.
• Underlying etiology is important in predicting outcome. Febrile status epilepticus is associated with an excellent prognosis.
• If a seizure goes over 2 mins= will become status epilepticus