1. Epilepsy Q: What is epilepsy?
A: Epilepsy is a brain disorder. It occurs when the electrical signals in the brain are disrupted. This change in the brain leads to a seizure. Seizures can cause brief changes in a person's:
Body movements
Awareness
Emotions
Senses, such as taste, smell, vision, or hearing People with epilepsy have repeated seizures.

2. Myth or Fact Myth #1 --- Epilepsy is rare
Fact --- More than 2.5 million Americans have epilepsy.
Myth #2 --- Epilepsy is contagious
Fact --- You cannot catch epilepsy from another person! Therefore it is not contagious.

3. Myth or Fact Myth #3 --- Epilepsy is a psychological condition
Fact --- Epilepsy is a medical condition. Seizures are the result of an excessive and disorderly discharge of electrical energy in the brain.
Myth #4 --- Epilepsy is a form of mental illness
Fact --- Epilepsy is a functional, physical problem, not a mental one. Its an umbrella term that describes about twenty different types of seizure disorders.

4. Myth or Fact Myth #5 --- Persons with epilepsy are “epileptics.”
Fact --- Persons with epilepsy are individuals who experience chronic, recurrent seizures and prefer being described as "persons with epilepsy.“
Myth #6 --- You have to be born with epilepsy
Fact --- Epilepsy often first appears in children and young adults, although anyone can develop epilepsy at any time.

5. Myth or Fact Myth #7 --- Epilepsy is a lifelong disorder
Fact --- Epilepsy is not necessarily a lifelong disorder. Many persons with epilepsy will not have seizures or require medication all of their lives.
Myth #8 --- You can’t prevent epilepsy
Fact --- While no specific cause can be pinpointed in a majority of epilepsy cases, some causes, such as severe head injuries experienced in falling from a bicycle or sustained in an automobile accident, have been identified. This is why helmet safety is so important for children as a preventive measure.

6. Myth or Fact Myth #9 --- Epilepsy cannot be treated or cured
Fact --- There is no known cure for epilepsy. However, modern treatment methods can achieve full control of seizures in a majority of cases. According to the EFA, 80 percent of those on medication have complete control of seizures. Within the past 15 years, several new drugs have been developed to help control seizures, and surgery is an option for some patients. Many people who have epilepsy lead productive, normal lives. Currently there is no cure, but some children tend to outgrow the condition.

7. Myth or Fact Myth #10 --- Epilepsy is a disease
Fact --- Epilepsy is a neurological condition characterized by recurring seizures. Epilepsy is not a disease or a mental illness, and it does not signal emotional instability or lack of intelligence. According to the Epilepsy Foundation of America (EFA), 9 percent of the population will have a seizure at some point in their lives. Of this group, 3 percent will develop epilepsy.

8. Myth or Fact Myth #11 --- All seizures are the same
Fact --- There are more than 20 forms of seizure disorders. The intensity and duration of the seizure depends on how many and what type of brain cells are affected. Seizures are not painful and range from convulsions to momentary lapses of attention. People with mild seizures may even be unaware they’ve had one. Seizures may occur minutes, days or years apart, depending on how well they are controlled by medication

9. Incidence Over a lifetime, 5-7 percent of us have a seizure
30 to 60 per 100,000 persons have epilepsy
Common in very young children
Most common neurological disorder of adolescence
60 percent completely controllable; 25 percent can reduce severity

10. Epileptic Syndromes
An epileptic disorder characterized by a cluster of signs and symptoms which occur together
Factors taken into consideration include seizure type, etiology, genetics, anatomy, precipitating factors and the interictal EEG
Proposed by ILAE in 1985, revised in 1989 currently under revision

11. Generalized seizures Electrical abnormality throughout cerebral cortex
Grand mal or generalized tonic-clonic seizures
Absence or petit mal
Atonic seizures

12. Generalized Tonic-Clonic Seizures
Person stiffens, falls, and convulses, losing consciousness
EEG abnormal in more than 2/3 of cases
Cause in young children due to infection, metabolic disorder or trauma
In older individuals, usually due to trauma or tumor
Outcome dependent upon age, cause, and ability to control seizures
Approximately 40 percent retarded

17. Absence or Petit Mal Seizures
Temporary lapse of consciousness that starts and ends abruptly
Brief periods of lack of awareness; may be unusual movements
Usual age of onset is 4 to 8 years
High genetic predisposition
Over 50 percent go into remission after adolescence
Generally normal IQ; only 5 percent retarded

18. Childhood Absence Epilepsy
Onset at 3-12 years
Peak at 6-7 years
Second peak at years
Females more than males
Family history in 15-44%
Risk of generalized TC seizures is 30-40%
Increased risk if absence seizures begin after the age of 8 years

20. Childhood Absence Epilepsy Treatment
Effective Drugs
Ethosuximide
Valproic acid
Clobazam
Lamotrigine
Topiramate
Ineffective Drugs
Carbamazepine
Phenytoin
Vigabatrin

21. Juvenile Myoclonic Epilepsy
A common cause of tonic-clonic seizures in teenagers and young adults
Interictal EEG shows normal background with polyspike-wave bursts
A photoconvulsive response is common

23. Juvenile Myoclonic Epilepsy
Diagnosis often delayed
Patients rarely report myoclonic jerks
Absence seizures occur in 25%
Myoclonic seizures precede tonic-clonic seizures by 2-3 years
Tonic-clonic seizures typically occur when patient reaches years

25. JME - Treatment Avoid sleep-deprivation and alcohol
VPA is treatment of choice
Clonazepam, Lamotrigine or Topiramate may be effective
Discuss teratogenesis for females and advise folic acid supplementation

26. Benign Rolandic Epilepsy
Most common partial epilepsy
Onset 3-13 years
M:F :1
10-13% have a single seizure
20% have frequent seizures
65% nocturnal
15% nocturnal or diurnal
10-20% waking state only

27. Interictal discharge

28. Benign Rolandic Epilepsy
Most common partial epilepsy
Onset 3-13 years
M:F :1
10-13% have a single seizure
20% have frequent seizures
65% nocturnal
15% nocturnal or diurnal
10-20% waking state only

29. Typical Seizure Child 5-10 years with episodes:
On waking, fully conscious, mouth to one side, salivating and focal twitching of one side of the face
Duration 1-2 mins;
Child may recall a sensation of numbness, pins and needles or “electricity” in the tongue, gums or cheeks;
Secondary generalization may be seen

30. Atonic seizures Sudden loss of muscle tone Individual collapses
No tonic-clonic phases
Head injury is greater risk

31. Partial Seizures Simple partial, focal, or Jacksonian seizures
Complex partial seizures
Generalized partial seizures

32. Simple partial seizures
Localized seizure disorder which lasts a few minutes and is characterized by motor or sensory phenomena in a hand, arm or body part
Includes Jacksonian seizures in which seizure moves sequentially from one area to another on the same side of the body
Most frequent between 5-15 years of age
25 percent of post traumatic seizures of this type
Outcome dependent upon where seizure origin is located; frontal lobe hard to control
Generally normal IQ

37. Complex partial seizures
Also called psychomotor or temporal lobe seizures
Individual loses awareness
Repetitive motor behaviors occur
Last 1 to a few minutes
Recovery includes confusion, irritability
Accounts for 2/3 of all epilepsies
Multifactorial causes: Genetic predisposition, prenatal trauma, brain lesions

38. Generalized Partial Seizures
Sometimes partial seizures develop into full body seizures
Usually this is when they are uncontrollable

39. Febrile Seizures
Brief seizure in a child which occurs in conjunction with a high fever
Occur in about 3 percent of young children
Peak occurrence between 9 to 20 months
Over 65 percent do not have subsequent seizure
If have multiple seizures, or associated with other anomalies (CP), then likely to have impact on intellect
Seems to run in families

40. Neonatal Seizures
May have a variety of causes: Trauma, metabolic, or infection
If have multiple neonatal seizures, 40 percent mortality rate
35 percent have mental retardation
If metabolic, especially due to drug withdrawal, outlook is better

41. Objectives How to investigate possible seizures
History of greatest importance
How to approach epilepsy syndromes
How to predict seizure recurrence
How to choose an anti-epileptic drug

42. An approach to Seizures

43. Acute Symptomatic Seizures
Meningitis
Encephalitis
Hypoxia-ischemia
Tumor
Vascular lesion
Hypoglycemia
Hyponatremia
Hypocalcemia
Trauma
Toxic process

44. Causes of Epilepsy Newborns: Children Head Trauma Infections Metabolic
Medications
Children
Fever
Infection
Toxins (Lead Poisoning)

45. Epilepsy in Adolescence
Most commonly occurring neurological disorder
Rapid changes associated with puberty may make seizures more common and severe, especially if grand mal type
Absence seizures may be improved
Due to psychosocial demands may be more problematic

46. Epilepsy in Adulthood Causes often trauma, or infections
Genetic predisposition
Emotional causes also documented

47. Developmental Effects
Not an obvious disorder
Generally no intellectual disability
Personal psychological reaction of loss of control
Family’s response to risk of seizure
Medication is crucial to control of seizures; especially difficult in adolescence

48. Women with Epilepsy
Pregnancy alters occurrence of seizures, usually making more frequent
Rate of major malformations is doubled for these women
Anti-epileptic drugs are associated with mild teratogenic effects (clefting, digit abnormalities)
If seizure free for 2-5 years, then drop drugs for 6 months to see if a single drug can control seizures
Single drug therapy associated with fewer malformations

49. Causes of Epileptic Seizures in Children
Genetic
Congenital Brain Abnormality
Brain Insult e.g. trauma, meningitis,
Progressive lesion e.g. tumor, AVM
Metabolic

50. Genetic Causes of Epilepsy
Familial neonatal convulsions
Benign familial convulsions of infancy
Benign partial seizures of infancy
Febrile seizures
Benign Rolandic seizures
Absence epilepsies
Juvenile myoclonic epilepsy