Lecture 2. Epilepsy in Children Flashcards
What are 4 clinical symptoms of epilepsy?
- Change in consciousness
- Involuntary movements
- Change in perception
- Behavior changes
What are the 4 phases of a seizure?
- Aura: before a seizure, some people feel an aura
- Ictal phase: during the seizure
- Post-ictal phase: after the seizure
- Inter-ictal phase: between seizures
Causes of epilepsy, e.g. a congenital brain defect
- Dysplasia
- Congenital infarction
- Tuberous Sclerosis Complex (TSC)
- Neurofibromatosis (NF)
- Neurodegenerative disease
- Dysplasia: cortical malformation –> before birth the brain was not developed correctly, it’s often very subtle
- Congenital infarction: bleeding in the brain
- Tuberous Sclerosis Complex (TSC): disease that will develop cysts in the organs, including the brain
- Neurofibromatosis (NF): disease that will develop benign tumors in the nervous system
- Neurodegenerative disease: mostly in older people, this is progressive over time with a loss of structure and function
Different types of seizures
- Simple partial seizure
- Complex partial seizure
- Absence seizure
- Tonic-clonic seizure
- Myoclonic seizure
- Simple partial seizure / focal onset aware seizure
Starts in 1 area of the brain, and the person remains alert and able to interact
Brief seizures, lasting a few seconds to less than 2 minutes
Different treatment options available (medication, diet, surgery, devices) - Complex partial seizure / focal onset impaired awareness seizure
Starts in 1 area of the brain, and the person is not aware of their surroundings
Typically last 1 to 2 minutes and may have an aura beforehand
May include automatisms (lip smacking, picking at clothes) and wandering off
Many treatment options available (medication, diet, surgery, devices) - Absence seizure / petit mall seizure
Have a generalized onset, beginning in both sides of the brain, mostly begin and end abruptly, lasting only a few seconds
Causes lapses in awareness, sometimes with staring, can be very subtle to see, and may be so brief that they are sometimes mistaken for daydreaming
They are more common in children - Tonic-clonic seizure / convulsion / grand mall seizure
The most famous kind of seizure, beginning on both sides of the brain, but can also start at one side and spread to the whole brain
Losing consciousness, beginning with stiffening of muscles (tonic) followed by jerking (clonic)
It can last 1 to 3 minutes, but can also take a longer time. If it lasts longer than 5 minutes, it’s a medical emergency
It often takes long to recover, people are often very tired afterwards - Myoclonic seizure
Brief shock-like jerks of a muscle or muscle group, easily mistaken for clumsy behavior
The person is usually awake and able to think clearly during this seizure
Classification of epileptic seizure is based on? (2x)
And from the 2nd one; which 3 kinds can be distinguished?
- Type of seizure: partial vs. generalized seizures
- Cause of seizure:
(1) symptomatic epilepsy cause recognized
(2) cryptogenic epilepsy no cause discovered, maybe genetic
(3) idiopathic epilepsy suspicion on cause, but not discovered
What 4 types of treatments are there for epilepsy?
- Anti-epileptic drugs (AED): these drugs suppress the seizures, so they do not cure epilepsy, 70% will be well treated.
- Vagus Nerve Stimulation (VNS): a pacemaker that fires pulses to the 10th cranial nerve, stimulating the brain to fire its own signals, so the brain is not directly stimulated. This will disrupt the firing of the epileptic brain discharges.
- Ketogenic diet: this diet creates the same metabolism as when fasting. The low carbohydrate and high fat makes the ketone concentration in the body higher, and this has an impact on the brain that will keep people from having seizures.
- Epilepsy surgery: surgical removal of the epileptic focus (location where the seizure starts). It’s only possible when there is a focus (so only in partial seizures) and only if that location does not represent important functions, such as speech or motor functions.
Epilepsy surgery, what is
- Focal resection
- Hemispherectomy
- Focal resection: the locus of the epilepsy is removed
2. Hemispherectomy: a whole hemisphere removal (nowadays disconnected
What is a sub-clinical seizure?
A seizure that you cannot see from the outside, but you can see a disturbance in the brain with EEG
What are 4 frequent cognitive effects of epilepsy?
- Somewhat lower IQ
- Attention problems
- Slower reaction time/motor speed
- Fluctuating in functions
What is the Wada test?
And what are pros and cons?
The hemisphere where the epilepsy is will be sedated for a few minutes, so that part of the brain cannot function, and then we can do language or memory tasks.
+: it’s very reliable –> the hemisphere that you need is working at that time and you can then test functions, since the patient can talk out loud
-: it’s very invasive, it’s a painful preparation, you have only 2 minutes to test and not all children are that cooperative. Also, you can only lateralize, and not localize
What is the grid procedure?
And what are pros and cons?
Electrodes are put directly on the brain through surgery, which can send out electric pulses to shortly stop the functioning of a little part of the brain. Then you can see whether these tasks are disturbed by these parts of the brain.
+: it’s very reliable, responses are verifiable (talking out loud), and it takes lots of time to test (days) so enough time to assess. Also, you can localize very precise (every number represents an electrode)
-: it’s very invasive (2 surgeries), it can be painful, and it’s testing by deduction (you have to test all these numbers and combinations that are next to each other)
Children with epilepsy who undergo surgery scored above average on these 4 personality traits.
Which of these traits decreased after 2 years? (but not normalized)
- Inadequacy (anxieties, low-self esteem, feeling down)
- Perseverance (persistency)
- Social inadequacy (withdrawn, shy, uncomfortable in social situations)
- Recalcitrance (distrust others, acting hostile, selfish)
Decreased: social inadequacy
Neuropsychological consequences: cognitive effects of epilepsy depend among others on the location in the brain.
Which types of cognitive deficits do you see in:
- Frontal lobe
- Temporal lobe
- Parietal & occipital lobe
- Frontal lobe: performance IQ, memory/learning, EF, processing speed, motor, behavior
- Temporal lobe: mental retardation, language, memory, and learning problems
- Parietal & occipital lobe: vision, visual-motor coordination, neglect
