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    Epilepsy Epilepsy Presentation Transcript

    • Recognizing epilepsies Dr. Francois Kouya
    • ALPHA waves
      • Alpha waves are those between 7.5 and thirteen(13) waves per second (Hz).
      • Alpha is usually best seen in the posterior regions of the head on each side, being higher in amplitude on the dominant side.
      • It is brought out by closing the eyes and by relaxation, and abolished by eye opening or alerting by any mechanism (thinking, calculating).
      • It is the major rhythm seen in normal relaxed adults - it is present during most of life especially beyond the thirteenth year when it dominates the resting tracing .
    • BETA waves
      • Beta activity is 'fast' activity.
      • It has a frequency of 14 and greater Hz.
      • It is usually seen on both sides in symmetrical distribution and is most evident frontally.
      • It is accentuated by sedative-hypnotic drugs especially the benzodiazepines and the barbiturates.
      • It may be absent or reduced in areas of cortical damage.
      • It is generally regarded as a normal rhythm.
      • It is the dominant rhythm in patients who are alert or anxious or who have their eyes open
    • Eyes Closed, 14 yrs. old. Very clear beta spindles Frontocentral
    • Eyes Open, 43 yrs. old: Clear frontocentral beta spindles, high-frequency (31-36 Hz).
    • THETA waves
      • Theta activity has a frequency of 3.5 to 7.5 Hz and is classed as "slow" activity.
      • It is abnormal in awake adults but is perfectly normal in children up to 13 years and in sleep.
      • It can be seen as a focal disturbance in focal subcortical lesions
      • It can be seen in generalized distribution in diffuse disorder or metabolic encephalopathy
      • In deep midline disorders or some instances of hydrocephalus
    • DELTA waves
      • Delta activity is 3 Hz or below.
      • It tends to be the highest in amplitude and the slowest waves.
      • It is quite normal and is the dominant rhythm in infants up to one year and in stages 3 and 4 of sleep.
      • It may occur focally with subcortical lesions and in general distribution with diffuse lesions, metabolic encephalopathy hydrocephalus or deep midline lesions.
      • It is usually most prominent frontally in adults (e.g. FIRDA - Frontal Intermittent Rhythmic Delta) and posteriorly in children e.g. OIRDA - Occipital Intermittent Rhythmic Delta).
    • Normal EEG
    • Benign centrotemporal lobe epilepsy of childhood:Benign Rolandic epilepsy
      • Idiopathic localization-related epilepsy that occurs in children between the ages of 3 and 13.
      • Seizures are typically nocturnal and confined to sleep
      • The patients are otherwise normal apart from the seizure
    • Partial or focal EP Benign rolandic epilepsy (BRE)
    • Rolandic spikes and Epilepsy with Continuous spike and waves during slow wave sleep (ECSWS)
    • Juvenile myoclonic epilepsy (JME)
      • Idiopathic generalized epilepsy
      • Generalized tonic-clonic seizures and absence seizures may occur.
      • Associated with sleep deprivation
    • Polyspike and wave discharges seen in juvenile myoclonic epilepsy
    • Autosomal dominant nocturnal frontal lobe epilepsy
      • Idiopathic localization-related epilepsy inherited epileptic that causes seizures during sleep
      • Frontal lobes and consist of complex motor movements, such as hand clenching
      • Arm raising/lowering, and knee bending
      • Shouting, moaning, or crying are also common
    • Frontal lobe EP
    • Autosomal dominant nocturnal frontal lobe epilepsy
    • Juvenile absence epilepsy
      • Idiopathic generalized epilepsy
      • Typically in pre-pubertal adolescence
      • Generalized tonic-colonic seizures can occur
    • EEG of a 53-year-old man with one day history of acute confusion and slowness of motor responses, showing almost continuous generalized spike wave activity.(status epilepticus)
    • Partial or focal EP Benign Rolandic epilepsy (BRE)
    • EEG of an 11-year-old patient, showing rhythmic midtemporal discharges during drowsiness
    • EEG of a 26-year-old patient, showing 6 Hz spike wave paroxysms (phantom spike wave).
    • EEG of a 9-year-old child with benign Rolandic epilepsy, showing a focus of right centrotemporal spike discharges. The right half of the figure shows a spike discharge with horizontal dipole distribution.
    • EEG of a 68-year-old patient with a long history of complex partial seizures, showing a focus of sharp waves and low-amplitude slow activity over the right anterior temporal region
    • Lennox-Gastaut syndrome
      • (LGS) is a generalized epilepsy that consists of a triad of developmental delay or childhood dementia.
      • Mixed generalized seizures
      • Onset occurs between 2-18 years
    • EEG of an 11-year-old patient with Lennox-Gastaut syndrome, showing generalized paroxysmal fast activity (B)
    • EEG of a 16-year-old child with mental retardation and tonic seizures, showing slow spike wave activity superimposed on a slow background .
    • Epilepsies in babies
    • EEG of a 3-day-old comatose neonate with history of seizures, showing an electrographic "alpha band" seizure pattern without clinical accompaniment
    • EEG of a 5-day-old neonate, showing focal ictal pattern characterized by rhythmic sharp waves in the left Rolandic region
    • EEG of a 5-day-old neonate on ventilator, showing "depressed brain seizure" characterized by less than one per second, low-amplitude sharp waves over the right hemisphere.
    • EEG of a 6-month-old infant with developmental delay and infantile spasms, showing typical hypsarrhythmic pattern
    • Childhood absence epilepsy
      • Idiopathic generalized epilepsy that affects children between the ages of 4 and 12 years of age
      • Recurrent absence seizures
    • Typical 3-Hz spike and wave discharges seen in absence epilepsy
    • EEG in Creutzfeldt-Jakob disease
    • Alzheimer's disease (AD)
      • Progressive degenerative brain disease.
    • EEG in Alzheimer's patients
    • Doose Syndrome(also called Epilepsy with Myoclonic-Astatic Seizure or EP with Myo-atonic seizure