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WHAT ARE THE MAIN TYPES OF EPILEPSY?
As we have already discussed, there are a number of different seizure types (Chapter 3) and numerous different types (or syndromes) of epilepsy. As most epilepsy begins in childhood and adolescence, it is not surprising that most of the syndromes refer to children. This chapter will provide a fairly comprehensive list of the various types of epilepsy which exist and will discuss a few of the commoner types in some detail. Further information on the rarer types of epilepsy can be obtained from your neurologist or paediatrician/physician with a special interest in epilepsy. It is important to bear in mind that the classification given here is not fixed and will certainly change to some degree as the years go by.
The first subdivision relates to age. This leads to four subgroups:
newborn babies
infancy and childhood
childhood
childhood and adolescence
Each of these four groups is shown below.
Epileptic syndromes in newborn babies
*Benign neonatal convulsions
Early myoclonic encephalopathy
Other epileptic syndromes in newborn babies
Epileptic syndromes in infancy* and childhood
(*Infancy implies that period from 1-12 months of life.)
* Febrile convulsions * Infantile spasms
Benign myoclonic epilepsy in infants
Severe myoclonic epilepsy in infants
* Myoclonic epilepsy in non-progressive encephalopathies
* Epileptic seizures in children with inborn errors of metabolism
*Myoclonic – astatic epilepsy of early childhood
*The Lennox ? Gastaut Syndrome
Epileptic syndromes in childhood
*Childhood absence epilepsy
*Epilepsy with myoclonic absences
* Epilepsy with generalised convulsive seizures
*Benign partial epilepsies of childhood
*Benign partial epilepsy with centro-temporal spikes
*Benign epilepsy of childhood with occipital spikes
*Benign psychomotor epilepsy
*The Landau – Kleffner Syndrome
* Epilepsy with continuous spikes and waves during slow sleep
Epileptic syndromes in childhood and adolescence
*Photosensitive epilepsies
*Juvenile absence epilepsy
* Juvenile myoclonic epilepsy
*Epilepsy with grand mal on awakening
*Benign partial seizures of adolescence
* Progressive myoclonic epilepsy in childhood and adolescence
This list may seem rather frightening. It demonstrates the fact that the classification of epilepsy is complicated and that there are a number of different types of epilepsy which are at least partly age-related.
It is not possible in a book of this sort to discuss all these syndromes. Discussion will be restricted to the commoner ones.
Febrile convulsions
Febrile convulsions occur in children aged six months to five years in association with fever. By definition, febrile convulsions do not occur if the fever is due to a brain infection such as meningitis or if the child has underlying epilepsy. Febrile convulsions are common and occur in about 4% of all children. They will recur in about 30% of children who have had a single febrile convulsion. Febrile convulsions are very frightening for parents who may think that their child is dying. This is not the case. Febrile convulsions are essentially harmless and do not lead to later epilepsy except in very particular circumstances.
Infantile spasms
Infantile spasms occur during infancy, most commonly between three and eight months of age. The diagnosis is made by a combination of the spasms, retardation and the findings of hypsarrhythmia (a totally disorganized EEG). The latter is seen in about 70 ? 80% of children with this condition. The features associated with infantile spasms are sudden symmetrical contractions of muscles which occur on both sides of the body. In the most common variety, there is a sudden bending of the body, either at the trunk or neck.
A baby who is not yet sitting may be lying quite comfortably and will suddenly bring its legs up at the hips, throw the arms out and try to lift the head. It is not uncommon for the baby to cry out after a spasm and be rather irritable. The attacks are repetitive, but each one is brief, lasting only a few seconds. Children who can sit will bend at the waist and put their head between the legs. Hence the term ’salaam’ attacks. Attacks may be provoked by handling the baby and occur more often when the child is drowsy, either just going off to sleep or just having woken.
Other seizure types may appear as the child gets older, especially grand mal seizures. The outlook for children with infantile spasms is poor, both with respect to control of seizures and also with respect to the occurrence of moderate to severe mental retardation. Only about 30% of affected children will end up physically and mentally normal.
The Lennox – Gastaut Syndrome
This type of epilepsy, occasionally called minor motor epilepsy, often first appears in the preschool years. It includes a number of seizure types such as drop attacks, head nodding, absences, tonic episodes and also grand mal seizures. Frequently the affected children are mentally retarded.
The outlook for this form of epilepsy, as for infantile spasms, is poor. Control of the seizures is often very difficult and thus they tend to persist into adolescence and adult life.
Benign focal epilepsy of childhood
This is a relatively common form of epilepsy. Making the correct diagnosis is important because it disappears spontaneously in mid-adolescence. The seizures consist mainly of speech difficulties with such things as choking noises, facial twitching and so on. These occur mainly at night and there may also be nocturnal grand mal seizures. The EEG is invaluable in diagnosis as it shows specific features which include spikes in the centro-temporal region. Treatment with anticonvulsant medication is usually highly successful and as the condition remits in adolescence, the outlook is excellent.
Reflex epilepsy
This implies a form of epilepsy which is triggered by some form of sensory stimulus. There are many different types of reflex epilepsy. The commonest form is photosensitive epilepsy. This is most usually related to watching television or may be associated with flickering lights such as strobe lights at a discotheque. Actually watching television is not a problem, but if the child sits with his nose glued to the set, or goes close to the set to change channels, the background flickering on the screen may be a stimulus to the fit. This also applies to computer video games, but does not seem to apply to standard office video display units. Photosensitive epilepsy usually consists of grand mal seizures sometimes preceded by myoclonus. Absences may also occur, but are uncommon.
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