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Neuropsychiatric Disorders > Assessment and Management of Subtle Seizure Manifestations > Flashcards

Assessment and Management of Subtle Seizure Manifestations Flashcards

1
Q

When might a condition be labelled as “epileptic encephalopathy”?

A

When frequent epileptic/epileptiform activity leads to deterioration in cognition and behaviour

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2
Q

What two types of cognitive impairment must you distinguish between when considering subtle manifestations of epilepsy?

A

▪️Permanent impairment
▪️State-dependent impairment

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3
Q

What is state-dependent cognitive impairment?

A

Potentially reversible and treatable cognitive impairment

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4
Q

What are the two types of state-dependent cognitive impairment seen in epilepsy?

A

▪️Drug induced
▪️Caused by epilepsy itself

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5
Q

What is a subtle manifestation in epilepsy?

A

A change resulting from:
▪️An effect that’s not an obvious manifestation of a seizure although seizure itself may be obvious
▪️An effect of a subtle seizure or epileptiform activity not manifesting as an obvious seizure

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6
Q

What is the most important factor to consider in the management of subtle manifestations of epilepsy?

A

Diagnosis!

Important to take a good history and examine the patient

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7
Q

What features of the ictal phase of a seizure may contribute to state-dependent cognitive impairment?

A

▪️Frequent absence seizures (non-convulsive status epilepticus)
▪️Complex partial status epilepticus
▪️Focal discharges - frequent localised and hemispheric discharge

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8
Q

What is TCI and what might cause it in epilepsy?

A

Transitory Cognitive Impairment

Frequent focal discharges

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9
Q

What is nonconvulsive status epilepticus (NCSE) ?

A

State of continuous seizure activity for at least 30 minutes with cognitive or behavioural change

Often altered mental status/consciousness

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10
Q

What EEG pattern is most frequently seen during seizure?

A

Spike-and-wave

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11
Q

What is the problem with subtle absence seizures with no clinical manifestation?

A

Sometimes able to carry on normally so may go undiagnosed

Frequent absence seizures mag be affecting cognition

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12
Q

What subtle manifestations might be seen with frequent absence seizures?

A

▪️Poorer cognitive performance
▪️Withdrawn behaviour
▪️Fragmented thought processes
▪️Attention deficit and motor overactivity
▪️Attention seeking behaviour

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13
Q

Why is knowing the pattern of manifestation important?

A

Can develop management strategies around it

E.g. if worse in mornings, such as in JME, causing functioning difficulties, then learn to get up an hour earlier

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14
Q

How might frequent left temporal discharges present?

A

Increased aggressive behaviour

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15
Q

What post-ictal factors might impact cognition?

A

▪️Frequent daytime seizures
▪️Frequent nighttime seizures
▪️Electrical status epilepticus during slow-wave sleep (ESES)

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16
Q

Why might frequent daytime seizures lead to cognitive impairment?

A

Unable to fully recover between them

17
Q

Why might frequent nighttime seizures and ESES lead to cognitive impairment?

A

Disrupted sleep

18
Q

Why might someone with epilepsy be misdiagnosed as having permanent cognitive impairment?

A

If in a constant post-ictal state from frequent seizures

19
Q

How might frontal lobe seizures present?

A

▪️Frequent brief nocturnal attacks
▪️Bizarre non-rhythmical limb movements
▪️Vocalisations
▪️Awareness

20
Q

What medications can be used for nocturnal frontal lobe seizures?

A

▪️Carbamazepine
▪️Levetiracetam

21
Q

How might nocturnal seizures affect daytime cognition?

A

▪️Lack of sleep
▪️Direct post-ictal effects

22
Q

What is Landau Kleffner syndrome?

A

A rare epilepsy, usually in young children, characterised by loss of language skills (aphasia) and silent electrical seizures during sleep (ESES)

23
Q

How might you treat Landau Kleffner syndrome and other epilepsies with CSWS and ESES?

A

▪️Valproate
▪️Combination therapy with lamotrigine, benzodiazepines, and steroids
▪️Multiple subpial transection

24
Q

What is ESES?

A

Electrical status epilepticus during slow wave sleep

(Age-dependent, self-limiting epilepsy syndrome in children characterised by cognitive and behavioural disturbances)

25
Q

What is CSWS?

A

Continuous spike and wave during slow wave sleep

(same as ESES)

26
Q

Can antiepileptic treatment help cognition?

A

Yes

27
Q

What is the main problem with treating CSWS/ESES epilepsies and subtle cognitive/behavioural manifestations?

A

Early, prompt treatment is recommended as may prevent permanent loss of skills/cognitive behavioural problems

28
Q

What could you consider if medication is ineffective?

A

Multiple subpial transection

29
Q

What should be used to investigate children with loss of skills?

A

Nocturnal EEG monitoring

Neuropsychiatric Disorders (30 decks)

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