DOCSLIB.ORG

10/21/2020 1 Outcome of Pediatric Epilepsies in Adulthood

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
10/21/2020 1 Outcome of Pediatric Epilepsies in Adulthood 10/21/2020 Outcome of Pediatric Epilepsies in Adulthood No financial disclosure Suad Khalil, MD Pediatric Neurologist and Epileptologist MSU- Assistant Professor 1 2 What does the term Objectives “outcome” mean ?? • History of seizures (remission or persistence of seizures, evolution of seizure pattern throughout life and response to AEDs) • Discuss global aspects of outcome of pediatric • The natural course of the disease causing the seizures epilepsies during adulthood • The comorbidities (changes in cognition, psychiatric • Discuss specific aspects of outcome in some symptoms, and sometimes of the neurological condition), epileptic syndromes, and focus on epilepsies that • The risk of mortality begin during infancy, childhood and adolescence • The familial and social impact of a disease that has started in childhood 3 4 Epilepsy Syndromes Age Seizure semiology EEG data Comorbidities 5 6 1 10/21/2020 The Epilepsy Syndrome Solar System Seizure types Focal Generalized Unknown Idiopathic onset onset onset Etiology JAE Epilepsy with Primary reading JME epilepsy 10 yr grand-mal Structural seizures upon awakening Epilepsies with BECTS 1 yr specific modes Genetic Childhood of activation Childhood 1 mo absence epilepsy Generalized Epilepsy types epilepsy with BMEI occipital BNC Combined Infectious paroxysms BNFC Focal Generalized Unknown West Generalized EME EIEE Syndrome & Focal Cryptogenic or Symptomatic Focal Lennox-Gastault Epilepsies Neonatal Seizures Syndrome Metabolic Focal Epilepsy with myoclono-astatic Rasmussen’s Comorbidities seizures Syndrome Severe myoclonic Immune epilepsy in infancy Epilepsy with ESESS myoclonic Landau-Kleffner absences Epilepsy Syndromes Syndrome Unknown Non-idiopathic 7 8 In general…. In general…. • 50% of patients with pediatric epilepsies are going into remission as they age • Some epilepsies are characterized by the evolution of the • This percentage varies greatly according to epileptic seizure pattern (type, severity or frequency, remission or syndromes and etiologies of epilepsies no remission, etc) • Generally, children with idiopathic focal or generalized epilepsies show better prognosis and evolution as many outgrow their seizures and are relatively unaffected from the • While in others, the evolution is better characterized by cognitive point of view the occurrence of comorbidities (cognition and psychiatric manifestations) that appear and progress over time overtaking the seizures themselves Camfield et al.,1993 9 10 In general… Neonatal Epilepsies • In symptomatic epilepsies, the etiology itself has a • Etiology…Etiology…and Etiology great impact on the overall prognosis in adulthood Self-limited neonatal seizures Self- limited familial neonatal epilepsy Seizures Progressive lesional brain processes • Start in the neonate between day 4 and 7 of life • Unilateral clonic events that recur and may Fixed brain lesion alternate sides from seizure to seizure • Seizures remit by 4-6 months of age. • May have seizures in later life, normal developmental milestones 11 12 2 10/21/2020 Early myoclonic encephalopathy (EME) Epileptic Early Myoclonic Encephalopathy (EME) Early Infantile Epileptic Encephalopathy (EIEE) ● Most often associated w inborn errors of metabolism, less common are Encephalopathies congenital brain abnormalities West Syndrome ● EEG showing burst suppression during sleep Lennox Gastuate Syndrome ● Clinical: encephalopathy + myoclonic (usu segmental) jerks in first few hours of Dravet Syndrome life, also have focal clonic seizures, later on tonic spasms ● Poor prognosis, depends on etiology 13 14 Early infantile epileptic encephalopathy (EIEE) ● Ohtahara syndrome, usually related to structural abnormalities ● Onset w/in 2-3 months, frequent tonic spasms, developmental delay, spasticity. Can also have hemi-convulsions. ● EEG burst suppression at all stages ● Poor prognosis, 50% die in infancy, if survive severe impairment 15 16 West Syndrome ● Epileptic infantile spasms ● Triad: spasms, psychomotor arrest, hypsarrhythmia ● 90% affect by 1 yo, between 3-7 mo ● Etiology: brain dysfunction of some sort (migrational, neurocutaneous, metabolic, congenital malformation, etc) ● Treatment: ACTH, occ prednisone. Vigabitrin w 2/2 TS. ● prognosis: usually progresses to LGS, w/cognitive impairment 17 18 3 10/21/2020 Dravet Syndrome (SMEI) • Severe myoclonic epilepsy of infancy, epileptic encephalopathy • Also has hypotonia, ataxia, pyramidal signs, dysautonomia • Mutation in SCN1A gene • Also in? (GEFS+) • Sz w/in 1 year of life, typically febrile clonic • Also get win 1-5 yo GTC Hypsarrhythmia • Hemiclonic, alternating (classic) • Absence, myoclonus, focal motor, dyscognitive 19 20 Dravet Syndrome (SMEI)- Prognosis Severe seizures in childhood, onset prior to age 8 • Many cases evolve into LGS from other epilepsy • Initial catastrophic period; epilepsy is very active and status epilepticusis syndromes (West) common Lennox- Cause: genetic, neurocutaneous, hypoxia, • The seizure frequency tends to diminish during adolescence Gastaut meningitis, head injuries, etc etc etc. • 25% have hx West syndrome • The seizures remain frequent for most patients despite AED polytherapy Syndrome • In adults, generalized or unilateral tonic clonic seizures become frequent often (LGS) Clinical: nonspecific, however preceded by myoclonic characterized by: • They occur predominantly or exclusively during sleep >> SUDEP • Multiple sz types (tonic, atonic, atypical absence, myoclonic) • Developmental regression and psychomotor retardation • Interictal EEG: <2.5 Hz spike-wave/atypical spike- wave, most predominant in frontal regions • Mental retardation/developmental delay 21 22 Lennox-Gastaut LGS-Prognosis Syndrome (LGS) The Lennox Gastaut syndrome (LGS) is among the most severe forms of childhood epilepsy and many adult • The course of the syndrome is not homogeneous depending on whether LGS is cryptogenic or ● Treatment: uncertain, however symptomatic, Epilepsy remains active and intractable can use VPA, LTG, TPX, • Seizures tend to become less frequent with age but cognitive and behavioral problems increase in most rufinamide, felbamate, clobazam patients ○ Do not use partial sz drugs eg • Cognition and behavioral problems usually aggravate with age carbamazepine • The proportion of severely retarded adult patients is around 50%, and is more important among ○ Others: Ketogenic diet, VNS, symptomatic than cryptogenic cases • The cognitive decline is continuous all along the course of the disease, but fluctuations with transient surgery phases of psychomotor worsening are seen in adult patients and are not always correlated with the frequency or severity of seizures • risk of mortality is high in adult patients with LGS, around 17% 23 24 4 10/21/2020 Long-term outcome of idiopathic generalized Juvenile Myoclonic Epilepsy (JME) epilepsies Idiopathic Generalized Epilepsies ● Adolescence Childhood ● Triad of myoclonic jerks, GTC, absence sz ○ Usually upon awakening, or w sleep deprivation Absence ○ Myoclonus (100%), GTC (85-100%), Absence (20-40%) Epilepsy ○ Absence predates other types, up to 5 years ○ Classic is clonic-tonic-clonic ● Often FH positive sz (33%) Juvenile Juvenile ● Epidemiology: 25-30% of idiopathic generalized epilepsies, 10% of all epilepsy Myoclonic Absence ○ Maybe slightly higher female preponderance Epilepsy Epilepsy ○ Age ~15yo 25 26 JME - Prognosis Childhood Absence Epilepsy (CAE) ○ The prognosis for JME is generally considered excellent as the majority of ● Benign generalized epilepsy, in otherwise healthy patients are able to be treated successfully with AEDs childhood ● Epidemiology: 6.3/1000 in study w/Swedish children, ○ Seizure-free rates of 60% to 90% have been reported more in female vs male ● ○ Achieving seizure freedom often involves lifestyle modifications as well as Seizure: typical is short, frequent spell of compliance with AEDs impairment of consciousness, lasting avg 10 seconds, ○ Cognition: Generally normal, however frontal lobe dysfunction common without change in muscle tone. Abrupt onset/offset ○ ○ Psychiatric: up to 50% have either anxiety or mood disorder Provoked by hyperventilation ○ Can occur 100s/day ○ ○ Multiple studies in the past have suggested that JME is a lifelong condition Can have first signs include eyelid movements, and the medications were not to be discontinued. eye opening, automatisms ○ Other seizure types RARE 27 28 CAE-Prognosis Benign Rolandic Epilepsy ● BECTS (Benign epilepsy with centro-temporal spikes) • CAE is one the relatively benign childhood epilepsies, but not all patients ● 10-20% of all childhood epilepsies, mean age 7-9yo become seizure-free. ● EEG: ...centrotemporal spikes. Normal PDR. ○ Characteristics: biphasic, negative followed by positive • Approximately 50% of patients with CAE will have a spontaneous remission ○ Bilateral, independent ○ by the age of 10 to 12 years, with a range of 21% to 89% remission. Occur almost exclusively during sleep (non-REM) ● If do not fit above, need to look further into other partial • In patients with absence seizures only, the seizure- free rate is epilepsies approximately 80%, while patients with GTC seizures and absence were only ● facial/oropharyngeal sz (twitching, hypersalivation, drooling, 30% seizure-free vocalizations • A Dutch study with long- term follow up (12 to 17 years) indicated that ● secondary generalizations, nocturnal seizure free-dom in the first 6 months of treatment predicted outcome ● Rx: only when disruptive/harmful ○ • Cognition: generally normal Carbamazepine (or derivatives
Load more

Recommended publications
  • A Clinical Guide to Epileptic Syndromes and Their Treatment
    Published August 13, 2008 as 10.3174/ajnr.A1231 dures and principles of treatment. These chapters are particu- BOOK REVIEW larly important for readers unfamiliar with the overall clinical presentation of the epilepsies and their diagnostic evaluation. A Clinical Guide to Epileptic Omitting these topics was a certain pitfall that has been Syndromes and Their Treatment, avoided. Basic techniques used in the evaluation of patients with of epilepsy, including anatomic and functional neuroim- 2nd ed. aging, are also included. The discussion of the relative value of C.P. Panayiotopoulos, ed. London, UK: Springer-Verlag; 2007, 578 EEG and its problems is particularly valuable. pages, 100 illustrations, $99.00. Subsequent chapters are devoted to the meat of the book, the epilepsy syndromes. These are presented in age-based he syndromic classification of epileptic seizures has been chronologic order, beginning with syndromes in the neonate evolving for more than a quarter century. Piggy-backed T and infant and continuing through syndromes in adults. onto major advances in neurophysiology and neuroimaging, Complete coverage of reflex seizures and reflex epilepsies in the current nomenclature of specific clinical epilepsy syn- chapter 16 is particularly welcome. Chapter 17 covers a group dromes now supersedes earlier seizure classifications based of disorders that are associated with epileptic seizures. The exclusively on seizure types. The practice of epilepsy has thus chapter gives excellent coverage of these disorders but makes joined mainstream medicine through its newfound ability to no pretenses at being comprehensive. For example, coverage link the signs and symptoms of epilepsy with specific under- of important disorders with epilepsy such as the Wolf- lying disorders.
    [Show full text]
  • Epilepsy & My Child Toolkit
    Epilepsy & My Child Toolkit A Resource for Parents with a Newly Diagnosed Child 136EMC Epilepsy & My Child Toolkit A Resource for Parents with a Newly Diagnosed Child “Obstacles are the things we see when we take our eyes off our goals.” -Zig Ziglar EPILEPSY & MY CHILD TOOLKIT • TABLE OF CONTENTS Introduction Purpose .............................................................................................................................................5 How to Use This Toolkit ....................................................................................................................5 About Epilepsy What is Epilepsy? ..............................................................................................................................7 What is a Seizure? .............................................................................................................................8 Myths & Facts ...................................................................................................................................8 How is Epilepsy Diagnosed? ............................................................................................................9 How is Epilepsy Treated? ..................................................................................................................10 Managing Epilepsy How Can You Help Manage Your Child’s Care? ...............................................................................13 What Should You Do if Your Child has a Seizure? ............................................................................14
    [Show full text]
  • Initiating an Epilepsy Surgery Program with Limited Resources in Indonesia
    www.nature.com/scientificreports OPEN Initiating an epilepsy surgery program with limited resources in Indonesia Muhamad Thohar Arifn1*, Ryosuke Hanaya2, Yuriz Bakhtiar1, Aris Catur Bintoro3, Koji Iida4, Kaoru Kurisu4, Kazunori Arita2, Jacob Bunyamin1, Rofat Askoro1, Surya Pratama Brilliantika1, Novita Ikbar Khairunnisa1 & Zainal Muttaqin1 To share the experiences of organizing the epilepsy surgery program in Indonesia. This study was divided into two periods based on the presurgical evaluation method: the frst period (1999–2004), when interictal electroencephalogram (EEG) and magnetic resonance imaging (MRI) were used mainly for confrmation, and the second period (2005–2017), when long-term non-invasive and invasive video-EEG was involved in the evaluation. Long-term outcomes were recorded up to December 2019 based on the Engel scale. All 65 surgical recruits in the frst period possessed temporal lobe epilepsy (TLE), while 524 patients were treated in the second period. In the frst period, 76.8%, 16.1%, and 7.1% of patients with TLE achieved Classes I, II, and III, respectively, and in the second period, 89.4%, 5.5%, and 4.9% achieved Classes I, II, and III, respectively, alongside Class IV, at 0.3%. The overall median survival times for patients with focal impaired awareness seizures (FIAS), focal to bilateral tonic–clonic seizures and generalized tonic–clonic seizures were 9, 11 and 11 years (95% CI: 8.170– 9.830, 10.170–11.830, and 7.265–14.735), respectively, with p = 0.04. The utilization of stringent and selective criteria to reserve surgeries is important for a successful epilepsy program with limited resources.
    [Show full text]
  • September | 2013 ISSN 1660-3656 Epileptologie | 30. Jahrgang
    Epileptologie | 30. Jahrgang September | 2013 ISSN 1660-3656 Epilepsie-Liga Seefeldstrasse 84 Postfach 1084 CH-8034 Zürich Redaktionskommission Thomas Dorn | Zürich Reinhard E. Ganz | Zürich Martinus Hauf | Tschugg Hennric Jokeit | Zürich Christian M. Korff | Genève Günter Krämer | Zürich (Vorsitz) Inhalt Oliver Maier | St. Gallen Andrea O. Rossetti | Lausanne Stephan Rüegg | Basel Kaspar Schindler | Bern Editorial 147 – 149 Serge Vulliémoz | Genève Combination of Electroencephalographic and Magnetic Resonance Imaging to Beirat Characterize Epileptic Networks Christoph M. Michel 150 – 157 Alexandre Datta | Basel Thomas Grunwald | Zürich Structure, Function and Genes: Christian W. Hess | Bern What Can We Learn from MRI Anna Marie Hew-Winzeler | Zürich Giorgi Kuchukhidze, Eugen Trinka 158 – 166 Günter Krämer | Zürich Theodor Landis | Genève Hereditäre epileptische Enzephalopathie Malin Maeder | Lavigny mit Amelogenesis imperfecta Klaus Meyer | Tschugg Kohlschütter-Tönz-Syndrom Christoph Michel | Genève (KTZS). Bericht über einen weiteren, Christoph Pachlatko | Zürich posthum erfassten Patienten aus der Monika Raimondi | Lugano Zentralschweiz. Andrea O. Rossetti | Lausanne Otmar Tönz, Bernhard Steiner, Anna Stephan Rüegg | Basel Schossig, Johannes Zschocke, Markus Schmutz | Basel Alfried Kohlschütter 167– 174 Margitta Seeck | Genève Urs Sennhauser | Hettlingen Epilepsie-Liga-Mitteilungen 175 – 198 Franco Vassella | Bremgarten Kongresskalender 199 – 200 Schweizerische Liga gegen Epilepsie Ligue Suisse contre l’Epilepsie Lega Svizzera contro l’Epilessia Swiss League Against Epilepsy Richtlinien für die Autoren Allgemeines - Zusammenfassung, Résumé und englischer Ab- stract (mit Titel der Arbeit): Ohne Literaturzitate Epileptologie veröffentlicht sowohl angeforderte als und Akronyme sowie unübliche Abkürzungen (je auch unaufgefordert eingereichte Manuskripte über maximal 250 Wörter). alle Themen der Epileptologie. Es werden in der Regel - Text: Dabei bei Originalarbeiten Gliederung in Ein- nur bislang unveröffentlichte Arbeiten angenommen.
    [Show full text]
  • Age of Onset in Idiopathic (Genetic) Generalized Epilepsies: Clinical and EEG
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Seizure 21 (2012) 417–421 Contents lists available at SciVerse ScienceDirect Seizure jou rnal homepage: www.elsevier.com/locate/yseiz Age of onset in idiopathic (genetic) generalized epilepsies: Clinical and EEG findings in various age groups a,b, a b Ali A. Asadi-Pooya *, Mehrdad Emami , Michael R. Sperling a Neurosciences Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran b Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, USA A R T I C L E I N F O A B S T R A C T Article history: Purpose: The prevalence and differences of idiopathic (genetic) generalized epilepsies (IGEs) with Received 5 February 2012 atypical age of onset compared to classical IGEs is a matter of debate. We tried to determine the clinical Received in revised form 11 April 2012 and EEG characteristics of IGEs in various age groups. Accepted 11 April 2012 Methods: All patients with a clinical diagnosis of IGE were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences from 2008 through 2011. We subdivided the patients into four Keywords: different age groups: 4 years of age and under, 5–11 years, 12–17 years, and finally, 18 years and above, Idiopathic generalized epilepsy at the time of their epilepsy onset. Syndromic diagnosis, sex ratio, seizure types and EEG findings were Age of onset compared. Statistical analyses were performed using Pearson Chi square test. Seizure type EEG Results: 2190 patients with epilepsy were registered.
    [Show full text]
  • Fostering Epilepsy Care in Europe All Rights Reserved
    EPILEPSY IN THE WHO EUROPEAN REGION: Fostering Epilepsy Care in Europe All rights reserved. No part of this publication may be reproduced, stored in a database or retrieval system, or published, in any form or any way, electronically, mechanically, by print, photoprint, microfilm or any other means without prior written permission from the publisher. Address requests about publications of the ILAE/IBE/WHO Global Campaign Against Epilepsy: Global Campaign Secretariat SEIN P.O. Box 540 2130 AM Hoofddorp The Netherlands e-mail: [email protected] ISBN NR. 978-90-810076-3-4 Layout/ Printing: Paswerk Bedrijven, Cruquius, Netherlands Table of contents Foreword ................................................................................................................................................. 4 Preface ................................................................................................................................................. 5 Acknowledgements ........................................................................................................................................ 6 Tribute ................................................................................................................................................. 7 Abbreviations ................................................................................................................................................. 8 Background information on the European Region .........................................................................................
    [Show full text]
  • What to Expect During Your Stay in the Epilepsy Monitoring Unit (EMU)
    What to expect during your stay in the Epilepsy Monitoring Unit (EMU) INTRODUCTION Epileptic seizures occur when the brain cells become overly excited due to electrical impulses. Seizures vary greatly from one person to another. For those recently diagnosed with epilepsy, it’s important to understand what type of seizures they are experiencing and from which part of the brain they originate. Such information can be recorded at the EMU, and it is essential to determine a proper diagnosis and treatment plan. Seton Brain & Spine Institute is dedicated to providing its patients with freedom from seizures and helping them experience the confidence and happiness that a seizure-free life can offer. Ours is the only Level 4 Epilepsy Center for adults in Central Texas. The rating is based upon guidelines recommended by the National Association of Epilepsy Centers. More information at SetonBrainandSpine.com/Epilepsy. WHAT IS VIDEO-ELECTROENCEPHALOGRAPHIC MONITORING? Electroencephalography (EEG) is a technique that records the brain’s electrical activity by using small, metal discs attached to the scalp. It is painless. Patients in the EMU are subject to continuous EEG monitoring. And because physical behaviors (either before, during, or after each seizure) also provide clues about the origin and classification of seizures, patients are also subject to continuous video/audio monitoring. WHAT WILL MY ROOM LOOK LIKE? All rooms are private and include two infrared video cameras as well as a microphone for audio recording. The infrared light allows for videotaping when the room is dark. An event button is available and should be used when a seizure is beginning.
    [Show full text]
  • Pediatric Epilepsy
    PEDIATRIC EPILEPSY Ø Epilepsy is one of the most common chronic neurological disorders. It is characterized by recurrent unprovoked seizures or an enduring predisposition to generate epileptic seizures. If epilepsy begins in childhood, it is often outgrown. Seizures are common in childhood and adolescence. Approximately 3% of children will experience a seizure. Ø A seizure occurs when there is a sudden change in behavior or sensation caused by abnormal and excessive electrical hypersynchronization of neuronal networks in the cerebral cortex. Normal inhibition is overcome by excessive excitatory stimuli. Ø If the cause of the seizures is known (for example: genetic, inborn errors of metabolism, metabolic (eg: low glucose, electrolyte abnormalities), structural (eg: malformations, tumours, bleeds, stroke, traumatic brain injury), infectious, inflammatory, or toxins) it is classified as symptomatic. If the cause is unknown, it is classified as idiopathic. 1. WHERE DID THE SEIZURE START? / WHAT KIND OF SEIZURE IS IT? 2. IS AWARENESS YES FOCAL ONSET GENERALIZED UNKNOWN IMPAIRED? NO Seizure that originates ONSET ONSET in a focal cortical area Seizure that involves When it is unclear YES with associated clinical both sides of the where the seizure 3. PROGRESSION TO BILATERAL? features. brain from the onset. starts. NO SEIZURE SEMIOLOGY (The terminology for seizure types is designed to be useful for communicating the key characteristics of seizures) CLONIC: sustained rhythmical TONIC: muscles stiffen or ATONIC: sudden loss of muscle tone, MYOCLONUS: sudden lighting- jerking movements. tense. lasting seconds. like jerk, may cluster. EPILEPTIC SPASM: sudden AUTONOMIC: eg: AUTOMATISMS: ABSENCE: brief (≤ 10s), OTHERS: change flexion, extension, or flexion- rising epigastric stereotyped, purposeless frequent (up to 100’s) in cognition, extension of proximal and sensations, waves of movements.
    [Show full text]
  • Care Recommendations for Children
    Recommendations for Care of Children with Epilepsy Seeking the best treatment from the right doctor at the right time! Contents Children withWhat of Doctors Type Treat Epilepsy? Children with New Onset Seizures Epilepsy Medication Children Taking Children with Uncontrolled Seizures (Refractory Epilepsy) Making the Office MostChild’s of Your Visit This booklet is to help parents and caregivers know when it is appropriate to seek treatment for a child experiencing seizures. For additional resources about epilepsy and tools to help manage your child’s condition, please visit www.epilepsyandmychild.org. 1 2 3 4 5 What Type of Doctors Treat Children with Children withWhat of Doctors Type Treat Epilepsy? Children with New Onset Seizures Epilepsy Medication Children Taking Children with Uncontrolled Seizures (Refractory Epilepsy) Making the Office MostChild’s of Your Visit Epilepsy? There are several types of doctors who treat epilepsy. For many children, epilepsy can be treated and success- fully managed by a primary care physician, a family physi- cian, or a pediatrician. This is often the case for those whose seizures are well controlled on one medication or who live in rural areas and must travel for hours to see an epilepsy specialist. Most children with epilepsy under the age of 16 are treated by a pediatric neurologist. A pediatric neurologist specializes in childhood diseases of the brain, spinal cord, and nervous system. A pediatric neurologist learns about treating epilepsy in children and is involved in their care during residency. A pediatric epileptologist is a neurologist who com- pletes a one or two year subspecialty fellowship in clinical neurophysiology and/or epilepsy in addition to the training in epilepsy that a pediatric neurologist receives.
    [Show full text]
  • High-Definition Transcranial Direct Current Stimulation in Early Onset
    BRAIN INJURY https://doi.org/10.1080/02699052.2017.1390254 High-Definition transcranial direct current stimulation in early onset epileptic encephalopathy: a case study Oded Meirona, Rena Galeb, Julia Namestnicb, Odeya Bennet-Backc, Jonathan Davida, Nigel Gebodhd, Devin Adaird, Zeinab Esmaeilpourd,e, and Marom Biksond aClinical Research Center for Brain Sciences, Herzog Medical Center, Jerusalem, Israel; bChildren Respiratory Unit, Herzog Medical Center, Jerusalem, Israel; cPediatric Neurology Department, Shaare Zedek Medical Center, Jerusalem, Israel; dDepartment of Biomedical Engineering, The City College of the City University of New York, New York, USA; eBiomedical Engineering Department, Amirkabir University of Technology, Tehran, Iran ABSTRACT ARTICLE HISTORY Primary objective: Early onset epileptic encephalopathy is characterized by high daily seizure-frequency, Received 5 March 2017 multifocal epileptic discharges, severe psychomotor retardation, and death at infancy. Currently, there Revised 3 October 2017 are no effective treatments to alleviate seizure frequency and high-voltage epileptic discharges in these Accepted 5 October 2017 catastrophic epilepsy cases. The current study examined the safety and feasibility of High-Definition KEYWORDS transcranial direct current stimulation (HD-tDCS) in reducing epileptiform activity in a 30-month-old Seizure; video- EEG; child suffering from early onset epileptic encephalopathy. Design and Methods: HD-tDCS was adminis- interictal sharp waves; tered over 10 intervention days spanning two weeks including pre- and post-intervention video-EEG electroclinical syndrome; monitoring. Results: There were no serious adverse events or side effects related to the HD-tDCS hypsarrhythmia intervention. Frequency of clinical seizures was not significantly reduced. However, interictal sharp wave amplitudes were significantly lower during the post-intervention period versus baseline.
    [Show full text]
  • Epilepsy Terms
    Absence seizure A generalized seizure, usually lasting less than 20 seconds, characterized by a blank stare & sometimes blinking, eye rolling or chewing movements. Can occur many times a day. Often mistaken for daydreaming. Usually begins in childhood. Outgrown by approximately 75% of children. Formerly called petit mal. Antiepileptic drugs Medication used to control seizures. Also called anticonvulsants. Atonic seizure A generalized seizure characterized by sudden loss of muscle tone, causes the head or body to drop suddenly with falling & potential injury. Recovery in a few seconds to a minute. Protective helmets are helpful to protect from injury.Also called a drop attack. Aura A warning period at the beginning of a seizure. May sense a feeling of fear or doom, or strange sensations such as an odd smell or taste, nausea, or palpitations. Actually a simple partial seizure occurring seconds or minutes before a complex partial or secondarily generalized tonic-clonic seizure, or it may occur alone. Automatism Purposeless, automatic & involuntary movements during a seizure, such as chewing, lip-smacking, picking at clothing or wandering around confused; may occur during complex partial & absence seizures. Benign rolandic epilepsy Epilepsy syndrome of childhood characterized by partial seizure affecting the fact, causing drooling & inability to speak, may be followed by a convulsion. Typically occur at night and are usually outgrown by age 16. Also called benign partial epilepsy of childhood. Catamenial epilepsy In women, the tendency for seizures to occur around the time of menstruation. Clonic seizure A generalized seizure characterized by rhythmic jerking movements involving both sides of the body. Complex partial seizure A seizure that affects only part of the brain, but causes impaired consciousness or awareness.
    [Show full text]
  • Epilepsy Monitoring Unit (EMU) Patient Information
    UNC Epilepsy Monitoring Unit (EMU) Patient Information Comprehensive Epilepsy Center Department of Neurology University of North Carolina Hospital INTRODUCTION You are scheduled for an evaluation at our Epilepsy Monitoring Unit (EMU). The goal of this testing is to record your typical events for diagnosis and/or to adjust your antiepileptic medication safely. To record your events, we use a video camera, microphones and continuous EEG recording. We do these so your doctor can learn more about your seizures and provide the best possible care for you. We would like to provide you with information that may make your stay easier for you. Please bring this booklet with you when you come into the hospital. WHY DO I NEED THIS TYPE OF RECORDING? A routine EEG lasts about half an hour. It gives us a “Snapshot” of the brain’s activity during that particular recording period. It may not give us enough information to help you with your seizure problem. Our recording has three parts: 1. VIDEO: A camera will record all your physical activity while your brain waves are being recorded on the EEG. By videotaping your seizures we can see exactly what happens before, during, and after one of your events. This allows us a more accurate picture of your seizures. 2. EEG RECORDING: You will also have a continuous EEG recording. This will allow us to detect any seizure activity that occurs, even if you are not aware it is happening. The EEG helps us decide in what portion of your brain your seizures begin, and gives us information about your brain wave activity between seizures.
    [Show full text]