Unit 06 Epilepsy
The overall aim of this Unit is to provide you with an understanding of the physiological basis of seizure disorders and their epidemiology, along with the detailed clinical knowledge necessary to manage children with seizure disorders to an advanced (tertiary) level. This Unit complements and expands upon the BPNA Paediatric Epilepsy Training (PET) face-to-face courses.Method of delivery: Online
Study Hours: 78.0
Continuing Professional Development Points: 78.0. You will be able to download a pdf of your CPD certificate following completion of each section within the unit.
Unit 06 Epilepsy
In this section you will learn about the definitions of epilepsy, seizure types, epilepsy types, and epilepsy syndromes, as recognised by the International League Against Epilepsy.
You will consider how clinical evaluation is the foundation to diagnosis and management of children presenting with suspected epileptic seizures, in particular the importance of the clinical history in achieving a correct and full diagnosis. You will develop a systematic approach to evaluating children with suspected seizure disorders. The emphasis will be on recognising key clinical features that aid differentiating seizure types and, where appropriate, the corresponding EEG features.
Feedback comments - what was the best thing about Section 1?
- "It was really well structured" - Specialist paediatric neurology trainee, Spain
- "Explanation of the DESSCRIBE system and running through the basic terms used and what they actually mean" - Specialist Paediatric Trainee, UK
- "Clarifying the terms, those that are no longer used, and those terms that are used now. Feel more confident that I can sensibly describe events to colleagues. It was good to go over the material again that I covered in PET1" - Specialist paediatric trainee, UK
- "New ILAE classification" - Consultant Paediatrician, Kenya
- "Good level for an introduction. Good resources" - Specialist Paediatric Trainee, UK
- "Better understanding for the new definition of epilepsy and why it changed from the old one" - Specialist Paediatric Neurology Trainee, Qatar
- "Good level of repetition and clinical examles to cement understanding of basics" - Specialist Paediatric Trainee, UK
- "Good overview of the different classifications of seizures and epilepsies prior to moving onto more in depth information in the next sections" - Specialist Paediatric Trainee, UK
This section is designed to provide paediatric neurologists with the theoretical basis necessary to understand how epileptic seizures may arise and the processes that may be involved in epileptogenesis.
Paediatricians with a more general background: this section may be of interest to you but is not essential that you complete it.
There are many different ways in which seizures are generated and this section address these in turn, encompassing the range of acquired and genetic disorders that can affect the developing brain throughout childhood and result in epileptic seizure disorders.
Feedback on this section - what was the best thing about Section 2?
- "I had started this section in the old format and the changes are excellent! Clear and thorough - helped me greatly to tie together a range of presentations I have seen" - Specialist Paediatric Trainee, UK
- "Excellent selection of papers and practical aspects of the course" - Specialist Paediatric Neurology Trainee, UK
- "Details about lissencephaly" - Clinical Fellow, UK
- "Metabolic disease and epilepsy" - Specialist Paediatric Trainee, UK
- "Case studies on channelopathies" - Consultant Paediatrician, UK
- "Excellent structured approach highlighting how to investigae suspected metabolic disorders and suspected genetic disorders" - Specialist Paediatric Trainee, UK
- "Case studies testing knowledge" - Specialist Paediatric Trainee, UK
If you have attended the BPNA Paediatric Epilepsy Training PET2 or NeoNATE course you will have had an introduction to the epilepsies presenting in the neonatal period. Here you will expand your knowledge base of these conditions.
The incidence of epileptic seizures is highest in the neonatal period compared to any other time of life, however newborns can also exhibit many movements that are not epileptic. Differentiating epileptic from non-epileptic events on clinical grounds can be challenging.
This section will provide you with a good working knowledge of the clinical presentation of neonatal seizures and their causes, differential diagnoses and management. You will understand the principals of neonatal EEG and amplitude integrated EEG (CFM) and their role in the diagnosis and management of neonatal seizures.
This section is provided in both Distance Learning Unit 2 Neonatal Neurology and Unit 6 Epilepsy. You only need to complete the section once.
Feedback - what was the best thing about Section 3?
- "Teaching material was excellent" - Consultant Paediatrician, Pakistan
- "Practical and comprehensive" - Specialist Paediatric Trainee, UK
- "Concise and to the point, uploaded papers were good" - Neurologist, India
- "Clear clinical and treatment guide, clar explanation relevant to clinical practice. Good articles definitely relevant" - Specialist Paediatric Neurology Trainee, Cambodia
- "Excellent structured approach to investigation, and honest discussion regarding the controversies of management" - Specialist Paediatric Trainee, UK
- "Relevance to clinical practice with clear and logical flow" - Consultant Paediatrician, UK
- "Case examples" - Specialist Paediatric Trainee, UK
- "Good exercises" - Clinical Fellow, UK
- "Tables were great, well organised and good summary" - Specialist Paediatric Neurology Trainee, Qatar
- "Classification and management advice. Reviewing EEGs and aEEGs" - Specialist Paediatric Neurology Trainee, UK
- "Section was well taught as if speaker talking directly to participant" - Specialist Paediatric Trainee, UK
- "Well structured. Useful learning around clinical features of neonatal seizures and neonatal EEG. Interesting information on vitamin deficient epilepsies" - Specialist Paediatric Trainee, UK
In this section you will take an in depth look at the conditions with seizure onset in infancy. The section is divided into 2 parts:
- Part A: Febrile Seizures are the most common childhood seizure disorder and represent a unique response of the young child's brain to fever. This section will outline the definition of febrile seizures and discuss the classification, differential diagnoses and management of the child presenting with febrile seizures.
- Part B: The Epilepsies of Infancy. In this part you will look at the most important epilepsies presenting in infancy and at the concepts of developmental versus epileptic encephalopathy.
Feedback - what was the best thing about Section 4?
- "Clinical cases" - Specialist Paediatric Trainee, UK
- "Clear, practical well structured" - Specialist Paediatric Trainee, UK
- "Clear logical systematic approach" - Consultant Paediatrician, UK
- "Good understanding of febrile seizures" - Clinical Fellow, UK
- "Case studies on seizures in infants" - Consultant Paediatrician, UK
- "Useful and relevant clinical papers" - Specialist Paediatric Neurology Trainee, UK
In this section you will learn about the epilepsies which first present during childhood, i.e. between infancy and adolescence. There are many epilepsy syndromes and related conditions encountered in this age group which are well recognised, and you will be helped to identify their key diagnostic features.
You will learn about the self-limiting and pharmacoresponsive epilepsies of childhood, particularly the common epilepsy syndromes: childhood absence epilepsy and childhood epilepsy with centrotemporal spikes.
You will also learn about the clinical features, differential diagnoses, and management of the important complex, epileptic encephalopathies encountered in childhood.
Feedback - what was the best thing about Section 5?
- "Excellent videos, good clear descriptions" - Specialist Paediatric trainee, UK
- Clinical revelance. Webinar lecture to supplement activities and commentary - Consultant Paediatrician, UK
- "Good and consequent description of seizures and seizure types. Good hints for differentiation between syndromes" - Specialist Paediatric Neurology Trainee, Germany
- "Videos were very useful. Papers selected were excellent and very informative" - Specialist Paediatric Neurology Trainee, UK
- "Very well planned. Content is good" - Consultant Paediatrician, India
In this section you will learn about the epilepsies with onset during adolescence. You will explore the clinical presentation, electroclinical features and treatment options of the epilepsy syndromes of adolescence, including juvenile myoclonic and juvenile absence epilepsy.
You will learn the clinical features of the most common of the reflex epilepsies.
You will study the progressive myoclonic epilepsies, understanding how to diagnose these individual conditions, and the diagnosis and management of the progressive epilepsy Rasmussen encephalitis.
Feedback - what was the best thing about Section 6?
- "Structural approach to the mycolonic epilepsies, including summary of the PMEs" - Specialist Paediatric Neurology Trainee, UK
- "Excellent case studies" - Specialist Paediatric Trainee, UK
- "Clear, logical summary. Improved my awareness of epileptic encephalopathies presenting in older children and of reflex epilepsies" - Consultant Paediatrician, UK
In this section you will consider the recognition and management of convulsive and non-convulsive status epilepticus (SE). You will learn about the ILAE’s newly revised definitions and classification of SE.
- develop a protocol for the investigation and management of the acutely unwell child in SE, and appreciate the time-critical nature of managing this condition;
- consider the approach to managing non-convulsive SE;
- consider the differential diagnoses for both convulsive and non-convulsive SE;
- learn about the specific epilepsy syndromes at high risk of developing into SE.
Feedback - what was the best thing about Section 7?
- "Structured approach to assessing status epilepticus" - Specialist Paediatric Neurology Trainee, UK
- "Clearly set out. References" - Consultant Paediatrician, UK
- "Excellent series of cases at the end pulling together knowledge from a few sections" - Specialist Paediatric Trainee, UK
- "Subject was taught with clinical scenarios" - Consultant Paediatrician, Pakistan
In this section we will be considering events that look like epileptic events but are not. This is one of the most common functional disorders you will encounter. You will recognize the features that suggest your patient’s episodes may not be due to epilepsy and understand the associated psychiatric co-morbidities. You will begin to develop strategies to explain this diagnosis to your patients and their families and to help them to manage this group of conditions.
Feedback - what was the best thing about this section?
- "Article by Markus Reuber on how to communicate the diagnosis and deal with the consultation" - Specialist Paediatric Trainee, UK
- "Overview of functional non epileptic events and terminology used. Reference to online resources. Lecture" - Consultant Paediatrician, UK
This section will provide you with a basis for the rational use of the EEG in the investigation of children with seizure disorders.
The EEG remains a key investigation in children presenting with epilepsy, particularly as it can often help in making a syndromic diagnosis. However, as we have already discussed in this unit, it will only aid diagnosis, and has to be interpreted in the context of the clinical history.
In this section you will study how the EEG is obtained, the range of EEG techniques available, the principle features of normal and abnormal EEGs, and how the EEG can be used to help diagnosis in particular clinical situations.
We have provided information previously taught at the PET EEG face-to-face course. We provide you with some of the lectures and workshops to consolidate your learning.
Feedback - what was the best thing about Section 9?
- "Excellent structured approach to the normal EEG, excellent examples" - Specialist Paediatric Trainee, UK
- "Lecture resources. Review of indications for requesting EEG; different EEG types" - Consultant Paediatrician, UK
The aim of this section is to enable you to select appropriate neuroimaging investigations when assessing children with seizure disorders, and to enable you to interpret and apply the results.
Feedback - what was the best thing about Section 10?
- "Excellent scans and explanations of the different MRI sequences and their utility" - Specialist Paediatric Trainee, UK
- "Review of indications for imaging and preferred modality to use" - Consultant Paediatrician, UK
- "Case histories" - Consultant Paediatric Neurologist, India
The aim of this section is to enable you to select appropriate investigations when assessing children with seizure disorders, and to enable you to interpret and apply the results.
Feedback - what was the best thing about this section?
- "Really helpful summary of much of the material that was covered in other sections, this was useful to bring it all together" - Specialist Paediatric Trainee, UK
- "Clinical relevance. Clinical cases and reflecting on individual considerations / decision making when arranging investigations" - Consultant Paediatrician, UK
- "Table of case studies in last section" - Specialist Paediatric Trainee, UK
- Understand the principles of antiepileptic drug (AED) medication in the treatment of children with epileptic seizure disorders.
- Be able to apply evidence from drug trials, reviews and other useful guidance to decide on the most appropriate AED for an individual patient.
This section will enable you to achieve an understanding of the types of childhood epilepsy that may be suitable for epilepsy surgery and the evaluation processes involved.
By the end of this section, you will understand the role of the ketogenic diet in the management of children with seizure disorders.
By the end of this section, you will understand the role of VNS and neuromodulation in the management of children with seizure disorders.
The aim of this section is to help you understand seizure disorders in children at the population level. Such information is vital in the planning of clinical services. You will understand how to define the epidemiological terms incidence and prevalence, at the risks of recurrence after a one and after two unprovoked seizures in defined situations and factors that modify recurrence risk.
You will look at how to prognosticate the possible outcomes of a seizure disorder for the family, how this information helps you to decide when to start and stop AED treatment, and at the risk of SUDEP in the childhood epilepsies.
The course is accessed via a dedicated website. On acceptance of your application, we will provide you with a username and password to access the website.
Each Unit is split into smaller Sections (see Course Content for details). For each section, you will download a zip file containing an Activity document and reference papers.
The Activity document leads you through each section, providing work-based activities for you to complete. You may choose to work through the Activity document on your computer or print off the materials so that you can work on a hard copy.
Each activity is designed to lead you through the topic. Sometimes an activity will ask you to read a paper and then answer questions. Other times it will ask you to consider a case. A Commentary follows each activity, to check your learning. For most units there are also a number of lectures to watch.
There is no start or end date to complete each unit. We would hope that you will work through it at a rate that is right for you, maintaining a balance between momentum and enjoyment.
As you complete the Activity document for each section, send it by email to the BPNA. Once it has been reviewed, we will provide a certificate of Continuing Professional Development. You can download this from your BPNA personal account.
WHO IS THIS FOR?
Consultant and trainee:
- Paediatric Neurologists
- Community Paediatricians
- RCPCH Epilepsy SPIN trainees
- All those who have completed PET courses and wish to learn more about epilepsy.
Unit 00 Introduction to Paediatric Neurology
Unit 06 Epilepsy
Unit 07 Cerebrovascular disease, trauma and coma
Unit 12 Headache
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