Genetic/idiopathic epilepsy. Characterized by absence seizures. Onset age 3-8. Frequent daily seizures with 3 Hz spike wave on EEG. Prognosis generally good - usually resolves spontaneously by teens
Juvenile myoclonic epilepsy
Genetic/idiopathic epilepsy. Characterized by myoclonic & generalized tonic-clonic seizures. Onset age 13-20. 4-5 Hz spike wave on EEG. Requires lifelong therapy
"Metabolic/structural epilepsy. Characterized by frequent seizures of any type (absence
Benign epilepsy with centro-temporal spikes
Genetic/idiopathic epilepsy. Characterized by simple partial & secondary generalized tonic-clonic seizures. Onset age 4-10. infrequent nocturnal seizures with centro-temporal spikes on EEG. Prognosis good - generally remits by teens
Temporal lobe epilepsy
Metabolic/structural epilepsy. Characterized by simple partial or complex partial seizures with onset at any age. May be associated with cognitive dysfunction or mesial temporal sclerosis. Temporal spikes on EEG. Prognosis poor - often refractory to medication. Surgery can often be very effective
"Cause of psychgenic seizures - generally precipitated by a traumatic event (""converted"" to a psychogenic seizure)"
"Generalized seizure. Involves brief loss of awareness - lasts 5-20 seconds. ""Staring spell"" with subtle movements (eye blinks or head nod) & no postictal period"
Simple partial seizure
Focal seizure. Characterized by aura. No alteration of responsiveness or consciousness (as opposed to complex partial seizure - in which loss of consciousness occurs. Signs & symptoms vary depending on the location of the seizure. Temporal lobe seizures - d�j� vu; olfactory or gustatory hallucinations; or epigastric rising sensations are common
Complex partial seizure
Focal seizure. Responsiveness is impaired. Lasts 1-2 minutes on average. Automatisms often occur - lip smacking & repetitive arm movements. May cause aphasias (temporal lobe). Amnesia & post-ictal confusion are characteristic (as opposed to absence seizures - in which there is amnesia but no post-ictal period). Frontal lobe - may cause thrashing & screaming - often misdiagnosed
Generalized seizure. Brief shocklike muscle contractions of the head; shoulders; and/or upper extremities. Consciousness is preserved. Precipitated by waking. May progress to generalized tonic-clonic seizure
Generalized tonic-clonic seizure
Generalized seizure. Involve loss of consciousness & fall with muscular rigidity (tonic) followed by rhythmic jerking (clonic). Respiration is inhibited leading to cyanosis. Lateral tongue bite is common & bowel/bladder incontinence often results. The patient is generally in a confused state following the seizure (postictal confusion)
"Generalized seizure. Sudden onset of loss of consciousness lasting a few seconds. Frequently associated with falls but may be more subtle (head drop). Injuries are common. May be called ""drop attacks"""
Secondary generalized tonic-clonic seizures
Occur when a focal seizure spreads to become generalized. Originating from frontal lobe - often cause thrashing seizures that can be misdiagnosed.
Often confused with seizures. Patients display normal EEG activity during the episode. Generally do not display characteristics of other types of seizures - may last much longer or lack stereotypical movements
Treatment for partial seizures & secondary generalized seizures
Traditionally carbamazepine or phenytoin (less commonly prescribed now due to side effects). Levetiracetam; lamotrigine; & oxcarbazepine are newer 1st-line drugs
Too much excitation: sodium & calcium = excitatory inward currents; glutamate & aspartate = excitatory NTs. Too little inhibition: inward chloride & outward potassium = inhibitory currents; GABA = inhibitory NT
AEDs that are hepatic enzyme inhibitors
AEDs that do not affect hepatic enzymes
AED-induced hemorrhagic disease
Occurs in newborns with mothers on AEDs. Characterized by bleeding in the 1st 24 hours of life due to a deficiency in tvitamin K-dependent clotting factors. Preventable with administration of vitamin K - to the mother (PO daily during the last month of pregnancy) or the child (1 mg IM at birth)