REFLEKSI KASUS

EPILEPSI

Della Rizki Anggilia

18105
Seizure
• Definition : “A seizure represents the clinical expression of
abnormal, excessive, synchronous discharges of neurons
residing primarily in the cerebral cortex”

• When the seizure is prolonged or immediately recurrent without

a return of consciousness, this is status epilepticus.
Epilepsy
Types of Seizures
ILAE classified seizures into 4 types based on clinical and EEG
data:
• Focal (partial) seizures : limited to one hemisphere, discretely
localized or more widely distributed, may or may not be
associated with impairment of awarenesss during attack (simple
vs complex partial seizure). Subtype: motor, sensory,
autonomic, focal without impairment of awareness, focal with
impairment of awareness.
• Generalized seizure : both hemisphere, awareness may be
impaired as initial manifestation, motor manifestation are bilateral,
can have motor manifestation or may be absence.
• Epileptic spasm : infantile spasm that involve spasm of muscles of
neck, trunk and extremities. There is insufficient knowledge about
the mode of seizure onset to categorize spasm a focal/generalized
and they are considered of unknown type by ILAE 2017
• Impact of age : Typical generalized tonic-clonic and absence
seizures are extremely uncommon in the first two years of life and
never occur in the newborn. These issues, unique to the child
between two months and two years, have prompted proposals for
classifications specifically directed to this age group.
Epidemiology
• Incidence of epilepsy is 0.5-8 per 1000 person per years
• 3-5% will have febrile seizure in first five years of life and 30%
will have additional febrile seizure. 3-6% of those febrile seizure
will develop afebrile seizures or epilepsy.
• Male > female
• Partial > generalized seizure
Etiology
• Genetic
• Structural or metabolic : can be caused by transient disruption
such as high fever, hypocalcemia, hyponatremia, minor head
trauma (concussion), bleeding, ischemia, inflammatory
excitation such as meningitis, encephalitis, sepsis, etc or
chronic disturbance such as perinatal asphyxia, tumor or
neurodegenerative disease.
• Neurodevelopmental lessions
Clinical Characteristics
• Stereotyped (each one is like the previous one)
• Random (occur at any time of the day or night)
• Rarely precipitated by specific environmental, psychological or
physiological events
• Some individuals have several different types of seizures
• Exceptions: some individuals have seizures only during sleep, others
only upon awakening in the morning, others always at the time of
menstruation (catamenial seizures), and some following specific
stimuli such as certain sounds, flashing lights, stubbing the foot, or
being tapped on the shoulder (reflex seizures). The latter seizures
(sensory provoked) are rare, but uncovering this information may
allow the clinician to classify the child as having a specific epileptic
syndrome and develop specific therapy (eg, special glasses with
filtered lenses for visually-provoked seizures)
When to Start Antiseizure Drug Therapy
• First-time unprovoked seizure: risk for recurrent seizures, effect of
early versus deferred therapy
• Second unprovoked seizure : usually get antiseizure drug therapy
since seizure recurrence indicates that the patient has a
substantially increased risk for additional seizures (epilepsy).
Exceptions if parents choose to no antiseizure drugs if the seizure
infrequent and/or mild (subjectively). By contrast, children with
absence/atonic seizure always treated because usually present to
clinician with established pattern of frequent seizure.
• Acute symptomatic seizure: have low risk of recurrence unless the
underlying etiology recurs.
• Febrile seizure : AAP concludes that neither continuous nor
intermittent anticonvulsice therapy is recommended for children with
one or more simple febrile seizure.
Selection of an Antiseizure Drug
• Single-drug therapy is the goal of treatment
• Seizure type-related consideration: Corticotropin (ACTH) for
infantile spasm, Valproate for absence and juvenile myoclonic
epilepsy, broad-spectrum antiseizure for generalized epilepsy
syndromes (narrow-spectrum can worsen the seizure),
carbamazepine and phenytoin can worsen absence and myoclonic
seizure
• Choose that require only once-twice daily and allow for make-up
dosing
• Look for the side effect of each drugs choosen
• Teratogenicity: valproic acid can increase risk of spina bifida for the
baby in pregnant women
Stopping Antiseizure Drug Therapy
• Withdrawal antiseizure drug should be considered in most
children after 2 years without seizures regardless of the
etiology. Risk of recurrence after 2 years without seizure is 30-
40%
• Tapering off in several weeks to few months are generally
recommended
TERIMA KASIH
Mohon asupan