Let’s talk about epilepsy.
So with epilepsy, what does it mean?
It means that you have unprovoked seizures.
I’ll give a general definition.
And what’s a seizure?
A hypersynchronous type of
electrical activity of the brain.
Herpes, so on and so forth.
Hypoxic ischemic injury at birth.
So anything that may result in ischemia
to the fetus could be a problem.
Family history of seizures.
History of febrile seizure as a
child, that’s important, okay?
We’ll talk about febrile seizure and when
we do so, we’ll be focusing upon children.
History of meningitis or encephalitis
or perhaps even head trauma.
These are risk factors for
unprovoked seizures, epilepsy.
Up to 10% of population will
have seizures in their lifetime.
So that’s actually quite high.
10% is no joke in the U.S.
After one unprovoked seizure, there is a
30% chance that there might be second one.
That’s all part of epilepsy.
1% of the population
has epilepsy itself.
So 10% could actually
have a seizure.
1% could go onto
epilepsy, whatever type.
The incidence in new onset
seizure is highest among
the very young and the very old.
Extreme, extremes of age.
Etiology of seizure varies –
A lot of your seizure and
a lot of your epilepsy,
the etiology is unknown.
Up to 60% actually.
Let’s talk about febrile seizures.
What does febrile mean to you?
This is a fever.
The most common cause of new
onset seizure in a child.
That’s what you want to know.
Typically occurs between the age
of six months and five years.
So once again here, the clinical
pearl is that the child has a fever
and then they go onto his or her
first hypersynchronous seizure.
Occurring in the setting
of a febrile illness.
Without evidence of
So there is no meningitis or whatever so
we’re not saying a fever or an infection
due to or from meningitis.
It could just be a
fever that existed.
in a new onset seizure.
It can occur before the
fever's even noticed.
Typically, generalized at onset.
And maybe recurrent with future fevers
and the fever itself will then
be the provoking portion.
So let me ask you something.
Would you call this epilepsy?
You would not.
Because epilepsy, by definition,
is unprovoked seizure.
If we or you as a doctor are able to
establish that the trigger for the seizure
in your child was fever, then you
call it febrile seizure, period.
Is that clear?
Child, fever, seizure,
Give me clinical pearls for
everything that you need to know here
about seizures in general.
We typically have a benign prognosis.
This is a child.
Other neurologic abnormalities
could be present.
And family history of
epilepsy could be present.
There is a rather small percentage
of these febrile seizure patients
that might go onto future epilepsy,
which then would mean what?
Obviously, treat the
darn fever, please.
And what about these antiepileptics that
we’ll talk about in greater detail?
It should only be used if the seizures are
prolonged or the fever cannot be controlled
and the seizures continue
to be problematic.
So in other words,
if you find that the seizures
cannot be controlled
and they do not go away
by managing that fever,
then at this point, you
need to unfortunately
look into your supply