S EIZURE D ISORDERS AND E PILEPSY

D EFINITION Epilepsy is a chronic neurologic condition of recurrent seizures that occur with or without the presence of other brain abnormalities A seizures may be defined as temporary, involuntary change of consciousness, behavior, motor activity, sensation, or automatic functioning

E TIOLOGY Provoked seizures occur frequently in children as a result of :  Fever  Acute illness  CNS infection  After TBI

E TIOLOGY A seizure starts with an excessive rate and hypersynchrony of discharges from a group of cerebral neurons that spreads to the adjoining cells. Called the epileptogenic

E TIOLOGY Some seizures may be directly attributed to the factor or factors that trigger the seizure, for ex. acute factors often described :  Hypoglycemia  Fever  Trauma  Hemorrhages  tumors  Infections  anoxia

E TIOLOGY Other seizures may be attributed to :  previous scarring and structural damage  Hormonal change Many seizures, esp. in children, have no discernible underlying disease and are therefore idiopathic

E VALUATION A child who has a seizure must undergo a thorough evaluation to determine the factors that caused it  A family history  Medical history  Developmental history  EEG Must be completed to help determine the type of seizure

Clinical presentation is quite variable  Age of onset  Seizure type  Interracial condition  EEG  Outcome Evaluate the:  the epileptic syndrome  Possible etiology The seizure type and syndrome type determine the  Specific appropriate treatment  Further evaluation E VALUATION

C LASSIFICATION EEG Seizures are classified by their clinical signs or symptoms and electroenceph alographic characteristics.

C LASSIFICATION Generalized seizures Which involve the entire cerebral cortex Partial seizures Which begin in a single location and remain limited or spread to become more generalized The two major types of seizures according to this form of categorization are:

C LASSIFICATION Generalized seizures Tonic-clonic Absence Atypical absence Myoclonic Atonic forms Partial seizures Simple Complex The most common type of seizures disorder found in childhood Of the generalized seizures the Tonic-clonic occurs most frequently Of the generalized seizures the Tonic-clonic occurs most frequently

C LASSIFICATION Approximately 60 % of the cases are partial seizures An individual may experience both generalized and partial seizures, which is called a mixed seizure disorder

G ENERALIZED SEIZURES T ONIC - CLONIC A child having a tonic-clonic seizure may have an aura, a sensation, that the seizure is about to begin This nonspecific seizure can occur at any age and involves excessive neuronal firing from both hemispheres in a symmetric pattern

G ENERALIZED SEIZURES T ONIC - CLONIC This is usually followed by loss of consciousness, during which the body becomes rigid, or tonic, and then rhythmic clonic contractions of all the extremities occur Incontinence is common The seizure may last 5 minutes and is followed by a postictal period that may last 1 to 2 hours, during which the child is drowsy or in a deep sleep

G ENERALIZED SEIZURES A BSENCE Characterized by a momentary loss of awareness and the absence of motor activity except eye blinking or rolling There is no aura The seizure usually lasts less than 30 seconds There is no postictal period The onset of these seizures occur in the first decade of life

G ENERALIZED SEIZURES A BSENCE  Abrupt interruption of an activity  Glazed look  Stares  Unawareness of surroundings characterize a child having an absence seizure  This may be mistaken for daydreaming  Uncommon in children and early adolescents, accounting for only 5% of all seizures

G ENERALIZED SEIZURES A KINETIC This MILD form of generalized seizure consist of contractions by single muscle or small group of muscles In this MILD form of generalized seizure, the primary problem is a loss of muscle tone Children rarely have serious seizures for an extended period (30 minutes or longer)

G ENERALIZED SEIZURES A KINETIC These extended seizure are called status epilepticus and require medical management to maintain body functions and hydration Intravenous anticonvulsant medication is also indicated to treat this condition

PARTIAL SEIZURES COMPLEX Usually originate in the temporal lobe Children may show automatic reaction such as lip smacking, chewing, and buttoning and unbuttoning of clothes These seizure are focal The characteristic are similar to those of absence seizures

PARTIAL SEIZURES COMPLEX The individual may appear to be:  confused  disorganized  may have sensory experience, such as smelling and tasting items not the environment and hearing sounds of various types

PARTIAL SEIZURES S IMPLE Usually involve the motor cortex Result in clonic activity of the face or extremities o The typical seizure includes:  Nighttime awakenings  Twitching of facial muscles; this twitching interferes with speech and spreads to the hands

PARTIAL SEIZURES S IMPLE Psychic symptoms include :  Visual hallucinations  Illusions  Auditory hallucinations  Olfactory sensations

INFANTILE SPASM Pose of serious threat to development Typically begin at 6 months and disappear by 24 months During this time, development appears to stop and skills may be lost

INFANTILE SPASM Early treatment with adrenocorticotropic hormone can inhibit the seizure activity The effects on development are almost inevitable More than 90% of children with known cause for their seizures have intellectual impairments

V ENN D IAGRAM Venn diagram

E PIDEMIOLOGY The incidence and prevalence of seizures are difficult to estimate The incidence of generalized seizures, including (tonic-clinic, absence, and myoclonic seizures), has been reported to be approximately 2.5 per 1000 children

E PIDEMIOLOGY The incidence of partial seizures has been reported to be 1.7 to 3.6 per 1000 Unclassified and mixed seizures account for 2 per 1000 Many of these unclassified and mixed seizures may occur infrequently and cease as the child mature

S EIZURE THERAPY Anticonvulsant Surgery Specific Treatments Reassurance and Education General Treatment Seizure

S EIZURE THERAPY A NTICONVULSANTS Anticonvulsive medications are administered in an attempt to control the seizures In theory, these medications increase the intensity required to trigger the seizure or eliminate the recruitment of surrounding cells

S EIZURE THERAPY A NTICONVULSANTS Weinstein and Gaillard have described some of the common side effects of these anticonvulsive medications, including:  Cataracts  Weight gain  High blood pressure  Pathologic fractures  Drowsiness  Hair loss or gain  Nausea  Liver damage  Vomiting  Gum enlargement  Hyperactivity  Anorexia

S EIZURE THERAPY A NTICONVULSANTS Commonly prescribed medications include:  Carbamazepine (Tegretol)  Phenobarbital  Valopric acid (Depakene)  Phenytoin (Dilantin)  Ethosuximide (Zarontin)

S EIZURE THERAPY A NTICONVULSANTS Balancing the dosage of anticonvulsant medications can be a difficult process and is often repeated at various times as the child grows and matures Antiepileptic medications is often withdrawn or reduced in dose if the child has been seizure-free with a normal EEG for at least 2 years Withdrawal is done slowly and with caution, and health care workers are often asked to monitor the child closely during the withdrawal period

S EIZURE THERAPY SURGICAL INTERVENTION Surgical intervention is used if adequate control of the seizures cannot be achieved with medications effective by reducing the seizure focus of the brain, particularly in complex partial seizures arising from the temporal lobe

S EIZURE THERAPY SURGICAL INTERVENTION The timing for surgery is determined by: the effectiveness of medication seizure severity The impact of epilepsy on the child’s functioning

S EIZURE PROGNOSIS Even with optimal care, only about 50% to 75% of children can achieve complete seizure control with medication Having a seizure can be frightening to the child and those around him or her

S EIZURE PROGNOSIS Most children with seizure disorders have:  Normal intelligence scores  Achieve seizure control with a single antiepilepsy drug  Lead typical life The prognosis depends primarily on the type of seizure and the underlying brain pathology

E MERGENCY TREATMENT OF SEIZURES 1. Remain calm 2. Time seizure episode 3. Protect child during seizure:  Don’t attempt to restrain child or use force  If child is standing or sitting in wheelchair at beginning of attack, ease child down so that he or she will not fall; when possible, place cushion or blanket under child  Don’t put anything in child’s mouth  Loosen restrictive clothing  Prevent child from hitting hard or sharp objects that might cause injury during uncontrolled movements  Remove objects  Pad objects  Move furniture out of the way  Allow seizure to end without interference

E MERGENCY TREATMENT OF SEIZURES 4. When seizure stops:  Check for breathing; if not present, use mouth-to-mouth resuscitation  Time postictal period  Keep child on his/ her side  Check mouth, head, and body for possible injuries 6. Remain with child

E MERGENCY TREATMENT OF SEIZURES 7. Seek help if:  the child is not breathing  there is evidence of injury  child is diabetic  seizure lasts for more than 5 minutes  pupils are not equal after seizure  child vomits for more than 30 minutes after seizure  Child cant be awakened and is unresponsive to pain \seizure occur in water  This is the child’s first seizure

R EFERENCE Case-Smith, J. (Ed.). (2010). Occupational therapy for children (6th ed.). St. Louis: Mosby.