SEIZURE DISORDERS AND EPILEPSY

DEFINITION

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

ETIOLOGY

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

ETIOLOGY

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

ETIOLOGY

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

ETIOLOGY

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

EVALUATION

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

EVALUATION

CLASSIFICATION

EEG

Seizures are classified by their clinical signs or symptoms and electroencephalographic characteristics.

CLASSIFICATION

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:

CLASSIFICATION

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-

clonicoccurs most

frequently

CLASSIFICATION

Partial complex or mixed

Approximately 60 % of the cases are partial seizures

An individual may experience both generalized and partial seizures, which is called a mixed seizure disorder

GENERALIZED SEIZURESTONIC-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

GENERALIZED SEIZURESTONIC-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

GENERALIZED SEIZURESABSENCE

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

GENERALIZED SEIZURESABSENCE

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

GENERALIZED SEIZURESAKINETIC

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)

GENERALIZED SEIZURESAKINETIC

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 SEIZURESCOMPLEX

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 SEIZURESCOMPLEX

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 SEIZURESSIMPLE

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 SEIZURESSIMPLE

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

VENN DIAGRAM

Venn diagram

EPIDEMIOLOGY

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

EPIDEMIOLOGY

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

SEIZURE THERAPY

Anticonvulsant Surgery

Specific Treatments

Reassurance and Education

General Treatment

Seizure

SEIZURE THERAPYANTICONVULSANTS

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

SEIZURE THERAPYANTICONVULSANTS

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

SEIZURE THERAPYANTICONVULSANTS

Commonly prescribed medications include: Carbamazepine (Tegretol) Phenobarbital Valopric acid (Depakene) Phenytoin (Dilantin) Ethosuximide (Zarontin)

SEIZURE THERAPY ANTICONVULSANTS

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

SEIZURE 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

SEIZURE THERAPY SURGICAL INTERVENTION

The timing for surgery is determined by: the effectiveness of medication seizure severityThe impact of epilepsy on the child’s

functioning

SEIZURE 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

SEIZURE 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

EMERGENCY TREATMENT OF SEIZURES

1. Remain calm2. Time seizure episode3. 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

EMERGENCY 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

EMERGENCY 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

REFERENCE Case-Smith, J. (Ed.). (2010). Occupational

therapy for children (6th ed.). St. Louis: Mosby.