Epilepsy: Continuum (Pediatrics) and Rowan's Ch 5-7 Flashcards
3 Indications for Routine EEG
initial assessment
after AED introduction
After AED cessation
4 indications for cEEG
Pre epilepsy surgery To detect subclinical seizure Psychogenic non-epileptic attacks Refractory epilepsy Status Comatose pt without clear cause
4 Elements of assessing the Background
Organization
Symmetry/frequency
Reactivity
Continuity
Systematic approach to EEG (ACNS guideline) “BDASIC”
Background, Discharges/patterns, activation procedures, events/seizure, Impression, clinical correlation
What is Normal Organization
PDR present with normal A-P gradient. Describe Sleep stages and transients.
What is normal symmetry
No focal slowing
West Syndrome:
Onset and semiology
<2 years old / clusters of neck/truncal flexion with arm abduction often seen in the AM
West Syndrome:
Clinical triad
Psychomotor arrest, hypsarrhythmia and spasms
What is hypsarrhythmia
Seen in West Syndrom. High amplitude slow waves on a background of irregular multifocal spikes.
West Syndrome:
Treatment
ACTH first line. Vigabatrin in tuberous sclerosis.
Dravet Syndrome (severe myoclonic epilepsy of infancy): Onset and Semiology
< 2 years old. Hemiconvulsions with myoclonic and atypical absence
Dravet Syndrome: EEG specific ?
No
Dravet Syndrome: clinical symptoms and tx
regression with ataxia. NEVER sodium channel blockers (scn1a mut). VPA/BZD/LTC are common first line.
Benign epilepsy with centrotemporal spikes (BECTS or benign rolandic):
Onset and Semiology
age 7 with focal seizures that can be autnomic and focal involving mouth/throat. Tonic clonic as well.
Benign epilepsy with centrotemporal spikes (BECTS or benign rolandic):
EEG prognosis and tx
Centrotemporal BIPHASIC spikes/sharps that worsen in sleep. The are usually fine by age 16. Usually no tx but can use carbamazepine.
Lennox Gastaut (LGS: Triad
multiple seizure types, cognitive impairment, and slow spike and wave (1.5-2.5 Hz)
Syndrome that can precede LGS
West syndrome
LGS:
Tx and Prognosis
Can try ACTH, ketogenic diet but very pharmacoresistant with poor outcome.
Childhood Absence epilepsy:
Onset and semiology
ages 4-8 (age >9 is juvenile absence)
Staring spells but 30% can have GTC
Childhood Absence epilepsy:
EEG
3 Hz spike an wave with no post ictal slowing
Bedside test for childhood absence epilepsy
Hyperventilation for 3 minutes
Childhood Absence epilepsy:
Tx and Prognosis
Ethosuximide
70 % remit with 30% developing GTC which merits an added AED.
JME:
Onset and semiology
teenage years Mycolonic jerks (clumsy in AM) with potential for GTC
JME:
EEG
4-6 Hz Generalized spike/polyspike and wave discharge that are photosensitive
JME:
Tx and Prognosis
Lamotrigine or VPA indefinitely . Avoid photic stimuli/alcohol/stress and sleep deprivation
What is epilepsia partialis continua and what is it associated with ?
continuous focal clonic seizures without impairment of consciousness. Associated with Rasmussen’s encephalitis.
Tonic seizures, burst squppression, abnormal CT head
Ohtahara syndrome
Besides 3hz spike-wive what other finding in absence ?
OIRDA - occipitaly perdominant generalized rhythmic delta activity
Gene for Autosomal dominant partial epilepsy with auditory features
LGI1
Syndrome with language regression and electrical status epileptics in sleep
Landau-Kleffner
