Epilepsy

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Epilepsy is a common chronic seizure disorder.

General

  • Epilepsy = seizures that are "idiopathic", i.e. no brain tumour, no mass lesion, no brain injury.
  • Most common form: temporal lobe epilepsy.[1]

Etiology

  • Many.

Syndromic:

Tumour:

Types

Features:[4]

  • Temporal lobe epilepsy
  • Mesial temporal sclerosis = scarring of the medial temporal lobe.
    • Involves: hippocampus, parahippocampal gyrus and amygdala.

Hippocampal sclerosis

  • Most frequent histopathology in temporal lobe epilepsy (33% of all epilepsy surgery specimen).
  • ILAE classification for hippocampus specimen:[5]
    • ILAE type 1: cell loss predominantly in CA1 and CA4 sectors.
    • ILAE type 2: predominant CA1 neuron loss and gliosis.
    • ILAE type 3: CA4 predominant neuronal cell loss and gliosis.

Clinic: ILAE type 1: benefit from epilepsy surgery.

Notes:

  • Gliosis withot neuronal loss is not considered hippocampal sclerosis.

DDx:

Sudden unexpected death in epilepsy

  • Abbreviated SUDEP.

Diagnosis:

Epidemiology:[6]

  • Typically poorly controlled epilepsy.
  • Incidence: 0.09-9 per 1000 patient-years.

See also

References

  1. URL: http://emedicine.medscape.com/article/342150-overview. Accessed on: 20 November 2010.
  2. Cataltepe, O.; Turanli, G.; Yalnizoglu, D.; Topçu, M.; Akalan, N. (Apr 2005). "Surgical management of temporal lobe tumor-related epilepsy in children.". J Neurosurg 102 (3 Suppl): 280-7. doi:10.3171/ped.2005.102.3.0280. PMID 15881751.
  3. Im, SH.; Chung, CK.; Cho, BK.; Lee, SK. (Mar 2002). "Supratentorial ganglioglioma and epilepsy: postoperative seizure outcome.". J Neurooncol 57 (1): 59-66. PMID 12125968.
  4. MUN. 15 November 2010.
  5. Blümcke, I.; Thom, M.; Aronica, E.; Armstrong, DD.; Bartolomei, F.; Bernasconi, A.; Bernasconi, N.; Bien, CG. et al. (Jul 2013). "International consensus classification of hippocampal sclerosis in temporal lobe epilepsy: a Task Force report from the ILAE Commission on Diagnostic Methods.". Epilepsia 54 (7): 1315-29. doi:10.1111/epi.12220. PMID 23692496.
  6. Tomson, T.; Nashef, L.; Ryvlin, P. (Nov 2008). "Sudden unexpected death in epilepsy: current knowledge and future directions.". Lancet Neurol 7 (11): 1021-31. doi:10.1016/S1474-4422(08)70202-3. PMID 18805738.