Convulsions Flashcards
Definitions
Convulsion
Seizure
Types of seizures
Epilepsy
Acute symptomatic / provoked seizure
Status epilepticus
Focal seizure - 2 categories
Focal with intact awareness (simple partial)
Focal with impaired awareness (complex partial)
Simple partial seizures
Motor
Sensory
Autonomic
Psychiatric
Complex partial seizures
Classic complex seizure
Other forms
Generalized seizures - 6 main types
Abscence (petit mal) Tonic Clonic Tonic-clonic (grand mal) Myoclonic Atonic
Grand mal seizure
May have prodrome Loss of consciousness, patient falls Tonic ictal phase Clonic ictal phase Post-ictal phase
Generalized seizures commonly occuring in infants:
Tonic
Clonic
Atonic
Febrile seizure
Rapid temp. increase >39 14 - 18 month old most common age Positive family history Typical vs atypical presentation Tx: antipyretics, NOT anticonvulsants
Neonates most common seizure cause
Provoked seizures! ;
Neonatal encephalopathy
CNS or systemic infection
Metabolic disturbance
Infants, children - most common cause of seizures
Febrile seizures
Seizure history
SOCRATES; Before seizure - any prodrome, triggers Description of the seizure(s) Any post-ictal state History, physical exam, labs, imaging for cause of a provoked seizure EEG
Seizure inital management
Provoked seizure - treat underlying cause
Unprovoked - 1st seizure observation for recurrence
1st unprovoked seizure - increased risks for recurrence:
Abnormal EEG
Prior neurological insult
Significant MRI findings
Focal epilepsy pharmacotherapy
Carbamazepine
Oxcarbazepine
Generalized epilepsy pharmacotherapy
Valproate
Lamotrigine
Ethosuximide
Infantile spasms - specific Tx
ACTH
Childhood absence seizures specific Tx
Valproate
Ethosuximide
Juvenile myoclonic epilepsy specific Tx
Valproate
Side effects all antiepileptics
Drowsiness
Dizziness
Diplopia
Loss of balance
Valproate dose dependent side effects
Thrombocytopenia
Teratogenic
Drug dosing
Start low - increase gradually
Increase until 1) seizure stop, 2) SE unbearable or 3) serum levels reach therapeutic range
Stopping drugs
Should be done after 2 years no seizures
Taper off slowly
Recurrence of seizures 30-40%
Causes of provoked / acute symptomatic seizure
Hyponatremia Hypocalcemia Fever Toxin Intracranial bleeding Intracrania infection - meningitis, etc..
Epilepsy definition
2+ unprovoked seizures occuring >24h apart OR
1 unproked seizure and a probability of further seizures over the next 10 years
Partial seizure commonly occuring in infants:
Simple partial - motor type
Specifically ‘versive seizure’ - deviation of the eyes + ipsilateral deviation of the head and turning of the trunk
Infantile spasms (West syndrome)
Very specific type of seizure - 2 types of spasm. Occur in clusters.
