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Dr Tina WilliamsPLEAT
Frimley Park Hospital June 2011
Condition with recurrent, unprovoked seizures
Old Classification : ILAE 1989
Partial (Simple or Complex) and Generalised
Axes 1 to 4*
More than just identifying seizure type
Attempting to identify a clear Epilepsy Syndrome
Specific Treatment, Prognosis
Think Axes:◦Description – Sz or not, videos◦ ◦Seizure Type
◦Features of Identifiable Syndrome?
◦Specific Rx – NICE 2004, BNFc
Description of episodes – Signs and Symptoms, Standardised Terminology
Video recordingsEvents related
Focal (previously ‘partial’) seizure - initial activation of only part of one cerebral hemisphere occurs (although may generalize). (Luders 2001)
Generalized seizure – discharge from both cerebral hemispheres occurs. Loss of Consciousness may occur (Luders 2001)
Seizure Types
I Self Limited◦ Focal◦ Generalised
II Continuous (status epilepticus)◦ Focal◦ Generalised
I Generalized seizures
Tonic-clonic seizures
Clonic seizures
Typical absence seizures
Atypical absence seizures
Tonic seizures
Myoclonic seizures
Atonic seizures
II Focal seizures
Focal sensory seizures
Focal motor seizures (tonic/clonic/myoclonic
seizures)
With typical automatisms (Complex Partial Seizures)
III Secondarily Generalized seizures
Origin of symptoms and signs in focal seizures - Visual display over the dominant hemispheres
I Generalized status epilepticus
II Focal status epilepticus
Epilepsia partialis continua
Aura continua Hemiconvulsive status
with hemiparesis
Epilepsy Syndromes
An epileptic disorder or condition characterised by cluster of signs and symptoms customarily occurring together.
List not exhaustive
Benign Idiopathic focal epilepsies of infancy and
childhood Familial focal epilepsies (autosomal dominant) Idiopathic generalized epilepsies
Malignant Symptomatic focal epilepsies (Focal Pathology
eg tumour, bleed, infarct) Epileptic encephalopathies
Idiopathic focal epilepsies of infancy and childhood
Benign infantile seizures Benign childhood epilepsy
Familial focal epilepsies (autosomal dominant)
Benign familial neonatal seizures
Benign familial infantile seizures
Autosomal dominant nocturnal frontal lobe epilepsy
Idiopathic generalized epilepsies
Benign myoclonic epilepsy in infancy
Childhood absence epilepsy
Epilepsy with generalized tonic-clonic seizures only
Epileptic encephalopathies
Early myoclonic encephalopathy
West syndrome
Lennox-Gaustaut syndrome
Landau-Kleffner syndrome
Aetiology or Underlying Cause
Neurocutaneous Disorders Malformations due to abnormal cortical developments
Other cerebral malformations Tumours Bleeds/ Infarcts Chromosomal abnormalities Inherited metabolic disorders Pre/ perinatal ischaemic/ anoxic lesions or cerebral infections
Postnatal infections
Benign Rolandic Epilepsy Idiopathic, otherwise healthy children. EEG - high-voltage centrotemporal spikes
often followed by a slow wave. Onset usually 4-11yrs, peaks at 5-9yrs Boys:Girls - 6:4 Unilateral somatosensory aura, Speech
arrest, conscious in most cases Secondary generalisation: tonic/T-C
common May be nocturnal Rx – Carbamazepine usually Prognosis good
30% have a family Hx of Epilepsy Onset from 6 months – 3 years of age No other seizure types Usually upper extremities and head EEG may be normal, sleep EEG may show
changes. Prognosis : Good, up to 50% may have
developmental/ language delay
Onset 4-10 yrs; Peak 5-7yrs Female > Male Mild automatisms frequent, but major motor
involvement diagnosis. The EEG - characteristic "typical 3Hz spike-
wave" discharges. Prognosis is excellent in well-defined cases
of CAE with most patients "growing out" of their epilepsy
Onset 10-17 years, peak 10-12 years Male=Female More sporadic than CAE > 75% have tonic-clonic seizures EEG - spike-wave discharges most
prominent in the frontal region. Faster (3.5 Hz to 4.5 Hz) than in typical childhood absence epilepsy.
Prognosis: Respond well to Rx – Valproate, Ethosuxamide. If no other factors, prognosis good.
Usually abnormal brain eg TS - Invx Triad: infantile spasms, EEG pattern termed
hypsarrhythmia, and mental retardation Spasms affecting head and upper
extremities lasting 5-20seconds, clustering, sleep times
Rx: ACTH/Steroids/ Vigabatrin Prognosis – Seizure control often.
Developmental delay progresses
Childhood Epileptic Encephalopathy 1-4% of childhood epilepsies Multiple sz types, Dev Delay/regression
often follows EEG: Gen slow spike+wave discharges Common sz: tonic-axial, drops, atypical
absences, but can be myoclonic, gen tonic-clonic, focal.
Often resistant to Rx. Surgery to remove corpus callosum/
lobectomy works for select grous Ketogenic diet works in some
Onset 3-7 yrs Rare disorder Loss of expressive language → loss of
speech Rx – Speech Rx, AED Prognosis: Variable, Age of onset after 6yrs
is better
Females Loss of skills – speech, purposeful hand
movements Develop stereotypic Hand movements Onset 3months-3 yrs Prognosis poor - Regression
Severe Myoclonic Epilepsy of Infancy Begins in 1st year of life Febrile seizures, status then become afebrile Can be generalized, myoclonic, atypical
abscences, clonic, tonic-clonic, or focal EEGs - generalized and focal and multifocal
anomalies Rx – Difficult control Prognosis – Poor neurological outcome. 50%
severe
Think Axes:◦Description – Sz or not, videos◦ ◦Seizure Type
◦Features of Identifiable Syndrome?
◦Specific Rx – NICE 2004, BNFc
Questions?