Manual Outcome of Childhood Epilepsies (Progress in Epileptic Disorders)

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Myoclonic seizures are sudden and brief muscle contractions that may occur singly, repeatedly or continuously. They may involve the whole body in a massive jerk or spasm, or may only involve individual limbs or muscle groups.

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If they involve the arms they may cause the person to spill what they were holding. If they involve the legs or body the person may fall. Tonic seizures are characterised by generalised muscle stiffening, lasting seconds. Tonic seizures often occur during sleep. When tonic seizures occur suddenly with the child awake they may fall violently to the ground and injure themselves. Fortunately, tonic seizures are rare and usually only occur in severe forms of epilepsy. Atonic seizures produce a sudden loss of muscle tone which, if brief, may only involve the head dropping forward 'head nods' , but may cause sudden collapse and falling 'drop attacks'.

From these descriptions, it can be appreciated that the exact type of seizure may be difficult for a witness to determine. For example, a seizure with stopping and staring could be a complex partial focal seizure or an absence generalised seizure.

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Determination of the exact type of seizure is important and is obtained from patient and observer descriptions, home video recordings, EEG testing and sometimes video EEG monitoring. It is also important to remember that many episodic behaviours and disorders in children can mimic epilepsy, including breath holding spells, sleep movements, day dreaming, fainting, migraine, heart and gastrointestinal problems, and psychological problems. The most important aspect of the evaluation of a child or adolescent with a suspected seizure disorder is the clinical assessment by a specialist paediatrician or child neurologist.

This clinical assessment typically involves obtaining a detailed description of the child's episodes, medical history, development, learning and behaviour.

Recent advances in epilepsy

Crucial outcomes of the assessment are to determine:. Paediatricians are often the most accessible and experienced child health specialists when it comes to assessing a child with a suspected seizure disorder. The Neurology Department provides a consultative service to general practitioners and paediatricians for children with uncertain, poorly characterised or uncontrolled epilepsy. Special tests are performed in many children with epilepsy. Tests are not performed to determine if a child has epilepsy or not.

This is a clinical judgement made by a specialist. Children who present to their doctor or an emergency department with a first major seizure will usually have a blood test to check the sugar, calcium, magnesium and salt levels, as abnormalities of body chemistry can lead to seizures. In a child with epileptic seizures, a recording of brainwave activity EEG and a picture of the brain MRI may be obtained, where necessary.

In special circumstances, some children with seizures may have an examination of the spinal fluid lumbar puncture , metabolic testing of the blood or urine, or genetic tests. Children with seizures do not always need treatment. In many instances, explanation and reassurance by the doctor and advice about safety precautions and first aid management for possible future seizures is all that is required. Many children with epilepsy have only a single seizure and do not require medication.

For children with recurrent seizures, the decision to prescribe medication depends on the type of epilepsy and seizure, the age of the child, the presence of associated developmental and behavioural problems, and the attitudes and lifestyle of the child and family. Medical treatment usually means prescription of antiepileptic medication to prevent further seizures, but occasionally medication is prescribed to treat seizures only when they occur.

For children with uncontrolled epilepsy, that is epilepsy in which seizures are not adequately controlled by medication, other treatments are available, including:. The Royal Children's Hospital Melbourne. About epilepsy. About epilepsy About seizures Clinical assessment of seizures Diagnostic tests Treatments Other resources Many people in the community have seizures. Epilepsy can be thought of in terms of either: the site of seizure origin in the brain generalised or focal seizures , or the underlying cause Genetic epilepsies formerly called idiopathic or primary epilepsies occur in an otherwise normal person and are due to a genetic predisposition to seizures.

Epilepsy symptoms

Focal seizures without impaired consciousness Formerly called simple partial seizures, these arise in parts of the brain not responsible for maintaining consciousness, typically the movement or sensory areas. Young children might have difficulty describing such sensations or may be frightened by these Focal seizures with impaired consciousness Formerly called complex partial seizures, these arise in parts of the brain responsible for maintaining awareness, responsiveness and memory, typically parts of the temporal and frontal lobes.

Focal seizures becoming bilaterally convulsive Focal seizures may progress due to spread of epileptic activity over one or both sides of the brain. Tonic-clonic seizures Tonic-clonic seizures produce sudden loss of consciousness, with the person commonly falling to the ground, followed by stiffening tonic and then rhythmic jerking clonic of the muscles. Absence seizures Absence seizures produce a brief cessation of activity and loss of consciousness, usually lasting seconds. Myoclonic seizures Myoclonic seizures are sudden and brief muscle contractions that may occur singly, repeatedly or continuously.

Tonic seizures Tonic seizures are characterised by generalised muscle stiffening, lasting seconds. Atonic seizures Atonic seizures produce a sudden loss of muscle tone which, if brief, may only involve the head dropping forward 'head nods' , but may cause sudden collapse and falling 'drop attacks'. According to the United Kingdom's Epilepsy Society, nonepileptic seizures are not due to electrical activity in the brain. The causes can be physical, emotional, or psychological.

There are also different types of seizure. Seizures may vary between people with epilepsy, so in two individuals, the condition may look different. For this reason, it can be called a spectrum disorder. Epilepsy can affect a person's life in multiple ways, and the outlook will depend on various factors.

A study published in suggested that people with severe epilepsy who continue to experience seizures were more likely to have difficulties with cognitive ability and brain function. Longer periods of remission were linked with fewer cognitive problems. A review published in concluded that there may be a "mild but measurable" decline in some people in intellectual performance" of adults and children. However, the researchers point out that there is little reliable research in this area, and that "Due to many confounding variables, the effect of seizures per se is difficult to estimate, but appears limited.

If there is a risk, say the authors, it appears to be higher among those with generalized symptomatic types of epilepsy, with frequent seizures that started at an early age, and a high level of antiepileptic drug use. Recent studies have looked at cognitive changes in children as they age, either with or without epilepsy. Results suggest that epilepsy is associated with worse cognitive outcomes. The risk appears to be greater if the person also has a mental illness.

Suicides, accidents, and assaults accounted for Most people affected by these had also been diagnosed with a mental disorder. Our study also highlights the importance of suicide and non-vehicle accidents as major preventable causes of death in people with epilepsy. Article last updated by Yvette Brazier on Wed 13 December Visit our Epilepsy category page for the latest news on this subject, or sign up to our newsletter to receive the latest updates on Epilepsy.

All references are available in the References tab. Epilepsy , March Epilepsy fast fact. Epilepsy statistics , March Engel, J.

Definitions and classification

Epilepsy 1st ed. Facts and Statistics , March Epilepsy Society. Fazel, S. Premature mortality in epilepsy and the role of psychiatric comorbidity: a total population study [Abstract]. The Lancet, , Heinzen, E. Goldstein, D. Nonepileptic seizures. Prilipko, L. Atlas epilepsy care in the world 1st ed. Geneva: World Health Organization.

Seizure First Aid , March Sibilia, V. Cognitive outcome after epilepsy surgery in children: A controlled longitudinal study. Epilepsy Behav. Thompson, P. Cognitive decline in severe intractable epilepsy. Epilepsia, 46 11 ,— Treatments for epilepsy. Vingerhoets, G.

Dr. Eric Kossoff - 'A Century of Progress: Ketogenic Diets for Epilepsy in Children and Adults'

Cognitive effects of seizures. Seizure: European Journal of Epilepsy, 15 4 , — MLA Nordqvist, Christian. MediLexicon, Intl. APA Nordqvist, C. MNT is the registered trade mark of Healthline Media. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional.

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Epilepsy is a neurological disorder. Primary symptoms commonly include seizures. Seizures have a range of severity depending on the individual. Treatments include anti-seizure medications. Epilepsy is a neurological condition. A person with epilepsy will have recurrent seizures. Related coverage.