Epilepsy Terms
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Status Epilepticus Clinical Pathway
JOHNS HOPKINS ALL CHILDREN’S HOSPITAL Status Epilepticus Clinical Pathway 1 Johns Hopkins All Children's Hospital Status Epilepticus Clinical Pathway Table of Contents 1. Rationale 2. Background 3. Diagnosis 4. Labs 5. Radiologic Studies 6. General Management 7. Status Epilepticus Pathway 8. Pharmacologic Management 9. Therapeutic Drug Monitoring 10. Inpatient Status Admission Criteria a. Admission Pathway 11. Outcome Measures 12. References Last updated: July 7, 2019 Owners: Danielle Hirsch, MD, Emergency Medicine; Jennifer Avallone, DO, Neurology This pathway is intended as a guide for physicians, physician assistants, nurse practitioners and other healthcare providers. It should be adapted to the care of specific patient based on the patient’s individualized circumstances and the practitioner’s professional judgment. 2 Johns Hopkins All Children's Hospital Status Epilepticus Clinical Pathway Rationale This clinical pathway was developed by a consensus group of JHACH neurologists/epileptologists, emergency physicians, advanced practice providers, hospitalists, intensivists, nurses, and pharmacists to standardize the management of children treated for status epilepticus. The following clinical issues are addressed: ● When to evaluate for status epilepticus ● When to consider admission for further evaluation and treatment of status epilepticus ● When to consult Neurology, Hospitalists, or Critical Care Team for further management of status epilepticus ● When to obtain further neuroimaging for status epilepticus ● What ongoing therapy patients should receive for status epilepticus Background: Status epilepticus (SE) is the most common neurological emergency in children1 and has the potential to cause substantial morbidity and mortality. Incidence among children ranges from 17 to 23 per 100,000 annually.2 Prevalence is highest in pediatric patients from zero to four years of age.3 Ng3 acknowledges the most current definition of SE as a continuous seizure lasting more than five minutes or two or more distinct seizures without regaining awareness in between. -
Cognitive Impairment: Causes, Diagnosis and Treatment
NEUROLOGY - LABORATORY AND CLINICAL RESEARCH DEVELOPMENTS COGNITIVE IMPAIRMENT: CAUSES, DIAGNOSIS AND TREATMENT No part of this digital document may be reproduced, stored in a retrieval system or transmitted in any form or by any means. The publisher has taken reasonable care in the preparation of this digital document, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained herein. This digital document is sold with the clear understanding that the publisher is not engaged in rendering legal, medical or any other professional services. NEUROLOGY – LABORATORY AND CLINICAL RESEARCH DEVELOPMENTS SERIES Intracranial Hypertension Stefan Mircea Iencean and Alexandru Vladimir Ciurea 2009 ISBN: 978-1-60741-862-7 (Hardcover Book) Intracranial Hypertension Stefan Mircea Iencean and Alexandru Vladimir Ciurea 2009 ISBN: 978-1-60876-549-2 (Online Book) Cerebral Blood Flow Regulation Nodar P. Mitagvaria and Haim (James) I. Bicher 2009 ISBN: 978-1-60692-163-0 Cerebral Ischemia in Young Adults: Pathogenic and Clinical Perspectives Alessandro Pezzini and Alessandro Padovani (Editors) 2009 ISBN: 978-1-60741-627-2 Dizziness: Vertigo, Disequilibrium and Lightheadedness Agnes Lindqvist and Gjord Nyman (Editors) 2009: ISBN 978-1-60741-847-4 Somatosensory Cortex: Roles, Interventions and Traumas Niels Johnsen and Rolf Agerskov (Editors) 2009. ISBN: 978-1-60741-876-4 Cognitive Impairment: Causes, Diagnosis and Treatment Melanie L. Landow (Editor) 2009. ISBN: 978-1-60876-205-7 NEUROLOGY - LABORATORY AND CLINICAL RESEARCH DEVELOPMENTS COGNITIVE IMPAIRMENT: CAUSES, DIAGNOSIS AND TREATMENT MELANIE L. -
The Effect of Temporal Lobectomy Upon Two Cases of an Unusual Form of Mental Deficiency by D
J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.17.4.267 on 1 November 1954. Downloaded from J. Neurol. Neurosurg. Psychiat., 1954, 17, 267. THE EFFECT OF TEMPORAL LOBECTOMY UPON TWO CASES OF AN UNUSUAL FORM OF MENTAL DEFICIENCY BY D. W. LIDDELL and D. W. C. NORTHFIELD From Runwtvell Hospital, Wickford, Essex In 1898, when giving the final particulars and the Case Histories necropsy findings of a case of epilepsy which fully Case l.-M. G., aged 18 years, was referred to exemplified dreamy states and automatisms, Hugh- Runwell Hospital from the Royal Eastern Counties lings Jackson (1931a) wrote that there were post- Hospital because of bouts of violent uncontrollable epileptic actions " of a kind which in a man fully behaviour and repeated attempts to abscond. He was himself would be criminal ". But another 25 years the seventh child of healthy working-class parents. were to elapse before Penfield began his studies on There is no family history of epilepsy. His birth was brain-scars (Penfield and Erickson, 1941) which were normal and he was breast fed for nine months. He guest. Protected by copyright. eventually to secure for surgery a began to walk and talk at about 14 months. As a child place in the be was placid but active, easily managed, and there were treatment of epilepsy. At first the operations were no difficulties in toilet training. restricted to those patients resistant to medical At the age of 7 years he fell out of a tree and was treatment in whom there was conclusive evidence of momentarily unconscious. -
Status Epilepticus: Pathophysiology, Epidemiology, and Outcomes
Arch Dis Child 1998;79:73–77 73 CURRENT TOPIC Arch Dis Child: first published as 10.1136/adc.79.1.73 on 1 July 1998. Downloaded from Status epilepticus: pathophysiology, epidemiology, and outcomes Rod C Scott, Robert A H Surtees, Brian G R Neville Convulsive status epilepticus (CSE) is the most consciousness being regained between the sei- common neurological medical emergency and zures. This gives the impression that status epi- continues to be associated with significant lepticus is always convulsive and is a single morbidity and mortality. Our approach to the entity. There are, however, as many types of epilepsies in childhood has been clarified by the status epilepticus as there are types of seizures, broad separation into benign and malignant and this definition is now probably outdated. syndromes. The factors that suggest a poorer To show that status epilepticus is a complex outcome in terms of seizures, cognition, and disorder, Shorvon has proposed the following behaviour include the presence of multiple sei- definition. Status epilepticus is a disorder in zure types, an additional, particularly cognitive which epileptic activity persists for 30 minutes disability, the presence of identifiable cerebral or more, causing a wide spectrum of clinical pathology, a high rate of seizures, an early age symptoms, and with a highly variable patho- of onset, poor response to antiepileptic drugs, physiological, anatomical, and aetiological and the occurrence of CSE.1 basis.2 CSE needs diVerent definitions for Convulsive status epilepticus is not a syn- diVerent purposes. Many seizures that last for drome in the same sense as febrile convulsions, five minutes will continue for at least 20 benign rolandic epilepsy, and infantile poly- minutes, and so treatment is required for most morphic epilepsy. -
Status Epilepticus: Initial Management
DATE: July 2018 TEXAS CHILDREN’S HOSPITAL EVIDENCE-BASED OUTCOMES CENTER Initial Management of Status Epilepticus Evidence-Based Guideline Definition: Status Epilepticus (SE) is a disease process Diagnostic Evaluation resulting in prolonged seizures of longer than 5 minutes. (1) The NOTE: Central nervous system (CNS) infection should be cause of SE can stem from the malfunction of the response to excluded. terminate a seizure or from the commencement of the mechanisms that result in prolonged seizures. (2) If SE History: Assess for continues for longer than 30 minutes, there can be permanent Seizure onset neurological damage, including neuronal death, neuronal Known seizure disorder injury, and alteration of neuronal networks. (2,3) Ingestion Fever (e.g., signs of serious infection) Epidemiology: Convulsive status epilepticus (CSE) is the Medications (4) most common neurological emergency seen in childhood. It o Received prior to presentation (e.g., type, dose, is also among the top five reasons for admission to the PICU at dosage, route) Texas Children’s Hospital and is the third most common o Current anticonvulsant medications reason for transport calls. SE is a medical emergency and is o Use of psychopharmacologic medications associated with an overall mortality rate of 8% in children and Toxic/Subtherapeutic anticonvulsant levels (4,5) o 30% in adults. Among children, the overall incidence of SE Nonadherence and/or recent change (4-6) o is approximately 1 to 6 per 10,000/year. The incidence Vagus Nerve Stimulation (VNS) appears to be higher in children under 1 year of age with over Metabolic abnormalities 50% of cases occurring in children under 3 years. -
Pediatric Epilepsy Clips by Pediatric Elizabeth Medaugh, MSN, CPNP-PC , Pediatric Nurse Practitioner, Neurology
Nursing May 2016 Pediatric Clips Pediatric Nursing Pediatric Epilepsy Clips by Pediatric Elizabeth Medaugh, MSN, CPNP-PC , Pediatric Nurse Practitioner, Neurology Advanced Practice Sophia had been exceeding down to sleep, mother heard a Nurses at Dayton Case Study the expectations of school. thump and went to check on her. Her teachers report her being Sophia’s eyes were wide open Children’s provides Sophia is a 7 year old Caucasian focused the first two quarters, and deviated left, left arm was quick reviews of female who presented to her but have found her attention to stiffened with rhythmic shaking, be somewhat off over the last Sophia’s mouth was described common pediatric primary care physician with concerns of incontinence few weeks. Teachers have asked as “sort of twisted” and Sophia conditions. in sleep. Sophia is an parents if Sophia has been was drooling. The event lasted otherwise healthy child, with getting good rest as she has 90 seconds. Following, Sophia uncomplicated birth history, been falling asleep in class. was disoriented and very sleepy. Father reports his sister Dayton Children’s appropriate developmental Sophia’s mother and father had similar events as a child. progression with regards note that she has had is the region’s Sophia’s neurological exam to early milestones, and several episodes of urinary was normal, therefore her pediatric referral previously diurnal/nocturnally incontinence each week over pediatrician made a referral toilet trained. No report of the last 3-4 weeks. Parents center for a to pediatric neurology. Given recent illness, infection or ill have limited fluids prior to bed Sophia’s presentation, what 20-county area. -
The Value of Seizure Semiology in Lateralizing and Localizing Partially Originating Seizures
Review Article The value of seizure semiology in lateralizing and localizing partially originating seizures Mohammed M. Jan, MBChB, FRCP(C). observations help in lateralizing (left versus right) and ABSTRACT localizing (involved brain region) the seizure onset. Therefore, this information is vital not only for seizure Diagnosing epilepsy depends heavily on a detailed, and accurate description of the abnormal transient classification, but more so for identification of surgical neurological manifestations. Observing the candidates. The EEG and neuroimaging, particularly seizures yields important semiologic features that MRI, are needed to identify focal physiological and characterize epilepsy. Video-EEG monitoring allows pathological brain abnormalities.3-5 The development of the identification of important lateralizing (left video-EEG monitoring has allowed careful correlation of versus right), and localizing (involved brain region) semiologic features with simultaneous EEG recordings.6 semiologic features. This information is vital for As a result, clinical semiology gained greater reliability identifying the seizure origin for possible surgical in diagnosing specific seizure types and localizing their interventions. The aim of this review is to present a onset.7 The aim of this review is to present a summary summary of important semiologic characteristics of various seizures that are important for accurate seizure of important semiologic characteristics of various lateralization and localization. This would most seizures that are needed for accurate lateralization likely help during reviewing video-EEG recorded and localization. This would most likely help during seizures of intractable patients for possible epilepsy reviewing video-EEG recorded seizures of intractable surgery. Semiologic features of partial and secondarily patients for possible epilepsy surgery. generalized seizures can be grouped into one of 4 History taking. -
Benign Rolandic Epilepsy
Benign Rolandic Epilepsy What is Benign Rolandic Epilepsy (BRE)? Benign Rolandic Epilepsy is a common, mild form of childhood epilepsy characterized by brief simple partial seizures involving the face and mouth, usually occuring at night or during the early morning hours. Seizures are the result of brief disruptions in the brain’s normal neuronal activity. Who gets this form of epilepsy? Children between the ages of three and 13 years, who have no neurological or intellectual deficit.The peak age of onset is from 9-10 years of age. BRE is more common in boys than girls. What kind of seizures occur? Typically, the child experiences a sensation then a twitching at the corner of their mouth. The jerking spreads to in- volve the tongue, cheeks and face on one side, resulting in speech arrest, problems with pronunciation and drooling. Or one side of the child’s face may feel paralyzed. Consciousness is retained. On occasion, the seizure may spread and cause the arms and legs on that side to stiffen and or jerk, or it may become a generalized tonic-clonic seizure that involves the whole body and a loss of consciousness. When do the seizures occur? Seizures tend to happen when the child is waking up or during certain stages of sleep. Seizures may be infrequent, or can happen many times a day. How is Benign Rolandic Epilepsy diagnosed? A child having such seizures is given an EEG test to confirm the diagnosis, a test that graphs the pattern of electrical activity in the brain. BRE has a typical EEG spike pattern—repetitive spike activity firing predominantly from the mid-temporal or parietal areas of the brain near the rolandic (motor) strip. -
A Small Number of People Have What Is Known As Reflex Epilepsy, In
A small number of people have what is known What are the features of reflex epilepsy? as reflex epilepsy, in which seizures are set off There are many different types of reflex by specific stimuli. These can include flashing epilepsy, depending on the area of the brain that lights, a flickering computer “monitor”, sudden is affected. Seizure stimuli may be very specific, noises, a particular piece of music, or the phone or they may be broad categories. They can ringing. Some people even have seizures when include: they think about a particular subject or see their own hand! flashing or flickering lights, including computer monitors or video games. This is What are other terms for reflex epilepsy? called photosensitive epilepsy. It is the most Other terms for reflex epilepsy that you may common childhood form of reflex epilepsy, come across include: and the child may eventually outgrow it. the sight of a particular pattern; this is called epilepsy with reflex seizures visual pattern reflex epilepsy sensory precipitation epilepsy thinking about certain things stimulus sensitive epilepsy performing a certain task, such as typing; this is called praxis-induced epilepsy There are also many terms for specific types of reading reflex epilepsy. language-related stimuli such as writing, listening to speech, singing, or reciting What causes reflex epilepsy? certain passages of music; this is called The seizure stimulus is not the underlying cause musicogenic epilepsy of the epilepsy. Rather, it sends a particular certain sounds; this is called audiogenic message to a sensitive, seizure-prone area of the epilepsy brain, excites the neurons there, and causes a surprises or startles seizure. -
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. -
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. -
Photosensitive Epilepsy
photosensitive epilepsy factsheet If you have epilepsy you may be able to identify triggers – situations that set off your seizures. Common triggers include stress or tiredness. If seizures are triggered by flashing lights 1 or certain patterns, this is called photosensitive epilepsy. how common is photosensitive epilepsy? how is photosensitive epilepsy treated? Around 1 in 100 people has epilepsy, and of these Photosensitive epilepsy usually responds well to people, around 3% have photosensitive epilepsy. anti-epileptic drugs (AEDs) that treat generalised Photosensitive epilepsy is more common in children seizures (seizures that affect both sides of the brain and young people (up to 5%) and is less commonly at once). diagnosed after the age of 20. See our booklet and chart medication for epilepsy for more information. how can I tell if I am photosensitive? Many people know this if they have a seizure Triggers are individual, but the following sources when they are exposed to flashing lights or patterns in themselves are not generally likely to trigger as a photosensitive trigger will usually cause photosensitive seizures. See over the page for a seizure straightaway. possible triggers and what increases the risk. An electroencephalogram (EEG) may include testing • UK TV programme content. Ofcom regulates for photosensitive epilepsy. This involves looking at a material shown on TV in the UK. The regulations light which will flash at different speeds. If this causes restrict the flash rate to three hertz or less, and any changes in brain activity the technician can stop they also restrict the area of screen allowed for the flashing light before a seizure develops.