Epilepsies with Juvenile and Adult Onset (12 Years and Older)
Epilepsies with Juvenile and Adult Onset (12 Years and Older)
The groups of epilepsy syndromes and the specific epilepsy syndromes with juvenile and adult onset (12 years and older) and accompanying seizure types are listed in Table 7-1.
I. SYMPTOMATIC AND PROBABLY SYMPTOMATIC FOCAL EPILEPSIES
Symptomatic focal epilepsies can occur at any age. Three seizure types are associated with these epilepsies: simple partial (focal); complex partial (psychomotor, temporal lobe); and tonic-clonic (grand mal). The clinical and electroencephalographic (EEG) features of these three seizure types are reviewed in Chapter 2; management and prognosis are reviewed in Chapter 3. Differential diagnostic entities to consider in children and adults in the diagnosis of these seizure types are listed in Chapter 3 and reviewed in Chapter 9.
Depending on locus of onset, five types of symptomatic focal epilepsy syndromes have been recognized (Table 7-1). Clinical and EEG features and management and prognosis of these five types are reviewed in Chapter 3.
II. IDIOPATHIC GENERALIZED EPILEPSIES
A. Juvenile Absence Epilepsy
Childhood and juvenile absence epilepsy are reviewed in detail with childhood epilepsies in Chapter 6. Only special features of this epilepsy in adults are presented here.
Childhood and juvenile-onset absence epilepsies persist into adulthood in 30% to 50% of patients and may be difficult to control. Absence seizures may be overlooked during childhood and first come to medical attention in the late teens or early twenties (e.g., after joining the military, going to college, or starting a job). Absence seizures must be clearly differentiated from complex partial seizures, because both may first be seen with lapses of consciousness and automatisms (see Chapter 9). The treatment of absence seizures differs from that of complex partial seizures. Hyperventilation is useful for producing clinical and EEG manifestations of absence seizures in patients of all ages.
Absence seizures may be difficult to control in adults who fail to “outgrow” them. The combination of ethosuximide and valproic acid is sometimes effective when monotherapy fails.
Approximately one third to one half of patients with absence seizures experience tonic-clonic seizures at some time during their lives. Unlike absence seizures, tonic-clonic seizures persist past the teens in the majority of patients. Because of the high incidence of tonic-clonic seizures in juvenile absence seizures, some physicians start all such patients on valproic acid as the first drug.
Table 7-1. Groups of epilepsies and epilepsy syndromes with juvenile and adult onset (12 years and older)
Symptomatic and probably symptomatic focal epilepsies
