Epilepsy is a broad term used to describe various neurologic conditions that cause seizures. According to the Centers for Disease Control and Prevention (CDC), the U.S. had approximately 3 million adults and 470,000 children with epilepsy in 2015. Children with epilepsy are more likely to report academic difficulties, experience cognitive impairment, and live in poverty. Today we bring you Part 1 of our conversation with epilepsy expert Nancy Nussbaum, Ph.D., ABPP-CN. We cover a range of topics including the definition of epilepsy, epileptic syndromes and etiologies that are common in childhood, assessment, treatments, outcomes, and much more.
A pdf of the transcript for this episode is available here: NavNeuro Transcript_22_Pediatric Epilepsy – With Dr. Nancy Nussbaum (Part 1)
Show Notes (with time stamps)
- Definitions of seizure (1:50), pre- and post-ictal phases (2:16), diagnosis of epilepsy (2:33), unprovoked seizure (2:55), and provoked seizure (3:00)
- Etiologies of epilepsy (4:30)
- Prevalence of epilepsy (5:05)
- Partial vs. generalized seizures (5:49)
- Partial seizures: simple and complex (6:19)
- Generalized seizures: absence and tonic-clonic (6:38)
- What is an epilepsy “aura”? (7:53)
- Temporal lobe epilepsy (8:20), febrile seizure (9:44), status epilepticus (9:58), and anti-epileptic drugs (12:10)
- Prevalence and etiology of epilepsy (13:06)
- Benign epilepsy with centro-temporal spikes (14:30)
- Juvenile myoclonic epilepsy (18:46)
- Dravet syndrome (19:59)
- Why do seizures often occur after a brain injury or infection? (21:12)
- Seizure threshold (22:55)
- Lennox-Gastaut Syndrome (23:55)
- Infantile spasm (24:28)
- Petit mal seizures (25:30)
- Does each event cause brain damage that is cumulative over time? (26:30)
- Hippocampal sclerosis (29:44)
- Why is the temporal lobe more seizure prone? (32:07)
- Emotional sequelae of seizures (34:12)
- Do ethnicity/race, sex, or other factors moderate the symptomatology of epilepsy? (38:38)
- Role of telemedicine (40:43)
- Protecting someone from harm during a seizure (41:38)
- International League Against Epilepsy (ILAE) Practical Clinical Definition of epilepsy (45:11)
Nancy Nussbaum, Ph.D., ABPP-CN, is a pediatric neuropsychologist (she holds the subspecialty board-certification through ABPP) with over 30 years of experience. She is part of an interdisciplinary team at Dell Children’s Medical Center in Central Texas and is particularly interested in the assessment and treatment planning of children with epilepsy. Dr. Nussbaum is also the past president of the American Board of Clinical Neuropsychology (ABCN) and is involved in research and training through the University of Texas.
Fisher, R. S., Acevedo, C., Arzimanoglou, A., Bogacz, A., Cross, J. H., Elger, C. E., et al. (2014). ILAE official report: a practical clinical definition of epilepsy. Epilepsia, 55(4), 475-482.
Glauser, T., Shinnar, S., Gloss, D., Alldredge, B., Arya, R., Bainbridge, J., et al. (2016). Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the Guideline Committee of the American Epilepsy Society. Epilepsy currents, 16(1), 48-61.
NINDS. (2015). Epilepsy: Hope Through Research: NIH Publication.
Nussbaum, N. L., Potvin, D. C., & Clarke, D. F. (2014). Application of a multidisciplinary model to a case example of presurgical epilepsy planning. The Clinical Neuropsychologist, 28(8), 1321-1335.
CDC. (2017). School Health Policies and Practices Brief: Epilepsy and Seizure Disorder. Atlanta, GA: Centers of Disease Control and Prevention, US Dept of Health and Human Services.
Sauro, K. M., Wiebe, S., Dunkley, C., Janszky, J., Kumlien, E., Moshé, S., et al. (2016). The current state of epilepsy guidelines: A systematic review. Epilepsia, 57(1), 13-23.
Zack, M. M., & Kobau, R. (2017). National and state estimates of the numbers of adults and children with active epilepsy—United States, 2015. MMWR. Morbidity and mortality weekly report, 66(31), 821.
Today we bring you the conclusion of our conversation with epilepsy expert Nancy Nussbaum, Ph.D., ABPP-CN. We cover a range of topics including the role of a clinical neuropsychologist on an interdisciplinary team, common academic challenges, various treatment options, providing psychoeducation for families, and much more. We also ask Nancy about her experience as President of the American Board of Clinical Neuropsychology (ABCN) and advice regarding leadership in the field.
A pdf of the transcript for this episode is available here: NavNeuro Transcript_23_Pediatric Epilepsy – With Dr. Nancy Nussbaum (Part 2)
Show notes (with time stamps)
- Common anti-epileptic drugs (AED; 01:21)
- Alternative treatments (3:57)
- The trade-off between removing epileptogenic tissue and chronic cognitive and emotional deficits (7:49)
- What is the role of a neurologist and neuroradiologist on an interdisciplinary team? (10:39)
- What is the role of a neuropsychologist on that interdisciplinary team? (12:10)
- Timeline of testing (14:52)
- Special considerations for the diagnostic interview of a pediatric epilepsy case (15:26)
- Neuropsychological battery for pediatric epilepsy post-surgery (17:09)
- Do you give feedback to the child, family, or both? (19:47)
- Vagus nerve stimulation (20:39)
- Ketogenic diet (21:36)
- CBD (24:11)
- How common are pediatric epilepsy cases? (25:28)
- Academic difficulties in children with epilepsy (27:39)
- Strategies for managing seizures in a school setting (29:28)
- How does a diagnosis of epilepsy affect driving? (30:14)
- Providing psychoeducation to the family about their child with epilepsy (31:59)
Epilepsy Foundation: www.epilepsy.com
Chelune, G. J. (1995). Hippocampal adequacy versus functional reserve: predicting memory functions following temporal lobectomy. Archives of Clinical Neuropsychology, 10(5), 413-432.
Kanner, A. M., Ashman, E., Gloss, D., Harden, C., Bourgeois, B., Bautista, J. F., et al. (2018a). Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new-onset epilepsy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology, 91(2), 74-81.
Kanner, A. M., Ashman, E., Gloss, D., Harden, C., Bourgeois, B., Bautista, J. F., et al. (2018b). Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs II: Treatment-resistant epilepsy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology, 91(2), 82-90.