Types of epilepsyTTypes of epilepsyTypes of epilepsyEnglishNeurologyChild (0-12 years);Teen (13-18 years)BrainNervous systemConditions and diseasesCaregivers Adult (19+) EducatorsNA2010-02-04T05:00:00ZElizabeth J. Donner, MD, FRCPC​12.000000000000023.0000000000000416.000000000000Flat ContentHealth A-Z<p>Read about three types of epilepsy (symptomatic, cryptogenic and idiopathic) and suggested treatment. </p><p>Sometimes, epilepsy is caused by a specific brain injury or abnormality that is visible on an MRI or CT scan or by a metabolic disorder. Because the epilepsy is a symptom of another problem, it is called symptomatic epilepsy. </p> <p>In other forms of epilepsy, there is no apparent underlying cause. This kind of epilepsy is called idiopathic epilepsy.</p> <p>When it is not clear what is causing the seizures, but doctors suspect that there is some underlying brain or chemical abnormality, the epilepsy is called cryptogenic. </p><h2>Key points</h2> <ul><li>Idiopathic epilepsy is epilepsy with no clear underlying cause, such as benign neonatal convulsions, childhood absence epilepsy and juvenile myoclonic epilepsy.</li> <li>Symptomatic epilepsy is caused by known damage to the brain or an underlying disease such as a brain tumour, stroke or metabolic disorder.</li> <li>Cryptogenic epilepsy is epilepsy without an obvious cause. </li> <li>Idiopathic and cryptogenic epilepsy are usually controlled with medications. Symptomatic epilepsy is controlled by treating the underlying cause with medications and/or surgery.</li></ul>

 

 

Types of epilepsy2058.00000000000Types of epilepsyTypes of epilepsyTEnglishNeurologyChild (0-12 years);Teen (13-18 years)BrainNervous systemConditions and diseasesCaregivers Adult (19+) EducatorsNA2010-02-04T05:00:00ZElizabeth J. Donner, MD, FRCPC​12.000000000000023.0000000000000416.000000000000Flat ContentHealth A-Z<p>Read about three types of epilepsy (symptomatic, cryptogenic and idiopathic) and suggested treatment. </p><p>Sometimes, epilepsy is caused by a specific brain injury or abnormality that is visible on an MRI or CT scan or by a metabolic disorder. Because the epilepsy is a symptom of another problem, it is called symptomatic epilepsy. </p> <p>In other forms of epilepsy, there is no apparent underlying cause. This kind of epilepsy is called idiopathic epilepsy.</p> <p>When it is not clear what is causing the seizures, but doctors suspect that there is some underlying brain or chemical abnormality, the epilepsy is called cryptogenic. </p><h2>Key points</h2> <ul><li>Idiopathic epilepsy is epilepsy with no clear underlying cause, such as benign neonatal convulsions, childhood absence epilepsy and juvenile myoclonic epilepsy.</li> <li>Symptomatic epilepsy is caused by known damage to the brain or an underlying disease such as a brain tumour, stroke or metabolic disorder.</li> <li>Cryptogenic epilepsy is epilepsy without an obvious cause. </li> <li>Idiopathic and cryptogenic epilepsy are usually controlled with medications. Symptomatic epilepsy is controlled by treating the underlying cause with medications and/or surgery.</li></ul><h2>Symptomatic epilepsy</h2> <p>Between 25 per cent and 45 per cent of childhood epilepsy is symptomatic. Symptomatic epilepsy is caused by known structural abnormalities or damage in the brain or by an underlying disease. <p>Your child’s doctor may want to rule out these causes with a neurological examination, laboratory tests and possibly brain imaging such as a CT scan or an MRI. Brain imaging has improved over the last several decades so that doctors can detect smaller lesions and structural problems. As a result, many cases of epilepsy that would once have been called idiopathic or cryptogenic are now known to be symptomatic. </p> <h2>What are other terms for symptomatic epilepsy?</h2> <p>Other terms for symptomatic epilepsy that you may come across include:</p> <ul><li>remote symptomatic epilepsy</li> <li>secondary epilepsy (this term is no longer used because it can cause confusion with secondarily generalized seizures).</li></ul> <h2>What causes symptomatic epilepsy?</h2> <p>Symptomatic epilepsy is caused by an underlying problem. Some common causes of symptomatic epilepsy are described below.</p> <h3>Injury or trauma</h3> <p>Head injury or trauma, at birth or later, may cause symptomatic epilepsy. Older teenagers and young adults are more likely to develop epilepsy as a result of injury, since they are more active and more likely to be injured than younger children. </p> <p>The more severe the injury, the higher the risk that a child will later develop epilepsy and the longer the child is at risk. Severe head trauma, where the child’s brain is bruised or the child is unconscious for more than 24 hours, increases the risk of epilepsy 17 times. Moderate trauma, where the child’s skull is fractured or the child is unconscious for more than half an hour, increases the risk three times. Ordinary bumps and bruises do not increase the risk of epilepsy. </p> <p>Epilepsy does not always develop right away. A child who has had a serious head injury may develop epilepsy years afterward. The risk of developing epilepsy is highest for the first year after the injury. </p> <h3>Lack of oxygen to the brain</h3> <p>Lack of oxygen to the brain before, during or shortly after birth can damage the brain and result in neonatal seizures. This may result from various birth complications, including difficult or prolonged labour, placental abruption (premature detachment of the placenta from the uterus) or compression of the umbilical cord. </p> <p>In children who are neurologically normal, there does not seem to be any evidence so far that these factors influence the risk of developing epilepsy later in life. However, it is possible that not all the risk factors have been identified or that no study has been able to measure all the risk factors. </p> <p>Lack of oxygen to the brain, for example from an accident, drowning or heart attack, can also result in seizures in older children and adults. </p> <h3>Infection</h3> <p>Infection of the brain is thought to cause up to a quarter of symptomatic epilepsy cases in children and 3 per cent to 6 per cent of all cases of epilepsy. Many different infections can result in seizures either at the time of infection or afterward, including: </p> <ul><li>meningitis, including bacterial meningitis and non-bacterial chronic meningitis from Lyme disease or neurosyphilis</li> <li>encephalitis, especially from herpes simplex infection</li> <li>opportunistic central nervous system (CNS) infections in children with a weakened immune system, for instance from HIV infection</li> <li>infections elsewhere in the body that cause metabolic changes or a lack of oxygen to the brain </li> <li>various parasitic infections of the CNS, including trichinosis, cerebral malaria, cysticercosis and toxoplasmosis (more common in developing countries but can be acquired anywhere).</li></ul> <p>The level of risk depends on the specific infection. For instance, viral encephalitis and bacterial meningitis increase the risk by a factor of 10 or more, but aseptic meningitis does not appear to increase the risk. </p> <h3>Brain tumour</h3> <p>Brain tumours are the second most common type of cancer in children, after leukaemia, but they are still rare. In Canada, about 300 children under the age of 15 are diagnosed with a brain tumour each year. Approximately 30-35 per cent of people with brain tumours have seizures, although they do not necessarily develop chronic epilepsy. The type of tumour affects the risk of developing epilepsy. Some studies suggest that epilepsy is more common in people with low-grade tumours that have been present for a long time than in people with malignant tumours. Brain tumours are a fairly rare cause of epilepsy, especially in children and young adults. </p> <p>Brain tumours are usually treated with surgery. If the tumour is malignant, radiation therapy may also be used. If surgery is not possible, some doctors use biopsy and radiation therapy. Chemotherapy could also be used. The tumour outcome depends on the tumour type. </p> <p>The outlook for children with epilepsy caused by a brain tumour varies, but is often good. With the right surgical procedure, most people become entirely seizure-free or have more than 80 per cent fewer seizures. How long a child has had epilepsy and the type of surgery may make a difference to the outcome. One study found that complete tumour removal, younger age at surgery, shorter duration of epilepsy and the absence of secondarily generalized seizures all related to better epilepsy outcome. </p> <h3>Cerebrovascular problem</h3> <p>A problem with the blood vessels in the brain, such as a tangle of blood vessels or a stroke, was the cause of almost 12 per cent of epilepsy cases in one large study. This is the leading cause of epilepsy in elderly people. In the same study, fewer than 10 per cent of symptomatic epilepsy cases in children were caused by cerebrovascular problems. </p> <h3>Developmental disability</h3> <p>Developmental disability does not cause epilepsy, but is commonly associated with it. Both conditions are caused by an underlying brain problem. </p> <p>Approximately one child in 165 to 330 live births has some form of developmental disability. About one-third of these children will also develop epilepsy. </p> <p>Developmental disabilities and other neurological problems are linked to between 25 per cent to 45 per cent of cases of epilepsy in children. Between 2 per cent and 15 per cent of children with Down syndrome may also develop epilepsy as adults. A number of other genetic syndromes may also result in epilepsy. </p> <p>About 5 per cent of children with epilepsy have vision problems and about 2 per cent have hearing problems.</p> <p>In many cases, the cause of a developmental disability cannot be easily identified. It seems likely that some underlying brain abnormality causes both the developmental disability and the epilepsy. When features such as developmental disability are present and suggest an underlying problem, but the details of the problem cannot be found, the child has cryptogenic epilepsy. </p> <h3>Congenital malformation</h3> <p>Before a baby is born, their brain is formed in a complicated process in which new brain cells move from the inside to the outside of the brain, passing through layers that have already been formed. Various types of congenital (present at birth) brain malformation exist, due to: </p> <ul><li>abnormal neuronal and glial proliferation, when too many or too few brain cells grow, or when brain cells multiply abnormally</li> <li>abnormal neuronal migration, when brain cells stop moving at the wrong time and end up in the wrong place</li> <li>abnormal cortical organization, when all or part of the brain forms in the wrong shape.</li></ul> <p>Almost any brain malformation can lead to seizures. Some common ones include:</p> <ul><li>lissencephaly-pachygyria, a condition in which the brain is “smooth,” without the usual number of folds</li> <li>double cortex syndrome, a genetic disorder which creates an extra brain layer, a “double cortex”</li> <li>periventricular heterotopia, in which brain cells which belong in the cortex are located along the ventricles.</li></ul> <p>These malformations can also lead to developmental disabilities, as described above. If a baby has very severe brain malformations, he may not survive.</p> <h3>Neurocutaneous syndromes</h3> <p>Neurocutaneous syndromes are congenital disorders that cause tumours to grow in the brain, spinal cord or peripheral nerves. They often cause skin lesions and may also cause developmental disability. </p> <ul><li>Tuberous sclerosis is a genetic disorder in which growths or “tubers” develop in the brain, and sometimes in the kidney and heart. Hypopigmented, or pale, areas, shaped like ash leaves, are found on the skin and a “butterfly-shaped” facial acne develops over time. Approximately 80 per cent of people with tuberous sclerosis develop epilepsy. Between 38 per cent and 65 per cent of children with tuberous sclerosis also have some degree of developmental delay or intellectual disability.</li> <li>Developmental issues can include hyperactivity, aggressive behaviour or problems with coordination, memory, speech, calculations or visual-spatial relationships. The number of tubers and their location seem to play important roles in cognitive and developmental outcome as well as seizure outcome.</li> <li>Sturge-Weber syndrome is also accompanied by a birthmark on the face and is connected with epilepsy in 70 per cent to 90 per cent of cases. Children with Sturge-Weber syndrome have hemiparesis (weakness or partial paralysis on one side of the body) in 30 per cent of cases and intellectual disabilities in 50 to 60 per cent of cases. Sturge-Weber syndrome is a progressive disease (it may get worse with time) but eventually stabilizes. Early treatment, particularly surgery, may improve seizure control and intellectual outcome.</li> <li>Neurofibromatosis, a group of genetic disorders in which many soft tumours develop throughout the body, often accompanied by skin changes. Epilepsy occurs in less than 14 per cent of cases.</li></ul> <h3>Mesial temporal sclerosis</h3> <p>Mesial temporal sclerosis, also known as hippocampal sclerosis, is a condition in which parts of the brain in the inner part of the temporal lobe shrink and develop scar tissue. The causes are unclear, but it is found in approximately 40 per cent of adults who undergo surgery for temporal lobe epilepsy that is resistant to medication. It is more common in older children and adults, but it has been seen in children as young as two years old.</p> <h3>Metabolic disorder</h3> <p>Metabolic disorders are problems with producing, absorbing, breaking down or storing specific substances in the body, including sugars, fats, proteins and vitamins. They usually happen when a child lacks a specific enzyme, often because of a genetic mutation. </p> <p>The treatment for metabolic disorders depends on the underlying cause. If the metabolic disorder can be corrected with a special diet or with supplements, the seizures may go away. In some cases it is not possible to correct the metabolic disorder completely, but the seizures can be treated with anti-epileptic drugs. </p> <h2>How many other children have symptomatic epilepsy?</h2> <p>Between 18 per cent and 50 per cent of children with epilepsy are thought to have symptomatic epilepsy. The numbers vary widely from study to study, partly because many symptomatic cases of epilepsy are not detected until the child has been treated or has had surgery. </p> <h2>How is symptomatic epilepsy treated?</h2> <p>The treatment for symptomatic epilepsy depends very much on the specific cause. If possible, the doctor will treat the underlying condition; this may reduce or eliminate the seizures. Some types of symptomatic epilepsy also respond to anti-epileptic drugs, and surgery can have very good results in some cases. </p> <p>Partial seizures are usually treated with anti-epileptic drugs. The right course of treatment usually produces good seizure control or remission in 60 per cent to 70 per cent of people with partial seizures. However, if a child has an obvious abnormality in the structure of her brain or if her seizures do not respond to anti-epileptic drugs after one or two years, she may be considered for surgery. </p> <h2>What is the outlook for a child with symptomatic epilepsy?</h2> <p>The outlook for a child with symptomatic epilepsy depends largely on the underlying condition.</p> <p>For most people with partial seizures, anti-epileptic drugs usually produce good seizure control. Children who have structural brain abnormalities or whose seizures are resistant to treatment after one to two years should be considered for surgery. The success of surgery will depend on the type and extent of the surgery and on whether the areas of the brain that serve motor or language functions are involved. </p> <p>Approximately half of children with symptomatic epilepsy who are seizure-free on medication will remain seizure-free when the medication is discontinued. </p> <h2>Is symptomatic epilepsy the same as provoked seizures?</h2> <p>Although they may be triggered by similar underlying causes, symptomatic epilepsy is different from <a href="/article?contentid=2064&language=English">provoked seizures</a>. Provoked seizures are acute and symptomatic epilepsy is chronic. For example, if a child has a serious head injury and has a seizure on his way to the hospital, this would be a provoked seizure. However, if they have seizures after the head injury has healed, this would be considered symptomatic epilepsy. </p> <h2>Idiopathic epilepsy</h2> <p>About 30 per cent of childhood epilepsy is idiopathic. Idiopathic epilepsy is epilepsy in which there is no apparent underlying cause. In this case, doctors are unable to identify a structural problem with the brain or a metabolic disorder. It is possible that idiopathic epilepsy is caused by tiny abnormalities at the cellular level or by a genetic or inherited condition. </p> <p>There are a variety of idiopathic epilepsy syndromes. Children with idiopathic epilepsy may have generalized or partial seizures. Many, although not all, idiopathic epilepsy syndromes are benign and the child will eventually grow out of them. Relatives of a child with idiopathic epilepsy often have a history of seizures. We are now learning that many idiopathic epilepsy syndromes have an associated genetic component. </p> <p>The good news with a diagnosis of idiopathic epilepsy is that there is no brain tumour or other abnormality, and that the child is more likely to outgrow their seizures. </p> <h2>What are other terms for idiopathic epilepsy?</h2> <p>An older term for idiopathic epilepsy is primary epilepsy. The terms “idiopathic epilepsy” and “cryptogenic epilepsy” are sometimes used interchangeably, especially in older books and articles. </p> <h2>What causes idiopathic epilepsy?</h2> <p>By definition, there is no apparent underlying cause of idiopathic epilepsy, such as a structural problem with the brain or a metabolic disorder. It is possible that idiopathic epilepsy is caused by tiny abnormalities at the cellular level. We are now learning that many, although not all, idiopathic epilepsy syndromes have an associated genetic component. </p> <p>In most cases, the exact way in which epilepsy is inherited is unclear. However, some researchers estimate that genes could account for 70 per cent to 90 per cent of the tendency to develop epilepsy. </p> <h2>What epilepsy syndromes are idiopathic?</h2> <p>Idiopathic epilepsy syndromes include:</p> <ul><li>benign epilepsy of childhood with centrotemporal spikes (BECTS) </li> <li>childhood epilepsy with occipital paroxysms </li> <li>benign neonatal familial convulsions </li> <li>benign neonatal convulsions </li> <li>benign myoclonic epilepsy in infancy </li> <li>childhood absence epilepsy </li> <li>juvenile absence epilepsy </li> <li>juvenile myoclonic epilepsy </li></ul> <h2>How many other children have idiopathic epilepsy?</h2> <p>Idiopathic epilepsy is common: about 30 per cent of childhood epilepsy is idiopathic. Together, idiopathic and cryptogenic epilepsy account for 55 per cent to 75 per cent of cases of childhood epilepsy. It is difficult to be precise, because different researchers define these terms differently. </p> <h2>How is idiopathic epilepsy treated?</h2> <p>Idiopathic epilepsy is treated with anti-epileptic drugs.</p> <h2>What is the outlook for a child with idiopathic epilepsy?</h2> <p>The outlook for a child with idiopathic epilepsy depends on the specific condition and how well the seizures respond to treatment. Several idiopathic epilepsy syndromes, such as childhood absence epilepsy and BECTS, usually go away on their own. With other syndromes, though, the child may need to take anti-epileptic drugs all his life. </p> <h2>Cryptogenic epilepsy</h2> <p>Cryptogenic epilepsy (from the Greek word “kryptos,” meaning “hidden”) is epilepsy with no obvious cause. There is neither a metabolic problem nor a clear injury or structural problem with the brain. However, doctors suspect that there is an underlying cause for the seizures, usually because the child is developmentally delayed or has abnormal findings on her neurological exam. </p> <h2>What are other terms for cryptogenic epilepsy?</h2> <p>Cryptogenic epilepsy may also be referred to as “probably symptomatic.”</p> <p>The terms “idiopathic” and “cryptogenic” are sometimes used interchangeably, especially in older books and articles. Doctors now find it more useful to distinguish between these conditions. </p> <h2>What causes cryptogenic epilepsy?</h2> <p>By definition, the cause of cryptogenic epilepsy is unknown. It is often assumed to be caused by a brain lesion that is not visible on CT scan or MRI. <p>Because brain imaging has improved over the last several decades, the proportion of cases that are defined as cryptogenic has decreased. In other cases, a child whose epilepsy is considered cryptogenic at first is later diagnosed with a metabolic or mitochondrial disease, and the classification changes to symptomatic epilepsy. </p> <h2>How is cryptogenic epilepsy treated?</h2> <p>Cryptogenic epilepsy is treated with anti-epileptic drugs. If the seizures have a focus that can be identified, surgery may be an option. Other treatment options include vagus nerve stimulation (VNS) and the ketogenic diet. </p> <h2>What is the outlook for a child with cryptogenic epilepsy?</h2> <p>As with most types of epilepsy, the outlook for a child with cryptogenic epilepsy depends on the underlying cause and any comorbid conditions.</p>Types of epilepsy

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