1. Epilepsy Diagnosis and CareEpilepsy Diagnosis and Care
for Childrenfor Children
May 8, 2014May 8, 2014
Elia M Pestana Knight, MDElia M Pestana Knight, MD
Staff PhysicianStaff Physician
Cleveland Clinic Epilepsy CenterCleveland Clinic Epilepsy Center

2. Epidemiology of EpilepsyEpidemiology of Epilepsy
Epilepsy affects 50 million people worldwide.

3. What is epilepsy?What is epilepsy?
• Epilepsy is a disease of the brainEpilepsy is a disease of the brain
• The main symptom of epilepsy isThe main symptom of epilepsy is
seizuresseizures
• Epilepsy is characterized byEpilepsy is characterized by
recurring or repeating seizuresrecurring or repeating seizures
caused by sudden changes in thecaused by sudden changes in the
electricity of the brainelectricity of the brain
• Sometimes patients with seizures doSometimes patients with seizures do
not have epilepsy.not have epilepsy.

4. Besides epilepsy what otherBesides 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

5. Epilepsy: Initial DescriptionEpilepsy: Initial Description
• AncientAncient
BabyloniansBabylonians
• Over 3000 yearsOver 3000 years
ago (1000 BC)ago (1000 BC)
• In a medical textIn a medical text
book “Sakikku”book “Sakikku”
(All Diseases)(All Diseases)
• DescribedDescribed
different epilepticdifferent epileptic
seizure typesseizure types

6. What are the main types ofWhat are the main types of
epilepsyepilepsy
• Focal or partial epilepsyFocal or partial epilepsy
• Generalized epilepsyGeneralized epilepsy

7. How doctors diagnoseHow doctors diagnose
epilepsy?epilepsy?
• Medical History and ExaminationMedical History and Examination
• TestsTests
- ElectroencephalogramElectroencephalogram
- Brain imaging (Brain MRI, CT scan, PETBrain imaging (Brain MRI, CT scan, PET
scan, etc.)scan, etc.)
- Blood tests looking for infections, highBlood 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: intellectualNeuropsychological tests: intellectual
abilities, behavior, etc.abilities, behavior, etc.

8. Medical historyMedical history
• What the seizures look like?What the seizures look like?
• Are factors that could indicate thatAre 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 otherIs there a history of other
neurological problems such asneurological problems such as
difficulties developing or learning ordifficulties developing or learning or
difficulties walking?difficulties walking?
• Is there a family history of epilepsy?Is there a family history of epilepsy?

9. What the seizures look like?What the seizures look like?

10. What the seizures look like?What the seizures look like?

11. What the seizures look like?What the seizures look like?

12. 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.

13. Post-Ictal PeriodPost-Ictal Period
• It is the period of time that follows aIt is the period of time that follows a
seizureseizure
• Patients can be tired or sleepy orPatients can be tired or sleepy or
complain of a headache or morecomplain of a headache or more
rarely being unable to move one partrarely being unable to move one part
of the bodyof the body
• It typically last 5-10 minutesIt typically last 5-10 minutes

14. Test: ElectroencephalogramTest: Electroencephalogram
(EEG)(EEG)
• Main test forMain test for
diagnosis or epilepsydiagnosis or epilepsy
and seizuresand seizures
• Electrodes attachedElectrodes attached
to the scalp to readto the scalp to read
brain wave activitybrain wave activity
• Does not hurt!!Does not hurt!!
• EEG has someEEG has some
variationsvariations

15. EEG trace: AwakeEEG trace: Awake

16. EEG trace: SleepEEG trace: Sleep

17. Test: Brain MRITest: Brain MRI
• Shows theShows the
structure of thestructure of the
brainbrain
• Persons gettingPersons getting
an MRI are notan MRI are not
getting radiationgetting radiation
exposureexposure
• Brain MRI doesBrain MRI does
not hurt!not hurt!

18. Brain MRIBrain MRI

19. Test: PET scanTest: PET scan
• It is used to detectIt is used to detect
abnormalities in theabnormalities in the
functioning of thefunctioning of the
brainbrain
• It helps to look forIt helps to look for
damaged areas of thedamaged areas of the
brain mainly when thebrain mainly when the
brain MRI is normalbrain MRI is normal
• Not all patientsNot all patients
diagnosed withdiagnosed with
epilepsy need a PETepilepsy need a PET
scanscan

20. PET scanPET scan

21. What to do if somebody isWhat to do if somebody is
having a convulsion?having a convulsion?
• DOSDOS
- Position the patient on his/her side (the A ofPosition 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 theMove dangerous objects from the range of the
patientpatient
- Place a small folded blanked or otherPlace a small folded blanked or other
cushioning under the head IF is movingcushioning 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 driveCall 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 thereunless 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 ifAllow the child to sleep after the seizures if
neededneeded

22. What to do if somebody isWhat 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 whoDO NOT drive with the patient who
is having a seizureis having a seizure

23. 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 firstThe skin looks blue. This first
may be noticed around mouth or nailmay be noticed around mouth or nail
beds.beds.
• 3.3. The seizure lasts more than 5The seizure lasts more than 5
minutes (even if color is good andminutes (even if color is good and
breathing is normal).breathing is normal).

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