ILAE Definition of the Idiopathic Generalized Epilepsy Syndromes: Position Statement by the ILAE Task Force on Nosology and Definitions
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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. -
1 ILAE Classification & Definition of Epilepsy Syndromes in the Neonate
ILAE Classification & Definition of Epilepsy Syndromes in the Neonate and Infant: Position Statement by the ILAE Task Force on Nosology and Definitions Authors: Sameer M Zuberi1, Elaine Wirrell2, Elissa Yozawitz3, Jo M Wilmshurst4, Nicola Specchio5, Kate Riney6, Ronit Pressler7, Stephane Auvin8, Pauline Samia9, Edouard Hirsch10, O Carter Snead11, Samuel Wiebe12, J Helen Cross13, Paolo Tinuper14,15, Ingrid E Scheffer16, Rima Nabbout17 1. Paediatric Neurosciences Research Group, Royal Hospital for Children & Institute of Health & Wellbeing, University of Glasgow, Member of European Reference Network EpiCARE, Glasgow, UK. 2. Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester MN, USA. 3. Isabelle Rapin Division of Child Neurology of the Saul R Korey Department of Neurology, Montefiore Medical Center, Bronx, NY USA. 4. Department of Paediatric Neurology, Red Cross War Memorial Children’s Hospital, Neuroscience Institute, University of Cape Town, South Africa. 5. Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino Gesu’ Children’s Hospital, IRCCS, Member of European Reference Network EpiCARE, Rome, Italy 6. Neurosciences Unit, Queensland Children's Hospital, South Brisbane, Queensland, Australia. Faculty of Medicine, University of Queensland, Queensland, Australia. 7. Clinical Neuroscience, UCL- Great Ormond Street Institute of Child Health, London, UK. Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Member of European Reference Network EpiCARE London, UK 8. Université de Paris, AP-HP, Hôpital Robert-Debré, INSERM NeuroDiderot, DMU Innov-RDB, Neurologie Pédiatrique, Member of European Reference Network EpiCARE, Paris, France. 9. Department of Paediatrics and Child Health, Aga Khan University, East Africa. 1 10. Neurology Epilepsy Unit “Francis Rohmer”, INSERM 1258, FMTS, Strasbourg University, France. -
EEG in the Diagnosis, Classification, and Management of Patients With
EEG IN THE DIAGNOSIS, J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.2005.069245 on 16 June 2005. Downloaded from CLASSIFICATION, AND MANAGEMENT ii2 OF PATIENTS WITH EPILEPSY SJMSmith J Neurol Neurosurg Psychiatry 2005;76(Suppl II):ii2–ii7. doi: 10.1136/jnnp.2005.069245 he human electroencephalogram (EEG) was discovered by the German psychiatrist, Hans Berger, in 1929. Its potential applications in epilepsy rapidly became clear, when Gibbs and Tcolleagues in Boston demonstrated 3 per second spike wave discharge in what was then termed petit mal epilepsy. EEG continues to play a central role in diagnosis and management of patients with seizure disorders—in conjunction with the now remarkable variety of other diagnostic techniques developed over the last 30 or so years—because it is a convenient and relatively inexpensive way to demonstrate the physiological manifestations of abnormal cortical excitability that underlie epilepsy. However, the EEG has a number of limitations. Electrical activity recorded by electrodes placed on the scalp or surface of the brain mostly reflects summation of excitatory and inhibitory postsynaptic potentials in apical dendrites of pyramidal neurons in the more superficial layers of the cortex. Quite large areas of cortex—in the order of a few square centimetres—have to be activated synchronously to generate enough potential for changes to be registered at electrodes placed on the scalp. Propagation of electrical activity along physiological pathways or through volume conduction in extracellular spaces may give a misleading impression as to location of the source of the electrical activity. Cortical generators of the many normal and abnormal cortical activities recorded in the EEG are still largely unknown. -
Epilepsy Foundation Awards $300K in Grants for New Treatments
Epilepsy Foundation Awards $300K in Grants for New Treatments dravetsyndromenews.com/2019/02/05/epilepsy-foundation-awards-300k-in-grants-for-new- treatments/ Mary Chapman February 5, 2019 With the goal of advancing development of new treatments for patients living with poorly controlled seizures, the Epilepsy Foundation has awarded $300,000 in grants to two leading researchers. The grants will go to Matthew Gentry, PhD, a professor at the University of Kentucky, and Greg Worrell, MD, PhD, professor of neurology and chair of clinical neurophysiology at the Mayo Clinic, through the foundation’s New Therapy Commercialization Grants Program and Epilepsy Innovation Seal of Excellence Award. Each recipient will receive matching funding from commercial partners. Gentry was awarded $150,000 to support pre-clinical testing of a compound (VAL-1221) that has promise to treat Lafora disease, a progressive epilepsy caused by genetic abnormalities in the brain’s ability to process a sugar molecule called glycogen. Gentry has joined with Valerion Therapeutics to develop VAL-1221, now in clinical trials for Pompe disease, a rare genetic disorder characterized by the abnormal buildup of glycogen inside cells. Early evidence suggests the compound can break down aberrant glycogen in cells of Lafora patients. 1/3 Worrell will receive $150,000 to support research Cadence Neuroscience, an early-stage company developing medical device therapies for epilepsy treatment and management. The company’s core technology is management of uncontrolled epilepsy when a patient is undergoing Phase 2 evaluation for surgery. Early evidence suggests that this procedure, which tests a variety of electrical stimulation parameters on intractable (hard-to-manage) epilepsy patients during evaluation, can be used to customize brain therapy and enhance seizure control. -
Focus on Pregnancy: Vitamin K, Folic Acid
Practice Parameter update: Management issues for women with epilepsy−−Focus on pregnancy (an evidence-based review): Vitamin K, folic acid, blood levels, and breastfeeding: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society C. L. Harden, P. B. Pennell, B. S. Koppel, et al. Neurology 2009;73;142-149 Published Online before print April 27, 2009 DOI 10.1212/WNL.0b013e3181a6b325 This information is current as of April 27, 2009 The online version of this article, along with updated information and services, is located on the World Wide Web at: http://www.neurology.org/content/73/2/142.full.html Neurology ® is the official journal of the American Academy of Neurology. Published continuously since 1951, it is now a weekly with 48 issues per year. Copyright . All rights reserved. Print ISSN: 0028-3878. Online ISSN: 1526-632X. SPECIAL ARTICLE Practice Parameter update: Management issues for women with epilepsy—Focus on pregnancy (an evidence-based review): Vitamin K, folic acid, blood levels, and breastfeeding Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society C.L. Harden, MD ABSTRACT P.B. Pennell, MD Objective: To reassess the evidence for management issues related to the care of women with B.S. Koppel, MD epilepsy (WWE) during pregnancy, including preconceptional folic acid use, prenatal vitamin K C.A. Hovinga, PharmD use, risk of hemorrhagic disease of the newborn, clinical implications of placental and breast B. Gidal, PharmD milk transfer of antiepileptic drugs (AEDs), risks of breastfeeding, and change in AED levels K.J. -
REN Newsletter Nov 2019
REN November 2019 RARE EPILEPSY NETWORK (REN) NEWSLETTER November 2019 Issue Aaron’s Ohtahara International Rett Foundation Syndrome Foundation Aicardi Syndrome Foundation The Jack Pribaz Foundation Alternating Hemiplegia of Childhood KCNQ2 Cure Foundation Alliance Aspire for a Cure Lennox-Gastaut Syndrome Bridge the Gap Foundation SYNGAP Liv4TheCure The Brain Recovery Project NORSE Institute Carson Harris PCDH19 Alliance Foundation Inside this Issue: Phelan-McDermid CFC International Syndrome Foundation Chelsea’s Hope Pitt-Hopkins I. Upcoming events & News………..….….. p 2-6 The Cute Syndrome Research Foundation Foundation II. Active clinical trials and studies.….……. p 7 CSWS & ESES RASopathies Foundation Network III. About REN / Contact us ..….…………..… p 8 Doose Syndrome Ring 14 USA Epilepsy Alliance Outreach Dravet Syndrome Ring 20 Foundation Chromosome Alliance Dup15q Alliance SLC6A1 Connect Hope for Hypothalamic Hamartomas TESS Foundation Infantile Spasms Tuberous Sclerosis Community Alliance International Wishes for Elliott Foundation for CDKL5 Research !1 REN November 2019 SAVE THE DATES - KIm Rice The 4th International Lafora Workshop was held in San Diego September 6 – 8, 2018, attended by nearly 100 scientists and clinicians from eight countries as well as 25 family members of Lafora patients. Lafora research has progressed rapidly since the first Lafora Workshop in June, 2014, organized and funded by Chelsea’s Hope Lafora Research Fund. As a result of bringing together a handful of researchers working on REN workshop at the American this extremely rare orphan disease, the Lafora Epilepsy Epilepsy Society Meeting (AES) Cure Initiative (LECI) was formed and researchers are Sunday, December 8, 2019 now working collaboratively under a $9 million NIH grant. 12-2pm There are now two drug development companies (Ionis Hilton Baltimore, Baltimore, MD Pharmaceuticals and Valerion Therapeutics) More details to come soon. -
Title in All Caps
Epilepsy Syndromes: Where does Dravet Syndrome fit in? Scott Demarest MD Assistant Professor, Departments of Pediatrics and Neurology University of Colorado School of Medicine Children's Hospital Colorado Disclosures Scott Demarest has consulted for Upsher-Smith on an unrelated subject matter. No conflicts of interest Objectives • What is an Epilepsy Syndrome? • How do we define epilepsy syndromes? • Genetic vs Phenotype (Features) • So what? Why do we care about Epilepsy Syndromes? • How do we organize and categorize Epilepsy Syndromes? • What epilepsy syndromes are similar to Dravet Syndrome and what is different about them? Good Resource International League Against Epilepsy Epilepsydiagnosis.org https://www.epilepsydiagnosis.org/syndrome/epilepsy- syndrome-groupoverview.html What is an Epilepsy Syndrome? A syndrome is a collection of common clinical traits. For Epilepsy this is usually about: • What type of seizures occur? • Age seizure start? Electroclinical • Development? Features or • What does the EEG look like? Phenotype • Other Co-morbidities… Course of an Epilepsy Syndrome Developmental Trajectories - Theoretical Model Normal Previously Normal with Epileptic Encephalopathy Development Never Normal Gray represents Epilepsy Onset the intensity of Age Epilepsy How distinct are Epilepsy Syndromes? A B C Many features might overlap, but the hope is that the cluster of symptoms are “specific” to that epilepsy syndrome…this is often better in theory than practice. How does the individual patient fit? A B C Is this patient at type A,B or C? What about Syndromes Defined by Genes? Is SCN1A the same as Dravet Syndrome? …I don’t have a perfect answer for this… many diseases are being defined by the gene (CDKL5, SCN8A, CHD2). -
Myoclonic Status Epilepticus in Juvenile Myoclonic Epilepsy
Original article Epileptic Disord 2009; 11 (4): 309-14 Myoclonic status epilepticus in juvenile myoclonic epilepsy Julia Larch, Iris Unterberger, Gerhard Bauer, Johannes Reichsoellner, Giorgi Kuchukhidze, Eugen Trinka Department of Neurology, Medical University of Innsbruck, Austria Received April 9, 2009; Accepted November 18, 2009 ABSTRACT – Background. Myoclonic status epilepticus (MSE) is rarely found in juvenile myoclonic epilepsy (JME) and its clinical features are not well described. We aimed to analyze MSE incidence, precipitating factors and clini- cal course by studying patients with JME from a large outpatient epilepsy clinic. Methods. We retrospectively screened all patients with JME treated at the Department of Neurology, Medical University of Innsbruck, Austria between 1970 and 2007 for a history of MSE. We analyzed age, sex, age at seizure onset, seizure types, EEG, MRI/CT findings and response to antiepileptic drugs. Results. Seven patients (five women, two men; median age at time of MSE 31 years; range 17-73) with MSE out of a total of 247 patients with JME were identi- fied. The median follow-up time was seven years (range 0-35), the incidence was 3.2/1,000 patient years. Median duration of epilepsy before MSE was 26 years (range 10-58). We identified three subtypes: 1) MSE with myoclonic seizures only in two patients, 2) MSE with generalized tonic clonic seizures in three, and 3) generalized tonic clonic seizures with myoclonic absence status in two patients. All patients responded promptly to benzodiazepines. One patient had repeated episodes of MSE. Precipitating events were identified in all but one patient. Drug withdrawal was identified in four patients, one of whom had additional sleep deprivation and alcohol intake. -
Model Section 504 Plan for a Student with Epilepsy
8301 Professional Place, Landover, MD 20785 MODEL SECTION 504 PLAN FOR A STUDENT WITH EPILEPSY [NOTE: This Model Section 504 Plan lists a broad range of services and accommodations that might be needed by a student with epilepsy in the school setting and on school-related trips. The plan must be individualized to meet the specific needs of the particular child for whom the plan is being developed and should include only those items that are relevant to the child. Some students may need additional services and accommodations that have not been included in this Model Plan, and those services and accommodations should be included by those who develop the plan. The plan should be a comprehensive and complete document that includes all of the services and accommodations needed by the student.] Section 504 Plan for _____________________________ (Name of Student) Student I.D. Number__________________ School___________________________________ School Year_______________ _________________ ________________ Epilepsy____ Birth Date Grade Disability Homeroom Teacher_____________________ Bus Number________ OBJECTIVES/GOALS OF THIS PLAN: Epilepsy, also referred to as a seizure disorder, is generally defined by a tendency for recurrent seizures, unprovoked by any known cause such as hypoglycemia. A seizure is an event in the brain which is characterized by excessive electrical discharges. Seizures may cause a myriad of clinical changes. A few of the possibilities may include unusual mental disturbances such as hallucinations, abnormal movements, such as rhythmic jerking of limbs or the body, or loss of consciousness. In addition to abnormalities during the seizure itself, individuals may have abnormal mental experiences immediately before or after the seizure, or even in between seizures. -
ICTALS2019 the Epilepsy Journey
ICTALS2019 The Epilepsy Journey 2-5 September In partnership with Abstract book This conference is supported by a grant from the American Epilepsy Society ICTALS2019 The Epilepsy Journey Foreword The International Conference for Technology and Analysis of Seizures, 2019 (ICTALS2019) aims to bring together neurologists, neuroscientists, researchers from quantitative disciplines and people with lived experience of epilepsy in order to work as a community to advance our understanding of epilepsy and develop practical ways to improve diagnosis and treatment. The theme for this year’s conference is: The Epilepsy Journey: from first seizure to treatment and beyond. We will emphasise how advances in our understanding of the dynamics of brain networks can be used to make a difference to people with epilepsy at all points of their journey: from elucidating the causes of the first seizure to diagnosing epilepsy, understanding how ictogenic networks give rise to recurrent seizures and how this insight can inform personalised treatment. To encourage this focus on the whole epilepsy journey we seek to include all relevant communities. In addition to discussions on current scientific, clinical and technological advances, we will take steps to increase accessibility for people with lived experience of epilepsy. Dates: Monday 2 September 2019 - Thursday 5 September 2019 Venue: University of Exeter, Streatham Campus, Xfi Building Conference website: http://ex.ac.uk/ictals2019 Contact the organisers: [email protected] ICTALS2019 The Epilepsy Journey Partners We are partnering with charities Epilepsy Research UK and Epilepsy Action and Alliance for Epilepsy Research. Sponsors This event would not be possible without the generous contributions from our generous sponsors UCB, the Epilepsy Foundation, NeuraLynx, and Liva Nova. -
Epilepsy Syndromes E9 (1)
EPILEPSY SYNDROMES E9 (1) Epilepsy Syndromes Last updated: September 9, 2021 CLASSIFICATION .......................................................................................................................................... 2 LOCALIZATION-RELATED (FOCAL) EPILEPSY SYNDROMES ........................................................................ 3 TEMPORAL LOBE EPILEPSY (TLE) ............................................................................................................... 3 Epidemiology ......................................................................................................................................... 3 Etiology, Pathology ................................................................................................................................ 3 Clinical Features ..................................................................................................................................... 7 Diagnosis ................................................................................................................................................ 8 Treatment ............................................................................................................................................. 15 EXTRATEMPORAL NEOCORTICAL EPILEPSY ............................................................................................... 16 Etiology ................................................................................................................................................ 16 -
Infantile Spasms Sign up for Our Quarterly Newsletter
PATIENTS OR CAREGIVERS ADVOCATES PROVIDERS OR RESEARCHERS DONORS Home Sign Up for Newsletter Who We Are What We Do Contact Donate Now Disorder Directory: Learn from the Experts EDUCATIONAL ARTICLES PLUS FAMILY STORIES AND RESOURCES INDEX A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Infantile Spasms Sign Up for Our Quarterly Newsletter ARTICLE FAMILY STORIES RESOURCES Get “Families First” plus updates on grants, family resources and more. Sign Up Now DON SHIELDS, MD Dr. Shields is Professor Emeritus of Neurology and Pediatrics, David Geffen Find Us On School of Medicine at UCLA Positions held in National and International and other medical organizations President, Child Neurology Foundation Recent Tweets Vice President, Pediatric Epilepsy Foundation Councilor, Child Neurology Society, 1994-1996 2/25/16 - Great read! @disabilityscoop In Bid To Nominating Committee, American Epilepsy Society, 1996 Understand Autism, Scientists Turn Membership Committee, Professors of Child Neurology, 1995 To Monkeys https://t.co/5t9uz6NhWu Chairman, Membership committee, Child Neurology Society, 1988-1993 https://t.co/5t9uz6NhWu Membership committee, Child Neurology Society, 1986-1988 Co-chairman Awards Committee, American Epilepsy Society, 1989-1992 2/25/16 - Informative read! @mnt Epilepsy and marijuana: could Awards for scientific accomplishment cannabidiol reduce seizures? https://t.co/E3TlMqTQpy UCLA School of Medicine Sherman Mellinkoff Faculty Award for dedication https://t.co/E3TlMqTQpy to the art of medicine and to the finest in doctor-patient