Epilepsy Syndromes

Classification of epilepsies and epilepsy syndromes is helpful in determining appropriate pharmacotherapy. This classification scheme is based upon the type of seizures a patient has and an attempt to identify the etiology of the epilepsy or epilepsy syndrome:

• Idiopathic epilepsies: These syndromes are thought to be due to genetic alterations, but the underlying etiology is not identified. Neurologic functions are completely normal apart from the occurrence of seizures.

• Symptomatic epilepsies: There is an identifiable cause for the seizures, such as trauma or hypoxia.

• Cryptogenic epilepsies: In these epilepsies the seizures are the result of an underlying neurologic disorder that is often ill-defined or undocumented. Neurologic functions are often abnormal or developmentally delayed in patients with crypto-genic epilepsies.

A complete description of a patient's epilepsy should include the seizure type with the epilepsy or syndrome type (e.g., idiopathic, symptomatic, cryptogenic).

Commonly encountered epilepsy syndromes are:

• Juvenile myoclonic epilepsy (JME): A primary generalized epilepsy syndrome that usually starts in the early to middle teenage years and has a strong familial component. Patients have myoclonic jerks and tonic-clonic seizures and may also have absence seizures.

• Lennox-Gastaut syndrome (LGS): Patients with this syndrome have cognitive dysfunction and mental retardation. Their seizures usually consist of a combination of tonic-clonic, absence, atonic, and myoclonic seizures.

• Mesial temporal lobe epilepsy (MTLE): A type of epilepsy that consists of partial seizures arising from the mesial temporal lobe of the brain. Often this type of epilepsy is associated with an anatomical change described as hippocampal sclerosis. Patients with this type of epilepsy often have excellent surgical outcomes.

• Infantile spasms: A seizure syndrome that occurs in infants less than 1 year of age. It is characterized by a specific EEG pattern and spasms or jitters, and is also known as West's syndrome. Infants with infantile spasms often develop other seizure types and epilepsies later in life.

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