Childhood Epilepsy Flashcards
What are the factors associated with intellectual impairment or decline in epilepsy?
- Age of onset
- Ongoing seizure activity (intractability) esp for generalised seizures
- Frequency of seizures
- Types of seizures (e.g. status epilepticus/non convulsive status)
- Polytherapy or multiple medications
What is the difference between developmental decline vs developmental plateau and how is this assessed?
- Developmental decline = is a LOSS of skill, as determined by a decline in the raw scores on assessment
- Developmental plateau = child stays at the same level while peers progress. I.e., a failure to make cognitive gains. Each year raw scores should increase to maintain normal standard scores.
What are the different types of seizure onset?
1) Focal onset (‘partial seizures’)
2) Generalised onset
3) Unknown
Define focal onset seizures
- Epileptogenic activity originates within one hemisphere consistently across seizures
- The activity can remain in the one hemisphere or propagate to the contralateral hemisphere
- Can involve more than one network and more than one type of seizure, but each seizure has a consistent locus of onset which often has clinical relevance
What are the features used in describing focal onset seizures?
- awareness/unawareness (previously ‘simple partial’ and ‘complex partial’)
- motor/non motor
- dyscognitive symptoms (e.g. impaired language or orientation)
- progression of symptoms during seizure
Define generalised seizures
Epileptogenic activity originates in both hemispheres either simultaneously or starts in one and rapidly spreads bilaterally
What are the different types of generalised seizures?
- Absence seizures (sudden cease of activity lasting a few seconds)
- Tonic-clonic seizures (classic convulsive seizure)
- Myoclonic seizures (like a brief tonic-clonic)
- Clonic seizures
- Tonic seizures (rigid muscle tone)
- Atonic seizures (muscle tone loss)
Describe status epilepticus
A type of generalised seizure that is non self-limiting. Can be:
- Convulsive status (tonic-clonic) without recovery of consciousness between attacks.
- Non-convulsive or absence status where EEG is abnormal but may have no outward clinical signs
How long must a seizure continue before it is considered status epilepticus?
- For tonic clonic, > 5 mins
- For focal seizures with impaired awareness, > 10 mins
- For absence seizures, > 10 - 15 mins (but limited research on this)
Status epilepticus consistutes a medical emergency
What are common aetiologies of seizures?
Structural/metabolic
- Secondary to specific structural abnormalities or metabolic conditions such as leions, dysplasia, stroke, trauma, infection, autoimmune
Genetic
- Direct result of a known disorder where seizures are a core symptom
Unknown cause
- Accounts for up to 1/3 of all seizures
What are two childhood epilepsy syndromes?
- Continuous Spike and Waves During Slow-wave Sleep (CSWS)
- Llandau-Kleffner Syndrome (LKS)
- Childhoof Absence Elilepsy (CAE)
- Juvenile Absence Epilepsy (JAE)
- Juvenile Myoclonic Epilepsy (JME)
What types of seizures are associated with executive problems?
- Absence seizures
- Generalised seizures
- Some specific syndromes (JME, CSWS)
These also have a massive impact on academic functioning but are often overlooked compared to other more ‘overt’ conditions like TBI
Explain how surgery might be undertaken for epilepsy in children
When epilepsy is intractable/treatment resistant (about 30%).
Surgery is either:
- Resective (to excise the epileptogenic focus) or
- Functional (to interrupt tract which propagate seizures to other parts of the brain)
50-80% of children who undertake sugery will become seuizure free, 20% will have significant reduction in seizures. Earlier intervention usually has better cognitive outcomes though longterm outcomes are not well established.
When is surgery considered in epilepsy in children?
- When seizures have been resistant to multiple medications (3+)
- There is a clear epileptogenic focus on imaging or EEG
- The seizures severely impact the child’s QoL
- In seizures that result in status epilepticus, personal injury, speech or motor arrest, increasing post-ictal (post sz) disability
- In certain degenerative conditions e.g. Rasmussen’s encephalitis
How is a neuropsychologist helpful in epilepsy?
Pre-surgical workup
- The NP’s assessment can provide information regarding the lateralisation/locaisation. That is, the NP can identify areas of deficit consistent with suspected epileptic focus (e.g., L hippocampus locus is likely to produce deficits in verbal memory). This is especially important as techniques like the WADA procedure are contraindicated in childhood, and imaging techinques may be non-specific or present with technical difficulties (e.g., movement in fMRI, timing of injection in SPECT)
- Provides information on whether pattern of cognitive strengths and weaknesses concur with medical findings
- Can alert the medical team to possible negative impacts of surger on post operative cognitive functioning, given that lateralisation of function should not be assumed without assessment. E.g., assessment of a a LH boy with riht temporal focus that revealed poor verbal memory and intact visual memory supported the localisation of function (language problem in RH).
