Epilepsy II

Question 1

Intractable epilepsies

Answer 1

seizures which do not respond to a trial of at least 3 anticonvulsants

Question 2

What percent of new onset seizure patients may develop intractable epilepsy?

Answer 2

30%

Question 3

Status epilepticus

Answer 3

medical emergency

Question 4

Febrile seizures

Answer 4

An event in infancy or childhood, usually occurring between 3 months and 5 years of age, associated with fever, but without evidence of intracranial infection or defined cause.

Seizure with fever in children who have suffered a previous non-febrile seizure are excluded

Most common childhood seizure

Increased risk of epilepsy with complex febrile seizure, family history, or neurologically abnormal already

Question 5

Lennox Gastaut syndrome

Answer 5

intractable seizure disorder

Generalized Seizures
–Tonic
–Atonic
–Myoclonic
–Atypical absence

Cognitive dysfunction – not always present, and may evolve later

Onset typical in early childhood but can happen in adolescent or adulthood

Onset between 1-7 years of age

First seizure typically between 3-5 years of age

Question 6

Non-medication treatments available for intractable seizures

Answer 6

ketogenic diet, vagal nerve stimulation and epilepsy surgery

Question 7

Epilepsy

Answer 7

2 or more unprovoked seizures separated by greater than 24 hours or 1 seizure with studies suggesting further risk for seizures

Question 8

Old classification of epilepsy

Answer 8

symptomatic: know etiology

Idiopathic: genetic predisposition

Cryptogenic: thought to have an etiology that isn’t yet proven

Benign vs catastrophic

benign: easily treated, normal intelligence, usually get better with age
catastrophic: Intractable to meds, affect development,

Question 9

Current classifications of epilepsy

Answer 9

genetic, structural, metabolic, and unknown

Spasms now included

Question 10

Risk of recurrence of febrile seizure

Answer 10

25-40% will have a recurrent febrile seizures

Risk factors for recurrence:
–Less than 1 yr age
–Positive family history
–Low grade fever
–Brief fever

Simple: do not recur in 24 hours, less than 10-15 mins, generalized

Complex (20-30%): Focal in nature at onset or during, Longer than 10 – 15 minutes, Recur in less than 24 hours

Question 11

Causes of Lennox Gastaut Syndrome

Answer 11

Malformations
Hypoxic-ischemic injury
Encephalitis
Meningitis
Tuberous sclerosis!!!

Question 12

Ketogenic diet

Answer 12

Starvation: produces ketone bodies which have AED effect and diet continues ketosis

Useful with all seizures

Used in children more than adults

usually 4:1 fat to protein ratio

Question 13

Vagal nerve stimulation

Answer 13

A pacemaker like device where implanted in the left chest wall and stimulates a nerve in the neck (vagus nerve) that stops seizures

Has a baseline stimulation that the doctor sets but also has a magnet where it can be swiped over the device to make it go quicker

Question 14

Epilepsy surgery

Answer 14

Used for partial epilepsies

Not usually used for generalized seizures unless corpus callosotomy

Used when patients fail medications and where the natural history and prognosis is terrible

If the patients’ development status is regressing rapidly

Presence of lesion or single focus where not critical for function (i.e. motor, language and vision)