Idiopathic Generalized Epilepsy Flashcards
IGE
normal development prior to onset of seizures, normal MRI
onset of myoclonic,myoclonic-atonic, atonic seizures in 7 months to 6 years
Normal background EEG with 2-3Hz GPSWD without focal spike discharges
Epilepsy with myoclonic-astatic seizures
Most efficacious drug for EM-AS
Valproate
Drugs contraindicated in EM-As
Carbamazepine
Phenytoin
Vigabatrin
age at onset 4-10 yrs
normal neurologic state and development
brief and abrupt with absence seizures, with abrupt and severe impairment of consiousness
ictal EEG: with bilateral, synchronous and sym- t metrical 3 Hz GSWD, on a normal background activity
Childhood Absence Epilepsy
Prognosis of Childhood Absence Epilepsy
the prognosis of CAE is excellent
Remission occurs before the age of 12 years
Less than 10% of the patients may develop infrequent or solitary GTCSs in adolescence or adult life
It is exceptional for patients to continue having absence seizures in their adult life
Management of Childhood Absence Epilepsy
Monotherapy with either valproate or ethosuximide controls absences in 80% of patients
Another option is lamotrigine monotherapy , although this is less effective with around half of patients becoming seizure free
If monotherapy fails or unacceptable adverse reactions appear, the used drug should be replaced by another. Adding small doses of lamotrigine to valproate may be the best combination in resistant cases.
Contraindicated drugs in Childhood Absence Epilepsy
Carbamazepine Pregabalin Gabapentin Oxcarabazepine Phenytoin
age of onset around puberty
unequivocal clinical evidence of absence seizures with severe impairment of consciousness
nearly all patients have GTCs
a fifth have myoclonic jerks, mild do not show circadian distribution
documentation of Ictal 3-4Hz GPSWD,>4s, with impaired consciousness, and often with automatisms
Normal EEG seen in treated patients
Juvenile Absence Epilepsy
prognosis pf Juvenile Absence Epilepsy
it is a life-long disorder
seizures can be controlled in70-80% of patients
seizures tend to be less severe in the fourth decade
treatment of JAE
drug of choice Valproate, controls 70-80%
another good monotherapy is Lamotrigone, controls 50-60%
Juvenile Myoclonic Epilepsy is characterized by (3)
myoclonic jerks on awakening
GTCs in nearly all patients
typical absences in more than a third of the patients
precipitating factors in JME
fatigue
sleep deprivation
excessive alcohol intake
EEG in JME
The EEG in untreated patients is usually abnormal, with 3–6 Hz GPSWD, and with intradischarge frag-mentations and unstable intradischarge frequency
most effective AED in treatment of JME
Valproate
other meds for JME aside from Valproate
Levetriacetam Lamotrigine clonazepam phenobarbital others: topiramate and zonisamide
