1. Chapter 27 Epilepsy Overview Signs and symptoms
Epidemiology and causes
Basic classification
Common syndromes
Evaluation and treatment
Antiepileptic medications and side effects
Chapter 27 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

2. Seizures
Transient disturbances of brain function, abnormal excessive excitation of cortical neurons
Affect as many as 1 in 10 children
Epilepsy: two unprovoked seizures at least 24 hours apart
Epilepsy: 4–10 per 1,000 children, variable severity
Increased risk of epilepsy for those with developmental disabilities
Chapter 27 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

3. Case Study: Patricia
7 years old: staring spells, attention lapses, lower grades
Pediatric neurologist elicited a spell
Sleep-deprived EEG: 3 Hz spike/wave pattern of absence seizures
Ethosuximide, increased until asymptomatic
2 years later, discontinued medication
Chapter 27 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

4. Epilepsy: Definitions and Classifications
Most resolve after several years
30%: incomplete response to medication
5%–10%: intractable seizures
Predisposing factors:
Injury to brain cells
Disruption of brain cell circuits
Alterations in intrinsic brain cell excitability
Categories/classifications:
ILAE CCT New
1. Focal Idiopathic Genetic
2. Generalized Symptomatic Structural/metabolic
3. Epilepsy syndromes Cryptogenic Unknown causes
Chapter 27 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

5. Epilepsy: Definitions and Classifications (continued)
Classification of epilepsy and syndromes
Classification: generalized and partial plus class of syndromes
5-axis:
Descriptive ictal terminology
Seizure type
Syndrome
Etiology
Impairment
Generalized seizures
1/3 of all pediatric cases
Types: absence, myoclonic, tonic, clonic, tonic-clonic, atonic
Partial seizures
Localized area of cerebral cortex
Types: simple partial, complex partial, complex partial with secondary generalization
Chapter 27 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

6.
Chapter 1 materials in Children with Disabilities, Seventh Edition, Online Course Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

7. Epilepsy: Definitions and Classifications (continued)
Epilepsy syndromes
Seizure disorders with shared factors
Two categories:
Localization-related epilepsies
Generalized-onset syndromes
Infantile spasms
Lennox-Gastaut syndrome
Landau-Kleffner syndrome
Juvenile myoclonic epilepsy
Benign epilepsy syndromes
Febrile seizures (not an epilepsy syndrome because seizures are provoked by fever)
Chapter 27 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

8. Conditions that Mimic Epilepsy
Do not include abnormal discharges of cortical neurons
Can be triggered, interrupted, or modified by external stimuli
Examples
Random sleep movements, parasomnia
Behavior disorders (rage attacks, staring spells)
Breath holding spells
Chapter 27 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

9. Diagnosis and Evaluation
Two or more unprovoked seizures at least 24 hours apart
Starts with clinical history/physical evaluation
Detailed description of event
EEG provides information on
Background electrical activity
Presence/absence of epileptic discharges
Response to seizure-activating procedures
Neuroimaging
Chapter 27 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

10. Treatment Prehospital management of acute seizures:
Shower/no bath, doors unlocked, no climbing, etc.
For grand mal seizure: flat surface, turned on side
More than 5 minutes long, give medication
Antiepileptic drugs (AEDs)
First line of treatment
Consider the risks
Mechanisms, selection, and use of AEDs
Mechanisms:
Modulation of voltage-gated channels
Modulation of calcium channels
Inhibiting glutamate
Two types: narrow and broad spectrum
Chapter 27 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

11. Treatment (continued)
AED adverse effects, 3 categories:
Dose-related
Idiosyncratic reactions
Chronic
Drug interactions
Anticipate, avoid certain combinations, adjust doses, monitor for effects, monitor blood levels
AED and bone metabolism
Chronic use may lead to abnormal bone metabolism
AEDs in adolescent women
Contraception less effective
Teratogenesis
Chapter 27 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

12. Treatment (continued)
Other treatment options
Ketogenic diet
High fat, low carbohydrate, low protein
Monitor urine and blood ketone levels
Surgical resection of epileptic focus
With clear focal lesion, 80%–85% excellent outcome
Palliative surgery
No seizure focus/multiple foci
Corpus callosotomy
Nonspecific interventions
Vitamins, minerals, complementary and alternative medicine
Chapter 27 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

13. Multidisciplinary Care
School performance and special education
Possible cognitive/learning difficulties
Teacher awareness important
Eligible for special education services
Psychosocial issues
Health-related quality of life, social stigma, and others
Affects whole family
Outcome
70%–80% achieve seizure control with AED(s)
2/3 weaned off AEDs after 2 years seizure-free
Idiopathic epilepsy: best outcome, then cryptogenic and symptomatic
Chapter 27 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

14. Summary
Epilepsy: recurrent seizures from abnormal electrical discharges in brain
Seizures
Generalized or partial
Most often treated with single AED
Multiple disabilities/symptomatic causes: prognosis for disabilities/underlying cause
Assess medication side effects/comorbidities
Chapter 27 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.