Division of Pediatric Neurology
Image of the Week - Week 2

  Image of the Week
  Week 1 line
  Week 2

 

 

 

 

 

 

Reply to image 2 (without benefit of recourse to books, so I may be totally off base).

Looks like a generalized pattern; photosensitive epilepsy.
She could have generalized T/C seizures, also likely absences . Could she have JME? or just photosensitive generalized epilepsy.
Triggers: disco's, riding in a car with sunlight outside; waves at the beach, soome video games,etc.
Prevention: blue lens sunglasses (wrap around); At lease 3 feet from the TV, ambient light in the room; no more than 30 min. play time for videogames without a rest in between.
Meds: valproate risks PCO disease, teratogenic effects; try Keppra first; resort to Lamictal or Topamax if Keppra fails.

Ed Hart

 

My answer for the Pediatric Neurology Image of the Week - Week 2

1. Myoclonic jerks in a.m., family hx of JME
2. Absence seizures, myoclonic seizures, GTC's
3. Trigerrs - lack of sleep, alcohol, psychological stress
4. Tx options - Depakote- of choice, maybe Lamotrigine, Keppra, Topamax more recently. Tx duration - for life
5. For women at reproductive age - Depakote is not the best choice.

Rodica
 

 

 

 

 

 

 

 

 

 

 

 

Please click to enlarge

 

IOTW

13yr old developmentally normal child with new onset seizure. Normal MRI and doing well at school.

1. What  is  the likely clinical history that you would expect with this EEG? 
2. What seizure types might she experience ? 
3. Can you predict any potential triggers for her seizure ? 
4. What are your treatment options and for how long ?
5. Does her age or gender impact your decision about treatment? 

 

 

 

This EEG shows generalized 4-6Hz polyspike waves, a classical pattern seen in Juvenile Myoclonic Epilepsy (JME).

The onset of JME is ranges from 8-20yrs, but most commonly occurs in mid-adolescence.  Myoclonic seizures are the most prominent seizure type, followed by generalized tonic-clonic seizures, and occasionally absence seizures early in the course.  Seizures have a diurnal pattern and are triggered by sleep deprivation, alcohol, and photic stimulaton.   Individuals have normal intelligence.  Sometimes there is a family history of epilepsy.

 

Treatment options include valproic acid which is the mainstay of treatment and is effective in 80% of patients. For females who are getting closer to reproductive years other options to consider include, lamotrigine, levetiracetam, topiramate, and zonisamide.   Although the response to treatment is often good, the treatment is lifelong.