Childhood epilepsy Flashcards
Generalised-onset seizures
Seizures originating within and rapidly engaging bilaterally distributed networks
Focal onset seizures
Seizures originating within networks limited to one hemisphere
Aware or impaired awareness
Tonic seizures
Generalised stiffening of flexor or extensor muscle
Clonic seizures
Generalised jerking of the muscles
Myoclonic seizures
Sudden, brief, shock-life contractions that may involve the whole body or be confined to one or more body parts
Atonic seizures
Seizures are characterised by a sudden loss of muscle
Epileptic spasms
Characterised by sudden and brief contractions of axial and proximal limb muscles and usually occur in clusters of varying intensity
Focal to bilateral tonic-clonic seizures
Focal seizures that spread to involve both hemispheres
Types of motor onset focal onset seizures
- Automatisms
- Atonic
- Clonic
- Epileptic spasms
- Hyperkinetic
- Myoclonic
- Tonic
Types of non-motor onset focal onset seizures
- Autonomic
- Behaviour arrest
- Cognitive
- Emotional
- Sensory
Types of motor onset generalised-onset seizures
- Tonic-clonic
- Clonic
- Tonic
- Myoclonic
- Myoclonic-tonic-clonic
- Myoclonic-atonic
- Atonic
- Epileptic spasms
Types of non-motor onset generalised-onset seizures
- Typical
- Atypical
- Myoclonic
- Eyelid myoclonia
True or false:
Systems for grouping seizures by specific characteristics are very relevant for the treatment and management of epilepsy
False
Children with a particular seizure type may vary greatly in likely prognosis and responses to treatment
What is the term for behavioural episodes thought not to be the result of abnormal neuronal epileptic activity
Psychogenic seizures
**True or false:
**
The majority of genetic epilepsies show a Mendelian inheritance pattern
False
What is the most common genetic generalised epilepsy in children?
Childhood absence epilepsy
What is the most common genetic focal epilepsy syndrome of childhood?
Benign epilepsy with centrotemporal spikes
**Which statement is false about childhood absence epilepsy?
**
1. Average onset is six years
- Tonic-clonic seizures are the only seizures at presentation
- The seizures may be enhanced by hyperventilation
- The majority of children with CAE are well-controlled on monotherapy with AED
2 Is false.
Absence seizures are the only seizures at presentation, can occur frequently and are enhanced by hyperventilation in most children
**What is NOT a known genetic epilepsy?
**
1. Davet Syndrome
- Childhood absence epilepsy
- Benign epilepsy with centrotemporal spikes
- Landau-Kleffner syndrome
- Landau-Kleffner syndrome
The aetiology is unknown. It is considered an epileptic encephalopathy.
What kind of epilepsy is tuberous sclerosis?
A combined structural-genetic epilepsy
The seizures of frontal lobe epilepsy typically occur from what?
Sleep
**Which epilepsy has the earliest average/common onset?
**
I. Benign epilepsy with centrotemporal spikes
II. Temporal lobe epilepsy
III. Landau-Kleffner syndrome
IV. Tuberous sclerosis
Answer: IV: Tuberous sclerosis, typically before two years of age
I. has an average onset of between four and ten years
II. onset later in childhood and adolescence is common
III. Between three and ten years of age
What is an important predictor for predicting outcomes of epilepsy?
Multiple answers possible
Age of seizure onset, with earlier onset being associated with poorer outcomes
Treatment timing, with earlier treatment being associated with better developmental outcomes
Seizure severity
**True or false:
**
An EEG scan forms the basis for a diagnosis in children
False. It can aid in the diagnosis, BUT an EEG is normal in many children with confirmed epilepsy, but may also be abnormal in children with no evidence of seizures
Which AED is typically not given to women of childbearing age?
VPA, sodium valproate.
Which AEDs often produce unwanted side effects?
Levitaracetam (LEV) and topiramate (TPM)
Psychomotor slowing is an adverse effect of which AED?
Topiramate
What is an important predictor to predict long-term outcomes after surgery
Duration of epilepsy prior to surgery, with early surgery being desirable
**Which of these surgery types is associated with loss of contralateral motor function?
**
I. Temporo-parieto-occipital disconnection
II. Hemispherotomy
III. Craniotomy
IV. Palliative surgery
II. Hemispherotomy
This type of surgery isolates the entire epileptogenic hemisphere from the contralateral healthy hemisphere, and is associated with loss of contralateral motor function.
It is more likely to be performed when children have a pre-existing motor deficit or progressive unilateral disease
Temporo-parieto-occipital disconnection
A motor-sparing procedure for children with severe, uncontrolled epilepsy arising from the posterior quadrant of one side of the brain, but no significant pre-existing functional (motor/sensory) deficit
Craniotomy
Implantation of intercranial electrodes, allowing mapping of seizures and inter-ictal epileptic activity
Palliative surgery
Implantation of a device that produces electrical stimulation of the brain with the aim to reduce seizure frequency
What are the four distinct psychological profiles following epilepsy surgery?
- Seizure free post-surgery
- Continuing seizures post-surgery
- In remission, no surgery
- Continuing intractable epilepsy
Pre-surgical cognitive weaknesses are expected to after surgery
Persist
Material specificity model
Verbal memory is considered to be dependent on the left (language-dominant) temporal lobe, and non-verbal memory on the right temporal lobe
Episodic memory
Information that is unique to individual events and is specifically dependent on the mesial temporal lobe function
