Epilepsy Diagnosis and Care Epilepsy Diagnosis and Care for Childrenfor Children

May 8, 2014May 8, 2014

Elia M Pestana Knight, MD Elia M Pestana Knight, MD

Staff PhysicianStaff Physician

Cleveland Clinic Epilepsy CenterCleveland Clinic Epilepsy Center

Epidemiology of Epilepsy Epidemiology of Epilepsy

Epilepsy affects 50 million people worldwide.

What is epilepsy?What is epilepsy?

• Epilepsy is a disease of the brainEpilepsy is a disease of the brain

• The main symptom of epilepsy is The main symptom of epilepsy is seizuresseizures

• Epilepsy is characterized by Epilepsy is characterized by recurring or repeating seizures recurring or repeating seizures caused by sudden changes in the caused by sudden changes in the electricity of the brainelectricity of the brain

• Sometimes patients with seizures do Sometimes patients with seizures do not have epilepsy. not have epilepsy.

Besides epilepsy what other Besides epilepsy what other conditions can cause seizuresconditions can cause seizures

• High feverHigh fever

• Some medicationsSome medications

• Head injury or concussionHead injury or concussion

• Fainting or syncopeFainting or syncope

• Some medical conditions such as:Some medical conditions such as:

- DiabetesDiabetes

- Heart diseaseHeart disease

Epilepsy: Initial DescriptionEpilepsy: Initial Description

• Ancient Ancient BabyloniansBabylonians

• Over 3000 years Over 3000 years ago (1000 BC)ago (1000 BC)

• In a medical text In a medical text book “Sakikku” book “Sakikku” (All Diseases) (All Diseases)

• Described Described different epileptic different epileptic seizure typesseizure types

What are the main types of What are the main types of epilepsyepilepsy

• Focal or partial epilepsyFocal or partial epilepsy

• Generalized epilepsyGeneralized epilepsy

How doctors diagnose How doctors diagnose epilepsy?epilepsy?

• Medical History and ExaminationMedical History and Examination

• TestsTests- ElectroencephalogramElectroencephalogram- Brain imaging (Brain MRI, CT scan, PET Brain imaging (Brain MRI, CT scan, PET

scan, etc.)scan, etc.)- Blood tests looking for infections, high Blood tests looking for infections, high

or low blood sugar, lead poisoning, or low blood sugar, lead poisoning, anemia, liver and kidney functions, anemia, liver and kidney functions, metabolic and genetic testsmetabolic and genetic tests

- Neuropsychological tests: intellectual Neuropsychological tests: intellectual abilities, behavior, etc.abilities, behavior, etc.

Medical historyMedical history

• What the seizures look like?What the seizures look like?

• Are factors that could indicate that Are factors that could indicate that cause of the epilepsy? cause of the epilepsy?

• How is the child doing at school?How is the child doing at school?

• Is there a history of other Is there a history of other neurological problems such as neurological problems such as difficulties developing or learning or difficulties developing or learning or difficulties walking?difficulties walking?

• Is there a family history of epilepsy?Is there a family history of epilepsy?

What the seizures look like?What the seizures look like?

What the seizures look like?What the seizures look like?

What the seizures look like?What the seizures look like?

AurasAuras

• The earliest part of a seizure.

• It may be the only part remembered by the patient.

• Not all patients have auras.• Not all auras lead to clinical seizure activity

• Auras do not usually have an observable clinical manifestation.

- Usually felt by the patient prior to the clinical manifestation of seizure activity.

- Can present with symptoms such as nausea, blurred vision, feeling “funny” or “weird”. Some patients find it difficult to describe their aura.

Post-Ictal PeriodPost-Ictal Period

• It is the period of time that follows a It is the period of time that follows a seizureseizure

• Patients can be tired or sleepy or Patients can be tired or sleepy or complain of a headache or more complain of a headache or more rarely being unable to move one part rarely being unable to move one part of the bodyof the body

• It typically last 5-10 minutesIt typically last 5-10 minutes

Test: Electroencephalogram Test: Electroencephalogram (EEG)(EEG)

• Main test for Main test for diagnosis or epilepsy diagnosis or epilepsy and seizuresand seizures

• Electrodes attached Electrodes attached to the scalp to read to the scalp to read brain wave activitybrain wave activity

• Does not hurt!!Does not hurt!!

• EEG has some EEG has some variationsvariations

EEG trace: AwakeEEG trace: Awake

EEG trace: SleepEEG trace: Sleep

Test: Brain MRITest: Brain MRI

• Shows the Shows the structure of the structure of the brainbrain

• Persons getting Persons getting an MRI are not an MRI are not getting radiation getting radiation exposureexposure

• Brain MRI does Brain MRI does not hurt!not hurt!

Brain MRI Brain MRI

Test: PET scanTest: PET scan

• It is used to detect It is used to detect abnormalities in the abnormalities in the functioning of the functioning of the brainbrain

• It helps to look for It helps to look for damaged areas of the damaged areas of the brain mainly when the brain mainly when the brain MRI is normalbrain MRI is normal

• Not all patients Not all patients diagnosed with diagnosed with epilepsy need a PET epilepsy need a PET scanscan

PET scanPET scan

What to do if somebody is What to do if somebody is having a convulsion?having a convulsion?

• DOSDOS- Position the patient on his/her side (the A of Position the patient on his/her side (the A of

ABC)ABC)- watch for Breathing (the B of ABC)watch for Breathing (the B of ABC)- Time the seizureTime the seizure- Move dangerous objects from the range of the Move dangerous objects from the range of the

patient patient - Place a small folded blanked or other Place a small folded blanked or other

cushioning under the head IF is moving cushioning under the head IF is moving violently or at risk for head injuryviolently or at risk for head injury

- Call an ambulance if necessary, do not drive Call an ambulance if necessary, do not drive with the patient who is having a seizure, with the patient who is having a seizure, unless you are very near the hospital or there unless you are very near the hospital or there is poor ambulance service in your areais poor ambulance service in your area

- Allow the child to sleep after the seizures if Allow the child to sleep after the seizures if neededneeded

What to do if somebody is What to do if somebody is having a convulsion?having a convulsion?

• DON’TSDON’TS

- Do NOT lift or shake the patientDo NOT lift or shake the patient

- Do NOT restrainDo NOT restrain

- DO NOT put anything in the mouthDO NOT put anything in the mouth

- DO NOT drive with the patient who DO NOT drive with the patient who is having a seizureis having a seizure

When to call an ambulance?When to call an ambulance?

• 1. 1. The child stops breathing. The child stops breathing.

• 2. 2. The skin looks blue. This first The skin looks blue. This first may be noticed around mouth or nail may be noticed around mouth or nail beds. beds.

• 3.3. The seizure lasts more than 5 The seizure lasts more than 5 minutes (even if color is good and minutes (even if color is good and breathing is normal). breathing is normal).

QUESTIONS?QUESTIONS?

• Please type any questions you have Please type any questions you have for Dr. Pestana Knight into the “What for Dr. Pestana Knight into the “What should we talk about on air?” box should we talk about on air?” box found below the video screen.found below the video screen.