Epilepsy

Question 1

What is the pathophysiology behind an epileptic seizure

Answer 1

An epileptic seizure is the clinical manifestation of abnormal physio-electrical activity of the brain, and results in the in-balance between excitatory (e.g. glutamate) and inhibitory (e.g. GABA) neurotransmission.

The pathogenesis is multifactorial

Question 2

What four components can a seizure be divided into?

Answer 2

Prodrome
Aura
Ictal
post-ictal

Question 3

How can we classify a seizure?

Answer 3

Based on frequency and length:
- isolated, cluster, continuous (status epilepticus)
Based on localization:
- focal (partial, automotor) or generalized (tonic-clonic, clonic, atonic, absence episodes)
Related to the area of the brain they affect

Question 4

What is the definition of cluster seizures?

Answer 4

2 or more seizure episodes within 24h

Question 5

What is the definition of status epilepticus?

Answer 5

Seizures with duration above 5 minutes or several seizures without return to normal mentation between

Question 6

How can mentation be during a focal episode?

Answer 6

Mentation may be impaired -> automatism
Mentation may not be imparied -> partial

Examples of automatisms:
- aggression episodes
- inappropriate vocalisation

Question 7

Division of seizure activity in what four groups?

Answer 7

Reactive epileptic seizures: Transient reaction of the normal brain caused by metabolic disease or intoxication
Probable symptomatic or cryptogenic seizures: Suspect underlying but unidentifiable brain disease
Symptomatic epileptic seizures: Results from structural forebrain pathology
Idiopathic epilepsy: No cause identified, presumed genetic in origin. Exclusion diagnosis

Question 8

What are the probable causes for seizures in a patient < 6 months?

Answer 8

• anomaly/malformation
• metabolic
• degenerative
• inflammatory
• idiopathic

Question 9

What are the probable causes for seizures in a patient between 6 months -6 years?

Answer 9

• idiopathic
• inflammatory
• vascular
• neoplasia

Question 10

What are the probable causes for seizures in a patient > 6 years?

Answer 10

• vascular
• neoplastic
• inflammatory
• idiopathic

Question 11

What type of diagnosis is idiopathic epilepsy?

Answer 11

A diagnosis of exclusion - if all test results are negative and advanced imaging show no lesions -> idiopathic EP

Question 12

How many epileptic dogs are controlled with anticonvulsant medicine?

Answer 12

70%

Question 13

What is the aim of treatment?

Answer 13

Seizure control, not cute