23 - seizure Flashcards
What is a seizure?
a transient event which there is a sudden change of objective or subjective behaviour, in epilepsy this is caused by a paroxysmal discharge of susceptible neurons.
What is epilepsy
a condition which is defined by its reoccurring seizures which are often unprovoked but produced by direct activity from the brain (must have two or more episodes).
What a generalised absence seizure? Age? Features? What may it progress to?
Mx?
Generalised seizures, usually idiopathic.
Usually seen in children.
Frequent brief absent episodes lasting a few seconds.
May progress to tonic-clonic or juvenile myoclonic.
Treat with ethosuximide or sodium valproate
If you don’t know what happens in a tonic clonic you should drop out.
Triggers?
1st line Mx?
sleep deprivation, bright flashing lights, stress, anxiety.
Tonic: short phase, voluntary muscles pulled in.
Clonic - twitiching
Treat with sodium valproate.
Infantile spasms also called? features?
West syndrome.
Episodes involve crying out and flexion of the limbs lasting a few seconds.
Whats seen on EEG and what else is seen?
Hallmark EEG of hypsarrthymia plus learning difficulty.
What happens in juvenile myoclonic eplilepsy?
Usual age?
Most common trigger?
Mx? Avoid ?
Idiopathic generalised epilepsy.
Vacant episodes followed by myoclonic jerks.
Distinct from myoclonic jerks alone
Adolescent onset
Usually sleep deprivation is a trigger
Treat with sodium valproate, avoid alcohol and carbemazepine
Other name for an atonic seizure? What happens?
What is it often confused with?
What do people often get?
Mx?
drop attacks.
Brief lapse in tone. Seizure itself causes no damage but the fall might.
Not to be confused with narcolepsy (EEG)
Most common type of seizure to experience Todd’s paresis (3 mintues max.)
Treat with sodium valproate
What is todds paresis?
focal weakness / total body following seizure
What is a reflex anoxic seizure?
prognosis?
Mx?
Response to painful stimulus (can be other types), a tonic seizure.
Good prognosis, most grow out of them.
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Treat with sodium valproate.
What are gelastic seizures? Characteristic feature? Ix/Mx?
Partial seizure arising in hypothalamus.
Characterised by laughing.
As with all new onset focal seizures, needs imaging.
Treat with carbamazepine or lamotrigine
What happens in a jacksonian march? why?
Phenomenon of a spreading simple focal seizure.
The observed effect is that the seizure’s effect spreads from the distal limb to the ipsilateral face as electrical activity moves across the primary motor cortex.
What happens in complex partial seizures
A seizure starting focally in the brain and progressing to cause change in consciousness.
Often an aura (especially with temporal lobe origin)
Impaired consciousness
What are automatisms in complex partial seizures?
Mx?
nonpurposeful, stereotyped, repetitive behaviours, patients usually unaware of these
moaning, pin rolling, lip smacking, snorting, chewing etc.
Carbamazepine
Differentials of epilepsy?
Cardiac – Syncope, Arrythmia, Reflex Anoxic seizure
Metabolic - Hypoglycaemia
Neurological – TIA, migraine, cataplexy
Gastrointestinal – GORD
Behavioural – Head banging, night terrors
Psychiatric – pseudoseizures
