Overview of Seizures and Epilepsy

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Overview of Seizures and Epilepsy

• Lucyna Zawadzki, MD
• Director of Pediatric Epilepsy Program
• UWHC Madison

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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.

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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

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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

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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

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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

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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

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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.

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Epileptic Syndromes

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

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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

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• 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)

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• 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

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• 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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Not everything that looks like a seizure is a
seizure

• Migraine headache
• Syncope
• Psychogenic seizure
• Behavioral outbursts
• Breath holding spells
• Tics
• Sleep disorders

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Diagnosing Epilepsy

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

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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)

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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

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Spectrum of Severity
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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