Benign Rolandic Epilepsy (BCECTS)

by Carlo Raj, MD

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    00:01 Let’s talk about epilepsy syndromes.

    00:03 Benign rolandic epilepsy.

    00:05 Age of onset: Childhood.

    00:08 Seizure types: Simple.

    00:10 What does partial mean to you? How much of the brain? Focal, involving mouth and face.

    00:16 It could be also generalized tonic-clonic.

    00:18 What does that mean to you? The entire brain.

    00:21 And how is your patient going to present? All four extremities, extended, and then clonic jerking movements.

    00:29 Associated findings: Nocturnal preponderance of seizures.

    00:33 Nocturnal, at night.

    00:36 EEG finding: We have temporal spikes or centrotemporal spikes Treatment: Frequently, no treatment is needed as seizures are nocturnal and self-limited.

    00:48 Maybe, perhaps you’re thinking about a sodium channel blocker known as carbamezapine.

    00:53 We’ll get into treatment further, but at this point, benign rolandic epilepsy.

    00:58 Luckily, most of the time, with this being a nocturnal issue, self-limited in nature.

    01:06 Contratemporal spikes is the clinical pearl.

    01:10 Here, it’s called Lennox Gastaut syndrome.

    01:14 Huh, interestingly enough, there’s been this huge push.

    01:19 Well, not just push, but let’s just say, cannabis has taken on quite a bit of media attention, hasn’t it? CNN, all of these, you know about Dr. Gupta and his studies and his investigations on children that have had a particular epileptic issues such as Lennox Gastaut syndrome.

    01:45 Let’s begin.

    01:46 Age of onset: Childhood, early adolescence.

    01:50 I’m going to be very deliberate here, because this condition is no joke.

    01:56 Seizure type: Tonic-Clonic, myoclonic, generalized.

    02:00 All over the place, huh? All over the place.

    02:03 What else? Mental retardation association.

    02:07 EEG findings -- I need you to know this -- slow, 1 to 2 hertz, paroxysmal fast activity, multifocal spikes.

    02:17 Now, what you need to know at this point for management is not going to be cannabis, that is not going to be an answer.

    02:23 Please don’t choose that.

    02:25 Anyhow, the point is we know that marijuana and cannabis has been receiving quite a bit of attention because in certain types of epilepsies, especially in children in which the occurrence of such seizures are so severe that maybe perhaps marijuana has a place, but as far as you’re concerned right now, on your boards and wards.

    02:48 In current clinical practice, this is what you need to know.

    02:53 Almost all require AED type of work up.

    02:56 Now, we’ll go ahead into the drugs soon enough.

    02:59 We have valproic acid or valproate, lamotrigine, felbamate are most, most, broad-spectrum type of drugs that you’re thinking about with a particular childhood epileptic syndrome known as Lennox Gastaut syndrome.

    03:13 You’ve heard of Charlotte’s Web.

    03:18 Here, we have absence epilepsy.

    03:20 And this is this epilepsy or seizure that I had demonstrated at the beginning of our topic.

    03:27 Once again, childhood and adolescence will be the most common.

    03:30 Absence, meaning to say that you have these blank stares that may last for seconds.

    03:36 Associated findings: Hyperventilation, could be a trigger.

    03:40 But usually, you’ll have these children that will grow out of these seizures with time.

    03:45 Thank goodness.

    03:46 I’ll get into the treatment soon enough.

    03:48 You must know for absence, here we have 3 hertz spike-and-wave.

    03:54 Clinical pearl, 3 hertz for absence epilepsy.

    03:59 The drug of choice is going to be ethosuximide.

    04:04 Sure, valproate could be here, too, but your focus should be in ethosuximide.

    04:08 And I’ll tell you right now, focus on letter T, please, in ethosuximide.

    04:13 And those of you that are well-versed with your antiepileptic drugs, you know exactly why I’m having you focus on that.

    04:20 I’m just giving you an introduction.

    04:23 Let’s talk about juvenile myoclonic epilepsy.

    04:26 Adolescence as the name implies, young adult.

    04:29 Myoclonic, what does that mean? Absence.

    04:31 It could be generalized tonic-clonic as well.

    04:33 In terms of your jerky movements, you must know the associated findings.

    04:38 Here, we have early morning preponderance, please.

    04:42 Clinical pearl, early morning, young adult, no doubt, juvenile myoclonic.

    04:47 Triggers include sleep deprivation and perhaps alcohol.

    04:53 Here, we have 4 to 6 hertz.

    04:56 Treatment here will be valproate, maybe lamotrigine, and topiramate Usually, here, the medications require however for life long with juvenile myoclonic, unfortunately, many of your patients are not going to outgrow the issue.

    05:12 Whereas in absence, luckily, many of your children in fact will outgrow the issue.

    05:20 Let’s move on to adult epilepsy.

    05:22 Most adult onset epilepsy causes are partial onset seizures.

    05:26 What does partial mean, please? Focal.

    05:29 How much of the brain? Good.

    05:31 One portion.

    05:33 How many different types of partials do we look at or did you look at? You looked at the simple and you looked at the complex.

    05:41 With the complex, you could have automatisms.

    05:44 Before I move on, tell me about the consciousness? The description? You have loss and impairment.

    05:52 For focal, you’re focusing upon impairment.

    05:55 Lack of impairment, simple.

    05:58 Impairment of consciousness, complex and automatisms.

    06:04 Most common cause, idiopathic, understand what particular part of the brain is most susceptible to a focal type of seizure? It’s the medial temporal lobe.

    06:15 Medial temporal lobe.

    06:17 That’s a clinical pearl here.

    06:20 Tumors are much more common cause in adults than will be in children, that’s an important point.

    06:26 In the elderly, stroke, by far, 70% of your cause of adult epilepsy in the elderly will be stroke.

    06:34 Cerebrovascular accident.

    06:36 It could be trauma, could be tumor.

    06:38 Metabolic disturbances, what does that mean to you? You have maybe liver disease or perhaps kidney disease, are frequent causes, electrolyte issues such as hypomagnesemia, once again.

    06:49 Urinary tract infection perhaps.

    06:51 Medication-related and from maybe benzo withdrawal, that’s a big point.

    06:58 If you withdraw from benzo, perhaps your patient may present with epilepsy.

    About the Lecture

    The lecture Benign Rolandic Epilepsy (BCECTS) by Carlo Raj, MD is from the course Seizures. It contains the following chapters:

    • Benign Rolandic Epilepsy
    • Lennox-Gastaut Syndrome
    • Absence Epilepsy
    • Juvenile Myoclonic Epilepsy
    • Adult Epilepsy

    Included Quiz Questions

    1. Absence epilepsy
    2. Lennox-Gastaut syndrome
    3. Benign Rolandic epilepsy
    4. Juvenile myoclonic epilepsy
    5. Adult epilepsy
    1. Benign Rolandic seizures
    2. Absence seizures
    3. Lennox-Gaustaut Syndrome
    4. Juvenile myoclonic epilepsy
    5. Adult epilepsy
    1. Benign Rolandic Epilepsy shows centrotemporal spikes on EEG.
    2. Absence seizures show 4 Hz spikes on EEG.
    3. Lennox-Gestaut show 4 - 6 Hz spike and wave pattern on EEG.
    4. Adult epilepsy show slow (1 - 2Hz) spikes on EEG.
    5. Juvenile myoclonic epilepsy show 3 Hz spikes on EEG
    1. Lamotrigine
    2. Controlled Marijuana drug
    3. Ethosuximide
    4. Carbamazepine
    5. Benzodiazepine
    1. Temporal sclerosis
    2. Frontal sclerosis
    3. Parietal sclerosis
    4. Occipital sclerosis
    5. Fronto-temporal sclerosis

    Author of lecture Benign Rolandic Epilepsy (BCECTS)

     Carlo Raj, MD

    Carlo Raj, MD

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