A GUIDE for TEACHERS Epilepsyepilepsy
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The Art of Epilepsy Management
FOCAL EPILEPSY AND SEIZURE SEMIOLOGY Piradee Suwanpakdee, MD. Division of Neurology Department of Pediatrics Phramongkutklao Hospital OUTLINE • Focal onset seizure classification • The definition of semiology • How can we get the elements of semiology? Focal seizures • Originate within networks limited to one hemisphere • May be discretely localized or more widely distributed.… www.ilae.org What is the seizure semiology? • Seizure semiology is an expression of activation and disinhibition of cerebral areas • It thus provides some information what cerebral areas are “involved” during a seizure Symptomatogenic areas Left hemisphere lateral aspect Mesial aspect Symptomatogenic areas Left Insula How can we get the elements of seizure semiology? • The information on semiology comes from patient’s and witness’ history • Video EEG provides objective data on seizure semiology • Seizure classification aims to intellectually organise and summarise information about seizure semiology Notes • Atonic seizures and epileptic spasms would not have level of awareness specified • Pedalling grouped in hyperkinetic rather than automatisms (arbitrary) • Cognitive seizures • impaired language • other cognitive domains • positive features eg déjà vu, hallucinations, perceptual distortions • Emotional seizures: anxiety, fear, joy, etc Focal onset aware seizure • This term replaces simple partial seizure • A seizure that starts in one area of the brain and the person remains alert and able to interact is called a focal onset aware seizure. • These seizures are brief, lasting seconds to less than 2 minutes. Focal clonic seizure • Indicate involvement of contralateral primary motor cortex • Reliability is good Epilepsia partialis continua focal motor status involving a small portion of the sensorimotor cortex Focal Onset Impaired Awareness Seizures • A seizure that starts in one area of the brain and the person is not aware of their surroundings • Focal impaired awareness seizures typically last 1 to 2 minutes. -
Clinicians Using the Classification Will Identify a Seizure As Focal Or Generalized Onset If There Is About an 80% Confidence Level About the Type of Onset
GENERALIZED ONSET SEIZURES Generalized onset seizures are not characterized by level of awareness, because awareness is almost always impaired. Generalized tonic-clonic: Immediate loss of Generalized epileptic spasms: Brief seizures with awareness, with stiffening of all limbs (tonic phase), flexion at the trunk and flexion or extension of the followed by sustained rhythmic jerking of limbs and limbs. Video-EEG recording may be required to face (clonic phase). Duration is typically 1 to 3 minutes. determine focal versus generalized onset. The seizure may produce a cry at the start, falling, tongue biting, and incontinence. Generalized typical absence: Sudden onset when activity stops with a brief pause and staring, Generalized clonic: Rhythmical sustained jerking of sometimes with eye fluttering and head nodding or limbs and/or head with no tonic stiffening phase. other automatic behaviors. If it lasts for more than These seizures most often occur in young children. several seconds, awareness and memory are impaired. Recovery is immediate. The EEG during these seizures Generalized tonic: Stiffening of all limbs, without always shows generalized spike-waves. clonic jerking. Generalized atypical absence: Like typical absence Generalized myoclonic: Irregular, unsustained jerking seizures, but may have slower onset and recovery and of limbs, face, eyes, or eyelids. The jerking of more pronounced changes in tone. Atypical absence generalized myoclonus may not always be left-right seizures can be difficult to distinguish from focal synchronous, but it occurs on both sides. impaired awareness seizures, but absence seizures usually recover more quickly and the EEG patterns are Generalized myoclonic-tonic-clonic: This seizure is like different. -
Seizure Disorders
Seizure Disorders Author Anthony Murro, M.D. Medical College of Georgia Epilepsy Program Department of Neurology Medical College of Georgia Augusta, GA 30912 Contents · Seizure Definitions · Types of Seizures · Partial Seizures · Generalized Seizures · Automatisms · Post-ictal state · Evolution of seizure type · Provoked Seizures · Causes of provoked seizures · Causes of unprovoked seizures · Electroencephalogram · Neuroimaging · Epilepsy syndromes o Temporal lobe epilepsy: o Frontal lobe epilepsy: o Occipital lobe epilepsy: o West Syndrome o Lennox Gastaut Syndrome o Benign partial epilepsy syndromes o Childhood absence epilepsy o Juvenile myoclonic epilepsy (JME) o Simple Febrile Seizure o Complex Febrile Seizure o Neonatal seizures · Anticonvulsant therapy o When to start and stop anticonvulsant therapy o Principles of anticonvulsant therapy o Anticonvulsant side effects o Phenytoin o Carbamazepine o Phenobarbital o Valproate o Lamotrigine o ACTH/Corticosteroid o Oxcarbazepine o Zonisamide · Status Epilepticus · Drug Therapy for status epilepticus · Epilepsy Surgery · Counseling and patient education · Self assessment examination · Examination answers · References · Disclaimer · Permitted Use Statement Seizure Definitions · An epileptic seizure is a disorder of abnormal synchronous electrical brain activity. · A clinical seizure is a epileptic seizure with symptoms. · A subclinical seizure is a epileptic seizure without symptoms. · A non-epileptic seizure (pseudoseizure) is a disorder with symptoms similar to a epileptic seizure. However, a non-epileptic seizure is not caused by abnormal synchronous electrical brain activity. · A cryptogenic seizure is a seizure that occurs from an unknown cause. Older publications use idiopathic to describe a seizure of unknown etiology but the current ILAE guidelines discourage the use of idiopathic for describing a seizure of unknown etiology. · A symptomatic seizure is a seizure that occurs from a known or suspected brain insult known to increase the risk of developing epilepsy. -
The Approach to Patients with ''Non-Epileptic Seizures''
498 Postgrad Med J: first published as 10.1136/pgmj.2004.029785 on 5 August 2005. Downloaded from REVIEW The approach to patients with ‘‘non-epileptic seizures’’ J D C Mellers ............................................................................................................................... Postgrad Med J 2005;81:498–504. doi: 10.1136/pgmj.2004.029785 Up to one fifth of patients who present to specialist clinics with loose shorthand to refer to the psychological attacks alone.12 The terms psychogenic NES and seizures do not have epilepsy. The majority of such patients functional seizures overcome some of these suffer from psychologically mediated episodes; dissociative objections but formal psychiatric classification seizures, often referred to as ‘‘non-epileptic seizures’’. This systems provide clearly defined labels. Unfor- tunately, though, there are still inconsistencies: paper describes the diagnostic evaluation of seizure thus, within DSM IV13 such attacks are classified disorders, including clinical assessment and the role of special under somatoform disorder and in ICD 1014 the investigations. The organic and psychiatric imitators of diagnostic label ‘‘dissociative convulsions’’, is classified within the group of conversion dis- epilepsy are outlined and findings on psychiatric assessment orders. It is the latter terminology that will be are reviewed. This group of patients often proves difficult to adopted here. engage in appropriate treatment and an approach to As we have seen, dissociative convulsions or seizures (DS) are common, the diagnosis is often explaining the diagnosis is described. As yet there are no missed, and when it is patients not only fail to controlled trials of treatment in this disorder but preliminary receive appropriate treatment but are subject to evidence suggests cognitive behavioural therapy is both a unnecessary, costly,15 and potentially harmful medical interventions. -
Report of the ILAE Classification Core Group
Epilepsia, 47(9):1558–1568, 2006 Blackwell Publishing, Inc. C 2006 International League Against Epilepsy Special Article Report of the ILAE Classification Core Group Jerome Engel, Jr., Chair Reed Neurological Research Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, U.S.A. Summary: A Core Group of the Task Force on Classification is to present a list of seizure types and syndromes to the ILAE and Terminology has evaluated the lists of epileptic seizure types Executive Committee for approval as testable working hypothe- and epilepsy syndromes approved by the General Assembly in ses, subject to verification, falsification, and revision. This re- Buenos Aires in 2001, and considered possible alternative sys- port represents completion of this work. If sufficient evidence tems of classification. No new classification has as yet been subsequently becomes available to disprove any hypothesis, the proposed. Because the 1981 classification of epileptic seizure seizure type or syndrome will be reevaluated and revised or dis- types, and the 1989 classification of epilepsy syndromes and carded, with Executive Committee approval. The recognition of epilepsies are generally accepted and workable, they will not specific seizure types and syndromes, as well as any change be discarded unless, and until, clearly better classifications have in classification of seizure types and syndromes, therefore, will been devised, although periodic modifications to the current clas- continue to be an ongoing dynamic process. A major purpose of sifications may be suggested. At this time, however, the Core this approach is to identify research necessary to clarify remain- Group has focused on establishing scientifically rigorous cri- ing issues of uncertainty, and to pave the way for new classifica- teria for identification of specific epileptic seizure types and tions. -
Mesial Frontal Epilepsy
Epikpsia, 39(Suppl. 4):S49-S61. 1998 Lippincon-Raven Publishers, Philadelphia 0 International League Against Epilepsy Mesial Frontal Epilepsy Norman K. So Oregon Comprehensive Epilepsy Program, Legacy Portland Hospitals, Portland, Oregon, U.S.A. Summary: The mesiofrontal cortex comprises a number of occur. The task of localization of the epileptogenic zone can be distinct anatomic and functional areas. Structural lesions and challenging, whether EEG or imaging methods are used. Suc- cortical dysgenesis are recognized causes of mesial frontal epi- cessful localization can lead to a rewarding outcome after epi- lepsy, but a specific gene defect may also be important, as seen lepsy surgery, particularly in those with an imaged lesion. in some forms of familial frontal lobe epilepsy. The predomi- Key Words: Mesial frontal epilepsy-cingulate gyrus- nant seizure manifestations, which are not necessarily strictly Supplementary motor area-Absence seizure-Hypermotor correlated with a specific ictal onset zone, are absence, hyper- seizure-Postural tonic seizure-Epilepsy surgery. motor, and postural tonic seizures. Other seizure types also FUNCTIONAL ANATOMY convolution. Traditional cytoarchitectonics have further subdivided this anterior frontal region. The frontal pole The frontal lobe is the largest lobe in the brain, ac- refers to the anterior most portion of the frontal lobe, but counting for one-third to one-half of total brain volume there is little consensus on how far back this extends. and weight. On the medial surface, the most important One or more curved.sulci are seen anterior and inferior to landmark is the cingulate sulcus (Fig. 1). This runs as an the cingulate sulcus, called the superior and inferior ros- inverted “C” following the contour of the corpus callo- tral sulci. -
The Double Generalization Phenomenon in Juvenile Absence Epilepsy
Epilepsy & Behavior 21 (2011) 318–320 Contents lists available at ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh Case Report The double generalization phenomenon in juvenile absence epilepsy Daniel San-Juan a,b,⁎, Adriana Patricia M. Mayorga a, David J. Anschel c, Alvaro Moreno Avellán a, Maricarmen F. González-Aragón a, Andrew J. Cole d a Clinical Neurophysiology Department, National Institute of Neurology, Mexico City, Mexico b Centro Neurológico, Hospital ABC Santa Fe, Mexico City, Mexico c Clinical Neurophysiology Department, Saint Charles Hospital, Port Jefferson, NY, USA d Epilepsy Service, Massachusetts General Hospital, Boston, MA, USA article info abstract Article history: The characterization of a seizure as generalized or focal onset depends on a basic knowledge of the underlying Received 12 March 2011 pathophysiology. Recently, an uncommon phenomenon in generalized epilepsy—evolution of seizures Revised 7 April 2011 from generalized to focal followed by secondary generalization—was reported for the first time. We describe a Accepted 8 April 2011 15-year-old boy, initially classified as having partial epilepsy, who had a typical absence seizure that became Available online 14 May 2011 focal with second secondary generalization (double generalization). On the basis of these findings his epilepsy fi Keywords: was classi ed as juvenile absence epilepsy and his treatment was changed, resulting in seizure freedom. This fi Juvenile absence epilepsy is the rst report of this unusual electroclinical evolution in a patient with juvenile absence epilepsy. The Generalized epilepsy recognition of this particular pattern allows correct classification and impacts both treatment and prognosis. Focal findings © 2011 Elsevier Inc. -
Managing Children with Epilepsy School Nurse Guide
MANAGING CHILDREN WITH EPILEPSY SCHOOL NURSE GUIDE ACKNOWLEDGEMENTS TO THOSE WHO HAVE CONTRIBUTED TO THE NOTEBOOK Children’s Hospital of Orange County Melodie Balsbaugh, RN Sue Nagel, RN Giana Nguyen, CHOC Institutes Fullerton School District Jane Bockhacker, RN Orange Unified School District Andrea Bautista, RN Martha Boughen, RN Karen Hanson, RN TABLE OF CONTENTS I. EPILEPSY What is epilepsy? Facts about epilepsy Basic neuroanatomy overview Classification of epileptic seizures Diagnostic Tests II. TREATMENT Medications Vagus Nerve Stimulation Ketogenic Diet Surgery III. SAFETY First Aid IV. SPECIAL CONCERNS MedicAlert Helmets Driving Employment and the law V. EPILEPSY AT SCHOOL School epilepsy assessment tool Seizure record Teaching children about epilepsy lesson plan Creating your own individualized health care plan VI. RESOURCES/SUPPORT GROUPS VII. ACCESS TO HEALTHCARE CHOC Epilepsy Center After-Hours Care After Hours Health Care Advice Healthy Families California Kids MediCal CHOC Clinics Healthy Tomorrows VIII. REFERENCES EPILEPSY WHAT IS EPILEPSY? Epilepsy is a neurological disorder. The brain contains millions of nerve cells called neurons that send electrical charges to each other. A seizure occurs when there is a sudden and brief excess surge of electrical activity in the brain between nerve cells. This results in an alteration in sensation, behavior, and consciousness. Seizures may be caused by developmental problems before birth, trauma at birth, head injury, tumor, structural problems, vascular problems (i.e. stroke, abnormal blood vessels), metabolic conditions (i.e. low blood sugar, low calcium), infections (i.e. meningitis, encephalitis) and idiopathic causes. Children who have idiopathic seizures are most likely to respond to medications and outgrow seizures. -
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 -
Signs of Teen Drug Abuse 14 EDITS
Signs of Teen Drug Abuse SoberCollege.com Teen Drug Abuse Are you concerned that your child is using drugs or alcohol? Whether you are concerned about changes in appearance or behavior Sober College can help you find out more about a range of symptoms associated with drug use. Table of Contents: Symptoms Drug Types ......................................................................................................................................................... 2 Red eyes ...................................................................................................................................................... 3 Weight loss ...................................................................................................................................................... 4 Cuts, sores or bruises...................................................................................................................................... 5 Deterioration of physical appearance .......................................................................................................... 6 Shakes and tremors ........................................................................................................................................ 7 Anger issues ..................................................................................................................................................... 8 Financial difficulties ...................................................................................................................................... -
An Overview of Psychogenic Non-Epileptic Seizures: Etiology, Diagnosis and Management
REVIEW ARTICLE COPYRIGHT © 2018 THE CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES INC. An Overview of Psychogenic Non-Epileptic Seizures: Etiology, Diagnosis and Management Ángela Milán-Tomás, Michelle Persyko, Martin del Campo, Colin M. Shapiro, Karl Farcnik ABSTRACT: The purpose of this review is to provide an update of the research regarding the etiology, diagnosis and management of psychogenic non-epileptic seizures (PNES). A literature search using Pubmed, Ovid MEDLINE and EMBASE database was performed from 2000 up to August 2017. We have evaluated the different factors leading to PNES as well as the diagnostic approach and management of this disorder which continue to be very difficult. The coexistence of epilepsy and PNES poses special challenges and requires the coordinated efforts of the family physicians, psychiatrists, psychologists and neurologists. Although this condition has an overall poor prognosis, a multidisciplinary approach in the diagnosis and management of this disorder would likely improve the outcomes. We have proposed a diagnostic and treatment algorithm for PNES and suggested a national registry of patients suffering from this condition. The registry would contain data regarding treatment and outcomes to aid in the understanding of this entity. RÉSUMÉ: Vue d’ensemble des crises psychogènes non-épileptiques: étiologie, diagnostic et prise en charge. L’objectif de cet article est de présenter une mise à jour des activités de recherche qui concernent l’étiologie, le diagnostic et la prise en charge des crises psychogènes non-épileptiques (CPNE). Pour ce faire, nous avons mené de 2000 à août 2017 une recherche bibliographique au moyen des bases de données suivantes : PubMed, Ovid MEDLINE et Embase. -
Part Ii – Neurological Disorders
Part ii – Neurological Disorders CHAPTER 4 EPILEPSY Dr William P. Howlett 2012 Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania BRIC 2012 University of Bergen PO Box 7800 NO-5020 Bergen Norway NEUROLOGY IN AFRICA William Howlett Illustrations: Ellinor Moldeklev Hoff, Department of Photos and Drawings, UiB Cover: Tor Vegard Tobiassen Layout: Christian Bakke, Division of Communication, University of Bergen E JØM RKE IL T M 2 Printed by Bodoni, Bergen, Norway 4 9 1 9 6 Trykksak Copyright © 2012 William Howlett NEUROLOGY IN AFRICA is freely available to download at Bergen Open Research Archive (https://bora.uib.no) www.uib.no/cih/en/resources/neurology-in-africa ISBN 978-82-7453-085-0 Notice/Disclaimer This publication is intended to give accurate information with regard to the subject matter covered. However medical knowledge is constantly changing and information may alter. It is the responsibility of the practitioner to determine the best treatment for the patient and readers are therefore obliged to check and verify information contained within the book. This recommendation is most important with regard to drugs used, their dose, route and duration of administration, indications and contraindications and side effects. The author and the publisher waive any and all liability for damages, injury or death to persons or property incurred, directly or indirectly by this publication. CONTENTS EPILEPSY 79 EPILEPSY SYNDROMES � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 79 CLASSIFICATION�