23. Seizure Flashcards

Question

typical presentation febrile seizures

Answer 1

typically occur in children between the ages of 6 months and 5 years around 3% of children will have at least one febrile convulsion usually occur early in a viral infection as the temperature rises rapidly seizures are typically brief and generalised tonic/tonic-clonic in nature

Answer 2

IV magnesium sulphate call obs, anaestheist, emergency theatres, neonatal intensivist etc.

Answer 3

There is loss of consciousness and tonic (muscle tensing) and clonic (muscle jerking) movements. Typically the tonic phase comes before the clonic phase. There may be associated tongue biting, incontinence, groaning and irregular breathing. After the seizure there is a prolonged post-ictal period where the person is confused, drowsy and feels irritable or low.

Answer 4

start in a specific area of the brain may be impaired awareness or aware

Answer 5

motor or non-motor aura motor- jacksonian march - spreads from the distal part of the limb toward the ipsilateral face. They involve a progression of the location of the seizure in the brain, which leads to a "march" of the motor presentation of symptoms. non-motor: déjà vu, jamais vu

Answer 6

partial seizure

Answer 7

HEAD Hallucinations (auditory/gustatory/olfactory), Epigastric rising/Emotional, Automatisms (lip smacking/grabbing/plucking), Deja vu/Dysphasia post-ictal)

Answer 8

motor Head/leg movements, posturing, post-ictal weakness, Jacksonian march

Answer 9

sensory paraesthesia

Answer 10

visual floaters/flashes

Answer 11

Absence seizures typically happen in children. The patient becomes blank, stares into space and then abruptly returns to normal. During the episode they are unaware of their surroundings and won’t respond. These typically only lasts 10 to 20 seconds. Most patients (more than 90%) stop having absence seizures as they get older. quick recovery; often many per day

Answer 12

They are characterised by brief lapses in muscle tone. These don’t usually last more than 3 minutes. They typically begin in childhood. They may be indicative of Lennox-Gastaut syndrome.

Answer 13

sudden brief muscle contractions, like a sudden “jump”. The patient usually remains awake during the episode. They occur in various forms of epilepsy but typically happen in children as part of juvenile myoclonic epilepsy.

Answer 14

Long duration > 10 minutes Affective vocalisation Ictal crying Ictal eye closure Side to side movement of head or body Pelvic thrusting Fluctuating course Memory recall history of trauma and/or mental health problems

Answer 15

3 Hz generalised, symmetrical

Answer 16

Brief spasms beginning in first few months of life 1. Flexion of head, trunk, limbs → extension of arms (Salaam attack); last 1-2 secs, repeat up to 50 times 2. Progressive mental handicap usually 2nd to serious neurological abnormality (e.g. TS, encephalitis, birth asphyxia) or may be cryptogenic poor prognosis

Answer 17

May be extension of infantile spasms (50% have hx) onset 1-5 yrs atypical absences, falls, jerks 90% moderate-severe mental handicap

Answer 18

hypsarrythmia

Answer 19

slow spike

Answer 20

paraesthesia (e.g. unilateral face), usually on waking up

Answer 21

Typical onset in the teens, more common in girls 1. Infrequent generalized seizures, often in morning 2. Daytime absences 3. Sudden, shock like myoclonic seizure

Answer 22

MRI can be used to identify any serious disorder that may have provoked the seizure, such as a brain tumour or arteriovenous malformation (a blood vessel abnormality). electroencephalogram (EEG)

Answer 23

Most neurologists now start antiepileptics following a second epileptic seizure. unless: the patient has a neurological deficit brain imaging shows a structural abnormality the EEG shows unequivocal epileptic activity the patient or their family or carers consider the risk of having a further seizure unacceptable

Answer 24

- other medications antiepileptics can induce/inhibit the P450 system resulting in varied metabolism of other medications, for example warfarin - contraception both the effect of the contraceptive on the effectiveness of the anti-epileptic medication and the effect of the anti-epileptic on the effectiveness of the contraceptive need to be considered - pregnancy or wanting to get pregnant - breastfeeding

Answer 25

men, girls under 10 unlikely to need in future, women unable to have children 1. sodium valproate women and girls 1. lamotrigine or levetiracetam

Answer 26

1. lamotrigine or levetiracetam 2. carbamazepine, oxocarbazepine, zonisamide 3. lacosamide

Answer 27

1. ethosuximide 2. sodium valproate sodium valproate particularly effective if co-existent tonic-clonic seizures in primary generalised epilepsy

Answer 28

boys and men, girls under 10 unlikley need in future, women unable to have children 1. sodium valproate women and girls 1. levetiracetam

Answer 29

boys and men, girls under 10 unlikley need in future, women unable to have children 1. sodium valproate women and girls 1. lamotrigine

Answer 30

absence and myoclonic

Answer 31

The risks of uncontrolled epilepsy during pregnancy generally outweigh the risks of medication to the fetus. All women thinking about becoming pregnant should be advised to take folic acid 5mg per day well before pregnancy to minimise the risk of neural tube defects. Around 1-2% of newborns born to non-epileptic mothers have congenital defects. This rises to 3-4% if the mother takes antiepileptic medication.

Answer 32

folic acid 5mg per day well before pregnancy monotherpay - lamotrigine

Answer 33

associated with neural tube defects most common defect - hypospadias significant risk of neurodevelopmental delay in children following maternal use of sodium valproate.

Answer 34

cleft palate

Answer 35

Breast feeding is generally considered safe for mothers taking antiepileptics with the possible exception of the barbiturates

Answer 36

centro-temporal spikes

Answer 37

prednisolone or vigabatrin

Answer 38

Tongue biting and raised serum prolactin

Answer 39

6 months off if there are no relevant structural abnormalities on brain imaging and no definite epileptiform activity on EEG.

Answer 40

may qualify for a driving licence if they have been free from any seizure for 12 months if there have been no seizures for 5 years (with medication if necessary) a ’til 70 licence is usually restored

Answer 41

should not drive whilst anti-epilepsy medication is being withdrawn and for 6 months after the last dose

Answer 42

simple faint: no restriction single episode, explained and treated: 4 weeks off single episode, unexplained: 6 months off two or more episodes: 12 months off