Epilepsy syndrome-Adolescent

Question 1

Juvenile absence epilepsy

Answer 1

10-19 years
Clinical:
1.) Abrupt impairment of consciousness
-a/w behavioural arrest, or automatisms

2.) lasts longer than childhood absence epilepsy

EEG: generalized 3 Hz to 4 Hz spike- or polyspike-and-wave activity

Treatment: ethosuximide

Avoid: phenytoin, carbamazepine, gabapentin, pregabalin, and vigabatrin

Question 2

Juvenile myoclonic epilepsy

Answer 2

12-18 years

Clinical:
1.) myoclonic seizures predominantly involving upper extremity (especially upon AWAKENING)

EEG: generalized
4 Hz to 6 Hz spike- or polyspike-and-slow-wave activity

TRIGGERS: Photic stimulation, menses, sleep deprivation
**worsened by carbamazepine, oxcarbazepine, phenytoin, gabapentin, and vigabatrin

Question 3

Mesial Temporal Lobe Epilepsy with Hippocampal Sclerosis

Answer 3

Identified revised 2010 criteria

Clinical:

1. ) autonomic or abdominal auras
   - deja vu, jamais vu, fear, epigastric rising, or experiencing bad odors or taste
2. ) behavioural arrest, vacant stare and impaired responsiveness
   - 30-60 secs
3. ) automatisms
   - lip smacking, swallowing, chewing, picking movements

4.) post-ictal nose wiping–> ipsilateral to the focus

Question 4

Autosomal Dominant Partial/Focal Epilepsy With Auditory Features

Answer 4

Mutations in LG1 gene

Clinical:
1.) auditory hallucinations–> buzzing, clicking, ringing sounds

2. ) Accompanying symptoms:
   - ringing
   - singing
   - whistling,
   - humming or talking sounds,
   - visual, autonomic, psychic, or olfactory phenomena

***Impairment of consciousness rare

Question 5

Autosomal Dominant Nocturnal Frontal Lobe Epilepsy

Answer 5

Clinical:

1. ) hypermotor seizures
   - bicycling, flailing
2. ) clusters during sleep
3. ) vocalization may be prominent and signal the appearance of panic attacks