Ahmad Tho Tuching

What is Epilepsy?
2 or more unprovoked seizures
Incidence <10 years old 5.2 to 8.1 per 1,000 (highest <1

year)
Causes: Brain malformations, birth injury, infection,
tumor & trauma; 69% with unknown cause

What is a seizure?
Abnormal and excessive electrical activity of brain

cells (neurons)
Seizure types:
Generalized
Focal (Partial)
Focal with secondary generalization

 Generalized Seizures:

1.) Generalized tonic-clonic (grand mal)Unconscious, whole body shaking; variable duration
2.) Absence (petit mal) Staring, unawareness, brief
(seconds)
3.) Myoclonic Brief jerk of arm or leg
4.) Atonic Sudden drop

GRANDMAL

PETITMAL

 Focal (Partial) Seizures:

1.) Simple Consciousness preserved; twitching of

one side of face or body, numbness, visual
2.) Complex Impaired consciousness; twitching,
head/eye deviation etc.

Testing
EEG records brain activity; seizures or potential

for seizures
Video-EEG prolonged; overnight in hospital
MRI of brain picture of brain; look for abnormal
structure

 Common EEG abnormalities:

1.) Slowing
2.) Spikes
3.) Seizures

Normal

Slowing

Spikes

Spikes

Seizure

Etiology of Epilepsy
Specific etiology
Identifiable in only 30%
of cases
Idiopathic 67.6%

Trauma

Congenital20%
Trauma
HIE
Congenital brain
anomalies

Degenerative

Neurology Chapter of IAP

Infection

Vascular

4.7%
4.0%
1.5%

Neoplastic 1.5%

0.7%

Treatment
1.) Medication:
Monotherapy Drug
Choice based on type of seizures, EEG findings, side
effects, age and sex
2nd med may be added if seizures not controlled

Kejang Umum (generalized seizures)

Kejang
parsial

Tonic-clonic

Abscense

Myoclonic,
atonic

Drug of
choice

Karbamazepi
Valproat
n
Karbamaze
Fenitoin
pin
Valproat
Fenitoin

Etosuksimi
d
Valproat

Valproat

Alternativ
es

Lamotrigin
Lamotrigin
Gabapentin
Topiramat
Topiramat
Primidon
Tiagabin
Fenobarbita
Primidon
l
Fenobarbital

Clonazepa
m
Lamotrigin

Klonazepa
m
Lamotrigin
Topiramat
Felbamat

2.) Ketogenic Diet high fat and protein; low carb

3.) Surgery/Vagal Nerve Stimulator

Epilepsy Syndromes
Typical Absence
Juvenile Myoclonic Epilepsy
Benign Epilepsy in Childhood with Centrotemporal

Spikes (Rolandic Epilepsy)

Treatment of Epilepsy
Drug treatment should be regular

Simple as possible
Minimum of side effects
Monotherapy
Changes should be made gradually
High initial dosages increases side effects
Rapid withdrawal carries the risk of provoking status
Always calculate the dosage according to the weight

Neurology Chapter of IAP

Lennox- Gastaut Syndrome

Age of onset:1-8 yrs ( 3-6 more common)
Clinically, A Triad:
1. Multiple seizure types(tonic most common)
2. Cognitive/ motor impairment
3. Slow spike and wave
Etiology: Usually symptomatic
30 % of patients with infantile spasms develop LGS.

Lennox- Gastaut Syndrome

Treatment:
AED (Valproate, benzodiazepines, lamotrigine. Topamax,
Felbamate)
Nonpharmacologic (Ketogenic diet, Vagus nerve stimulator)
Surgery
Prognosis: Very poor
Less than 15 % are seizure free
Impaired cognition and cerebral palsy are common

Typical Absence
Generalized seizures
Sudden discontinuation of activity with loss of

awareness, responsiveness, and memory, with an

abrupt recovery
Most common in the first decade, particularly ages 57 years of age

Typical Absence
Most patients with typical absence have normal

neurological exams and intelligence scores

Generalized spikes on EEG
Medications: Zarontin, Lamictal, Depakote

Typical Absence
Average age when seizures stop is 10 years old
Typical absence seizures generally have a good

prognosis resolves in approximately 80 percent of

cases

Juvenile Myoclonic Epilepsy

Myoclonic jerks, generalized tonic-clonic seizures, and

sometimes absence seizures

Usual age at onset of absence seizures is 7 to 13 years;
myoclonic jerks, 12 to 18 years; generalized tonic-clonic
seizures, 13 to 20 years

Juvenile Myoclonic Epilepsy

More likely to have seizures with sleep deprivation

and alcohol ingestion

Risk for seizures is lifelong
Photic stimulation often provokes a discharge.
Seizures are usually well-controlled with medication
(Depakote, Lamictal)

Benign Rolandic Epilepsy

Onset is between 3 and 13 years
Peak age of onset is 7-8 years
Resolves by age 16
Normal intelligence amd neurological exam
Seizures usually happen after falling asleep or before

awakening

Benign Rolandic Epilepsy

One-sided numbness of the face, one-sided clonic or

tonic activity involving the face, unable to speak,

drooling
No loss of consciousness
Can have secondarily generalized tonic-clonic seizures

Benign Rolandic Epilepsy

Spikes in midtemporal and central head region
More spikes in drowsiness and sleep and 30% of cases

show spikes only during sleep

Benign Rolandic Epilepsy

No treatment is necessary in patients with infrequent,

nocturnal, partial seizures

If seizures are frequent and/or disturbing to patient
and family, treatment with Tegretol or Trileptal
Good prognosis

Seizure Safety
Lay child on floor on his/her side
Do not restrain
Nothing in the mouth

Stesolith (rectal valium)

Call ambulance
May be confused or sleepy after

Seizures Precautions
Avoid heights >4 feet
No baths
Swimming should be supervised

Keep bathroom door unlocked

Teens no driving X 1 year

Other
Good to inform school of childs condition
May play sports if seizures well controlled
Videogames okay for most

What is the Impact of Epilepsy?

Society
Economy
Psychology

Prognosis
Depends on seizure type
Usually treat at lest 2 years
Absence 80% resolve
JME- respond well to treatment but need meds for

life
Neurologically abnormal often difficult to control
seizures

Prognosis
Injuries common in epilepsy (Generalized tonic-

clonic)
Lacerations, Fractures, Burns
SUDEP not very common (2.3 times more than general
population)

Febrile Seizures
Not epilepsy
Often a family history
Seizures only occur with fever in children age 6

months 6 years
Up to 4% of children

 Simple 1 brief seizure (genralized)

Complex prolonged; more than 1; focal

Developmental delay or family history of epilepsy

more develop epilepsy

1/3 have second (1/2 of that third have third)

 Increase risk of recurrence if 1st before 18 months or

lower temperature
Increase risk of epilepsy if >3 febrile
Testing unnecessary with simple
Focal need MRI
EEG in high risk
Treatment usually not necessary

Resources
www.epilepsygroup.com
www.epilepsyfoundation.org
www.epilepsyadvocate.com
www.paceusa.org
www.epilepsy.com