NewsletterContact UsStart Page
 
 
         
 

 

 


Fraser Valley Epilepsy Society
34081 Cyril St., Abbotsford, B.C. V2S 2E8 Phone 604-852-2686 ext. 360 Fax 604-852-5794

Together, we will make a difference!

Click to Download Epilepsy Video

Doctor’ s Corner
Discussion Board
With: Dr. Lionel Traverse

Dr. Lionel Traverse is one of the co-founders of The Fraser Valley Epilepsy Society. He is the Medical Director of The Fraser Valley Child Development Center, and a Clinical Assistant Professor of Pediatrics at U.B.C. He has practiced Paediatrics in Abbotsford since 1986. He obtained his Medical Doctorate in Paris in 1980 and trained in Montreal, Saskatoon, and Vancouver. He holds degrees in Paediatrics in Canada, USA and France. He studied epilepsy and EEG reading in the prestigious Saint-Paul's center for Epilepsy in Marseilles, France in 1993.

  “Children with epilepsy suffer more from a lack of understanding from their seizures. The key to helping children with chronic health conditions is awareness; the more everyone knows about seizures, the happier and healthier my patients will be”.......

  WHAT IS EPILEPSY ???

Epilepsy is a vast term which encompasses a large variety of very different conditions. Epilepsy manifests itself by seizures that will be different according to which part of the brain is affected. Seizures are not synonymous with epilepsy. Some epileptic syndromes have several seizure types, and one seizure type can be seen in several different epileptic syndromes. 

This ICE (International Classification of Epilepsies) was adopted at the New Delhi Congress of the International League against Epilepsy in October 1989. It is based on 2 classical notions:

1) E. with generalized seizures & E. with Partial Seizures, and

2) distinction between known aetiology (cause) so-called symptomatic E. and unknown aetiology, called idiopathic E.

Based on these 2 notions the classification of epilepsies and epileptic syndromes is as follows. 

International classification of epilepsies, epileptic syndromes and related seizure

disorders

     (from: EPILEPSIA, 1989;30:389-399)

   1.-Localization-related (focal, local, partial) epilepsies and  epileptic syndromes

             1.1 - Idiopathic  

                         1.1.1. Benign Rolandic Epilepsy

                         1.1.2 Benign Occipital Epilepsy

                         1.1.3 Primary Reading Epilepsy

             1.2 - Symptomatic

                         1.2.1 Epilepsia Partialis Continua (Kojewnikow)

                         1.2.2 Specific mode of provocation

                         1.2.3 Other

                1.3 - Cryptogenic

   2.-Generalized epilepsies and epileptic syndromes

             2.1 - Idiopathic

                 2.1.1 Benign Familial Neonatal Convulsions

                 2.1.2 Benign Neonatal Convulsions

                 2.1.3 Benign Myoclonic Epilepsy of the Newborn

                 2.1.4 Childhood Absence Epilepsy

                 2.1.5 Juvenile Absence Epilepsy

                 2.1.6 Juvenile Myoclonic Epilepsy

                 2.1.7 Other including Photosensitive epilepsies

             2.2 - Cryptogenic and/or symptomatic  

                2.2.1 West Syndrome (Infantile Spasms)

                2.2.2 Lennox-Gastaut Syndrome

                2.2.3 Myoclonic Absences

             2.3 - Symptomatic:

                2.3.1 Non-specific aetiology  

                      Early Myoclonic Encephalopathy and 

                     Early Epileptic Encephalopathy

                2.3.2 Specific syndromes

   3.-Epilepsies and epileptic syndromes undetermined whether focal or generalized

             3.1 - With both generalized and focal seizures

                   3.1.1 Neonatal Seizures

                   3.1.2 Severe Infantile Myoclonic Epilepsy

                   3.1.3 Epilepsy with continuous Spikes Waves of Slow Sleep

                   3.1.4 Acquired Epileptic Aphasia

                   3.1.5 Other

             3.2 - Without unequivocal generalized or focal features

   4.-Special syndromes

             4.1 - Situation-related seizures

                   4.1.1 Febrile Seizures

                   4.1.2 Seizures in the context of an acute metabolic imbalance

             4.2 - Isolated seizures or isolated Status-Epilepticus.

IDIOPATHIC disorders are neither secondary to or caused by another disorder. There is no underlying cause other than a possible genetic predisposition. Idiopathic epilpesies are defined by an age related onset, specific clinical and EEG features and a presumed genetic aetiology.

SYMPTOMATIC disorders are considered as a consequence of a known or suspected disorder of the central nervous system.

One can notice that there is a group called CRYPTOGENIC epilepsies. These are epilepsies whose cause is  hidden or occult. It is assumed to be symptomatic, but the aetiology remains unknown in spite of all the investigations. 

 

In Localization-related (focal, local, partial) epilepsies and  epileptic syndromes the clinical aspect of the seizures or the results of investigations show a localized origin to the seizures. These patients have a constant, well-circumscribed epileptogenic "lesion". They may also have variable epileptogenic foci, without obvious lesions, and with possible involvement of both hemispheres. Localization related epilepsies can be idiopathic, symptomatic or cryptogenic.

 In Generalized epilepsies the clinical manifestation of the seizures indicates that both hemispheres are immediately involved, and the initial EEG features are bilateral.

Some epilepsies remain undetermined whether focal or generalized. This can be because they have both generalized and focal seizures, or because the seizures are without unequivocal generalized or focal features. some of these patients present with generalized tonico-clonic seizures but clinical and EEG findings are unable to determine if the seizures are generalized or localization related, e.g. generalized seizures during sleep.

Several syndromes have been described in each of these categories of epilepsies. The most frequent are shown in the following schema:

 

You will be able to refer to each specific syndrome in this web site. But first, here is some general advice that applies to all of us.

Advice

  In whatever decision you have to make: Be Realistic!      

  Your doctor can help you decide if the activity you are planning is compatible with epilepsy. The only limitations are related to safety. An activity that would put you or others at risk is not recommended. For instance, children love to climb on trees and climbing trees is not to be forbidden, but for any child and especially one with epilepsy it is preferable they stay on the lower branches.

 

School

    Since the majority of epilepsies have their onset during childhood, it is important to have a good cooperating relationship with the school. There are two issues with regard to schooling:

 

1. What to do in case of a seizure.

  In fact the school should follow the same recommendations as the ones outlined later in this web site. There are however some unique cases and each child should have a written plan of action for the school in case of seizures. If you do not have a seizure management plan in place for your child, contact your local health unit. Let them know you have a child with epilepsy and within a day or two your school health nurse should contact you to discuss a seizure management plan for your child.

 

2. What to expect in terms of learning abilities.

    The vast majority of children with epilepsy do not have any learning disabilities. When a learning disability is identified, it should be handled in the same way learning problems are dealt with in children who do not have epilepsy. The degree to which the LD is due to the epilepsy, to the seizures, or to the antiepileptic drugs is unknown and is probably different for each individual. There are support services and funding available in various categories within the Ministry of Education criteria. Children whose epilepsy has impacted on their learning and cognition may qualify. Please refer to our education page.

 

Sports.

    Swimming is usually not a concern provided it is in a pool under the supervision of a lifeguard who is aware of the seizure disorder.  In a private pool someone must be always present and supervising while the person with epilepsy is swimming. Unsupervised swimming is always dangerous, it can be fatal to children living with epilepsy.

Sailing, wind surfing and water skiing are allowed as long as a life jacket is worn. Scuba diving is definitely not recommended.

Biking does not present a problem as long as the biker wears a helmet and the biking is on quiet roads avoiding heavy car traffic.

      

Traveling.

  There are no contra-indications to traveling by any transport system. Air traveling does not aggravate epileptic seizures. However sleep deprivation may trigger seizures and one must be very cautious of jet lag. One should wear a Medic Alert bracelet specifying the chemical name of the medication, e.g.: "carbamazepine" not "Tegretol".

 

Video Games.

    Very few people have a "photosensitive epilepsy" and these are the only ones who should avoid playing video games. Most children with epilepsy can play video games without any more restrictions than non-epileptic children. People with a photosensitive epilepsy should avoid flashing lights such as the ones in night clubs.

 

Socialization.
Beware of alcohol!!! Seizures and alcohol do not mix!

 

Disclosure

  Issues of disclosure are individual and there are arguments on both sides.  However if we intend to dispel existing myths about epilepsy and educate the general public it is optimal to present the symptoms and first-aid information (should any be required) prior to a seizure. Some people who have never witnessed a seizure before can be frightened.  Knowledge is power so let us take the fear out of epilepsy and educate! If you are interested in having an education video presentation for work or school contact us.