Epilepsy Syndrome: Introduction and Classification

00:01 So let's talk about epilepsy, and how we make an epilepsy diagnosis? And what the different types of epilepsy are? The International League Against Epilepsy, which is the largest governing body, defines epilepsy syndromes as complex set of signs and symptoms that defines a unique epileptic condition.

00:19 Well, that's a lot of words that don't mean a whole lot to we as clinicians, or test takers looking at clinical vignettes.

00:26 So when I'm thinking about epilepsy, I think of a constellation.

00:30 That includes the type of seizures, the EEG findings, the age of onset of the patient, which is very important in making the right epilepsy diagnosis.

00:40 The course of the epilepsy, whether it resolves spontaneously or becomes progressive.

00:47 Any associated clinical features, either cutaneous findings on their general exam, or neurologic findings on their neurologic exam.

00:55 And then we think about the underlying pathophysiologic, or genetic mechanisms that may cause certain epilepsies, and not others.

01:03 And when we put all of these six features together, we can make a precise diagnosis of the type of epilepsy that a patient may be suffering.

01:14 With, when we think more specifically about classification, I'd like for you to think about two things that contribute to the classification of the epilepsy that help us determine, what type of epilepsy it is? The first is the EEG, that's one of those six criteria, and maybe one of the most important.

01:31 EEGs tend to show generalized onset seizures or localization related seizures, or focal-onset seizures.

01:38 An epilepsy is tend to be generalized or focal and how we describe them.

01:43 The second is I'd like to, for you to think about the etiology.

01:47 Is this an idiopathic epilepsy that doesn't have a cause? Or is this a symptomatic, or secondary form of epilepsy that comes from someone other underlying insult? Categorizing epilepsies in this way, can be extremely helpful.

02:02 We have certain anti-epileptics that are better for generalized seizures, and others for focal seizures.

02:07 And so there's a treatment implication to making a diagnosis based on these EEG findings.

02:13 In addition, this helps us with prognosis.

02:15 It tends to be that symptomatic or secondary epilepsies that come from some underlying cause have a worse prognosis.

02:22 are more medication refractory, and may result in early death than the idiopathic primary epilepsies.

02:31 In this lecture, we're going to talk about a few of the most common epilepsy syndromes.

02:35 There are many out there, but we're going to review the ones that you may see clinically, or maybe encountered on a clinical vignette.

02:43 And as we talked about, we can categorize them as generalized in onset or focal-onset, and idiopathic or symptomatic.

02:51 So the three seizure types in epilepsy syndromes that we'll talk about, that have a generalized-onset epilepsy and are idiopathic are childhood absence, juvenile absence, and juvenile myoclonic epilepsy.

03:03 These are idiopathic we don't know why they occur.

03:06 There's not an underlying insult that causes them.

03:09 And the seizures tend to be generalized and onset.

03:12 And that will help us with treatment decisions.

03:15 The focal-onset epilepsy that's also idiopathic, that we'll review as benign childhood epilepsy with centrotemporal spikes, which is called BECTS.

03:24 This is important idiopathic, it doesn't have a cause epilepsy syndrome, where the seizures are focal in onset.

03:32 And then we'll review some important symptomatic epilepsies.

03:35 West syndrome and Lennox-Gastaut syndrome, are probably two of the most important symptomatic or secondary generalized epilepsy syndromes.

03:43 They have a cause some underlying neurologic insult that drove the onset of seizures and other neurologic dysfunction.

03:51 And then the symptomatic focal-onset epilepsy will review as temporal lobe epilepsy.

03:55 Then this is one of the more common epilepsies particularly that we see in adults.

03:58 And it's important to understand from a treatment standpoint.