Overview of Seizures and Epilepsy: Lucyna Zawadzki, MD Director of Pediatric Epilepsy Program UWHC Madison

Overview of Seizures and
Epilepsy
Lucyna Zawadzki, MD
Director of Pediatric Epilepsy Program
UWHC Madison
Learning Objectives
• 1. After completing this activity, the learner will be able to define
current prevalence and trends related to epilepsy and seizures.
• 2. After completing this activity, the learner will be able to describe
current treatments-including alternative care and new methods of
drug delivery for children and adolescents with epilepsy.
• 3. After completing this activity, the learner will be able to propose
a plan of care for a student with epilepsy, including activity
restrictions.
• 4. After completing this activity, the learner will be able to describe
and implement effective strategies for communicating and
collaborating with health care providers around care for students
with epilepsy.
Definitions
• Epileptic seizure- a transient occurrence of signs
and/or symptoms due to abnormal excessive pattern
of excitability and synchrony among neurons in select
brain areas.
• Epilepsy- persistent epileptogenic abnormality of the
brain that is able to spontaneously generate
paroxysmal activity
– Recurrent seizures (two or more)which are not provoked
by systemic or acute neurologic insults
• Epilepsy syndrome- complex of signs and symptoms
that define a unique epileptic condition
Epilepsy Facts
• 1 in 26 people will develop epilepsy during
their lifetime
• More common then autism, cerebral palsy,
MS and Parkinson’s disease combined
• Epilepsy accounts for 1% of the global burden
of disease ( WHO), equal to burden of lung ca
in men and breast ca in women
Risk of Epilepsy
• Highest at extremes of life ( 1st year of life
and in elderly)
• Risk of having at least 1 seizure in lifetime is
10%, and 1/3 will develop epilepsy
• 2.2 mln of Americans
• 65 mln people worldwide
Incidence and Prevalence in Pediatric
Population
• 5 per 1000 in school-aged children
• 1.5 per 1000 in preschool-aged children
• Affects more then 300,000 children under age
15
• >90,000 not adequately treated
Seizure Classification
• International League Against Epilepsy (ILAE)

2010 revised classification
• Based on known causes of epilepsy:
– Genetic
– Structural/metabolic
– Unknown cause
Generalized Seizures
Tonic–clonic (in any combination)
Absence
Typical
Atypical
Absence with special features
Myoclonic absence
Eyelid myoclonia
Myoclonic
Myoclonic
Myoclonic atonic
Myoclonic tonic
Clonic
Tonic
Atonic
Focal Seizures
• Without impairment of consciousness or awareness
• With observable motor or autonomic components.
This roughly corresponds to the concept of “simple
partial seizure.
• Involving subjective sensory or psychic phenomena
only. This corresponds to the concept of an aura.
• With impairment of consciousness or awareness
(dyscognitive). This roughly corresponds to the
concept of complex partial seizure.
• Evolving to a bilateral, convulsive seizure (involving
tonic, clonic, or tonic and clonic components). This
expression replaces the term “secondarily generalized
seizure.”
Epileptic Syndromes
• Defined by:
– Clinical features
– Seizure type(s)
– Age of onset
– Family history
– EEG findings
– Diagnostic Investigations
– Treatment
– Prognosis
Electroclinical syndromes arranged by
age at onset
Neonatal period
Benign familial neonatal epilepsy (BFNE)
Early myoclonic encephalopathy (EME)
Ohtahara syndrome
Infancy
Epilepsy of infancy with migrating focal seizures
West syndrome
Myoclonic epilepsy in infancy (MEI)
Benign infantile epilepsy
Benign familial infantile epilepsy
Dravet syndrome
Myoclonic encephalopathy in nonprogressive disorders
• Childhood
• Febrile seizures plus (FS+) (can start in infancy)
• Panayiotopoulos syndrome
• Epilepsy with myoclonic atonic (previously astatic) seizures
• Benign epilepsy with centrotemporal spikes (BECTS)
• Autosomal-dominant nocturnal frontal lobe epilepsy
(ADNFLE)
• Late onset childhood occipital epilepsy (Gastaut type)
• Epilepsy with myoclonic absences
• Lennox-Gastaut syndrome
• Epileptic encephalopathy with continuous spike-and-wave
during sleep (CSWS)
• Landau-Kleffner syndrome (LKS)
• Childhood absence epilepsy (CAE)
• Adolescence – Adult
• Juvenile absence epilepsy (JAE)
• Juvenile myoclonic epilepsy (JME)
• Epilepsy with generalized tonic–clonic seizures
alone
• Progressive myoclonus epilepsies (PME)
• Autosomal dominant epilepsy with auditory
features (ADEAF)
• Other familial temporal lobe epilepsies
• Less specific age relationship
• Familial focal epilepsy with variable foci
(childhood to adult)
• Reflex epilepsies
• Distinctive constellations
• Mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE with HS)
• Rasmussen syndrome
• Gelastic seizures with hypothalamic hamartoma
• Hemiconvulsion–hemiplegia–epilepsy
• Epilepsies that do not fit into any of these diagnostic categories can be distinguished first on
the basis of the presence or absence of a known structural or metabolic condition
(presumed cause) and then on the basis of the primary mode of seizure onset (generalized
vs. focal)
• Epilepsies attributed to and organized by structural-metabolic causes
• Malformations of cortical development (hemimegalencephaly, heterotopias, etc.)
• Neurocutaneous syndromes (tuberous sclerosis complex, Sturge-Weber, etc.)
• Tumor
• Infection
• Trauma
• Angioma
• Perinatal insults
• Stroke
• Etc.
• Epilepsies of unknown cause
• Conditions with epileptic seizures that are traditionally not diagnosed as a form of epilepsy
per se
• Benign neonatal seizures (BNS)
• Febrile seizures (FS)
Not everything that looks like a seizure
is a seizure
• Migraine headache
• Syncope
• Psychogenic seizure
• Behavioral outbursts
• Breath holding spells
• Tics
• Sleep disorders
Diagnosing Epilepsy
• Detailed history and physical examination
• EEG, video EEG
• Imaging ( CT, MRI, PET)
History
• Precipitating factors
• Aura
• Area of body first involved
• Progression of activity
• Specific activity observed (head or eye deviation, type
of movement or posturing)
• Level of consciousness
• Incontinence
• Apnea or cyanosis
• Duration of seizure
• Postictal symptoms ( confusion, hemiplegia, aphasia)
Seizure Triggers
• Missed dose of medication
• Sleep deprivation
• Illness
• Stress, anxiety, overstimulation
• Hormonal changes
• Alcohol and drugs of abuse
• Hyperventilation
• Flashing lights
• Temperature extremes
• dehydration
Spectrum of Severity
Psychosocial effects of epilepsy
• Stigma of epilepsy
• Compromised quality of life
• Lower self-esteem
• “Vulnerable child”
• High incidence of depression, anxiety, ADHD
and learning problems
• Adverse effects of medications
• Parental stress

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Overview of Seizures and

• International League Against Epilepsy (ILAE)

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