Childhood epilepsy

• What is epilepsy?


  Abnormal and excessive neuronal activity = recurrent, unprovoked seizures
• How can epilepsy be characterised?

  Focal or generalised
• What are the different seizure types?

  Tonic-clonic

  Absense

  Myoclonic

  Atonic

  Tonic
• What are some risk factors for epilepsy?

  Genetic influences

  Structural/metabolic conditions

  Immune disorders
• What are some structural/metabolic condition risk factors for epilepsy?


  Cerebral malformations

  Neurocutaneuous syndromes

  Stroke and vascular disease

  Traumatic brain injury

  Infections

  Metabolic disorders
• What are some immune disorder risk factors for epilepsy?


  Autoimme dieases e.g. SLE

  Inflammation
• What happens if there is an overactivation of excitatory neurotransmitters?


  Increased Ca2+ influx = increased neuronal firing
• What are the 3 main types of epilepsy?

  Focal seizures

  Generalised seizures

  Unknown onset seizures
• What are the 3 main types of focal seizures?

  Focal aware seizures

  Focal impaired awareness seizures

  Focal to bilateral tonic-clonic seizures
• What are focal aware seizures?


  Alteration in consciousness or awareness

  Experience motor, sensory, autonomic or psychic symptoms
• What are focal impaired awareness seizures?


  Change or loss of consciousness

  Experience lip smacking, hand rubbing or repetitive movements
• What are focal to bilateral tonic-clonic seizures?


  Begins in one hemisphere of the brain -> rapidly involves both hemispheres = tonic-clonic seizure
• What are the different types of generalised seizures?

  Tonic-clonic

  Absence

  Myoclonic

  Tonic

  Atonic

  Clonic
• What is the characterisation of tonic-clonic seizures?


  Stiffening of the body (tonic) -> jerking movements (clonic)
• What is the characterisation of absence seizures?


  Lapses in consciousness

  Appears to 'zone out'
• What is the characterisation of myoclonic seizures?


  Sudden jerks or twitches of muscles or muscle groups
• What is the characterisation of tonic seizures?


  Sudden onset of increased tone in extensor muscles
• What is the characterisation of atonic seizures?


  Sudden loss of muscle tone = falling
• What is the characterisation of clonic seizures?


  Rhythmic jerking without tonic component
• What is classifed as an unknown onset seizure?


  Onset is not observed or known

  Can be reclassified if more info becomes available
• What are the first line investigations for epilepsy?

  EEG

  MRI
• What are some other investigations for epilepsy?

  Video EEG monitoring

  PET/SPECT scans
• What are some ddx for epilepsy?


  Syncope

  Psychogenic non-epileptic seizures

  Transient ischaemic attack
• What is the first line treatment for focal onset epilepsy in children?


  Carbamazepine or lamotrigine
• What is the first line treatment for generalised onset epilepsy in children?


  Levetiracetam or valproate
• What is the first line treatment for epilepsy in adults?

  Carbamazepine or lamotrigine
• What happens if seizures are not controlled by one anti-epileptic drug?


  Introduction of a second one
• How is epilepsy managed pharmacologically?


  Using anti-epileptic drugs
• How is epilepsy managed surgically?


  Resective surgery (e.g. temporal lobectomy)

  Disconnection procedures (e.g. corpus callosotomy)

  Neuromodulation techniques (e.g. deep brain stimulation)
• What diet could help reduce epileptic seizures?

  Ketogenic
• What are some physical complications of epilepsy?

  Status epilepticus

  Sudden unexpected death in epilepsy

  Injury from seizures
• What are some psychological complications of epilepsy?

  Mental health disorders

  Cognitive impairement
• What are some social complications of epilepsy?


  Social isolation

  Educational underacheivement and unemployment

  Driving restrictions