Epilepsy Flashcards
What are the two focal seizures
Occipital lobe/SeLEAS
SeLECTS - central-temporal part of brain
What are the Generalised Epilepsy Syndromes
Childhood Absence Epilepsy
Juvenile Absence Epilepsy
Juvenile Myoclonic Epilepsy
Epilepsy with generalised tonic clonic seizures
What does Myoclonic mean
Sudden brief muscle contractions
What does Tonic mean
Sudden stiffening
What does Atonic mean
Sudden loss of muscle tone
How is Epilepsy diagnosed
EEG and MRI
Have to have 2 or more unprovoked seizures to have epilepsy
What is a seizure
Physical manifestations of abnormal electrical activity in the brain
How many children grow out of epilepsy by adulthood?
50-60%
What causes epilepsy?
Genetic disorders, structural lesions, previous brain injury, epilepsy syndromes
What is epilepsy
The tendency to recurrent unprovoked seizures
Name the types of seizures
Focal seizure
Generalised seizure
Tonic Clonic
Absence
How are epilepsy syndromes charaterised?
By characteristic clusters or clinic and EEG features
Supported by structural, genetic, metabolic immune or infectious aetiologies
Give me information on SeLects
- It’s FOCAL
- Centro-temporal part of brain
- 4-10 years
- Often nocturnal events
- Normal development and cognition
- Typically involve focal clonic or tonic activity of throat/tongue and one side of the lower face
- EEG - normal background, high activity in C-T area and activated in sleep
- Infrequent seizures that usually stop at puberty
Tell me about Occipital lobe/SeLEAS
- It’s FOCAL
- Seizures further back in the brain are longer, and so it’s longer than absence seizures
- Self limited with autonomic seizures
- Infrequent - with 25% only having one seizure
- Remission in a few years is typical
Tell me about Childhood Absence Epilepsy
- GENERALISED
- Onset is 4-10 years
- Normal development
- Very frequent, like 40 a day
- 3-20 seconds
- EEG: 3Hx spike wave
- Seizures are brought out by hyperventilation
Treatment: Ethosuximide
Tell me about Juvenile Myoclonic Epilepsy
- GENERALISED
- Older children: 10-24 years
- higher rates in ADHD
- Myoclonic seizures on wakening, also Absence and GTCS
- Triggered by sleep deprivation and photic stimulation
- Generally a worse prognosis
Tell me about Developmental Epileptic Encephalopathy –> BAD
- Diseases where epilepsy itself contributes to cognitive and behavioural impairments
- Frequent epileptiform activity
- Many causes: Myogenetic, structural, metabolic, secondary to insult - BD before
Tell me about Infantile spasms
- Onset: 1-24 months
- Sudden and brief - arm extension and neck flexion
- Ass. with poor development and developmental regression
- Ass. with T21 and Tuberous sclerosis
- EEG: Hypsarrythmia –> slow and disorganised
- Treatment: Steroids and Vigabatrin
Tell me about Landau Kleffner syndrome
- Rare and in school aged children
- Acquired aphasia of childhood with seizures
- Epileptic Aphasia
- Verbal auditory agnosia
- Epileptiform activity in sleep
- Infrequent seizures; not the main issue
May lose speech they’ve developed - understanding of noise is affected
Tell me about epileptic medication
Taken twice a day
Tablet/liquid
Aim for 2 years seizure free and wean off
After 2 unprovoked seizures
If it’s infrequent, like SeLEAS or SeLECT –?
What medication is given for convulsive seizures exceeding 5 mins
Buccal Midazolam
What are non pharmalogical treatments?
- Keotgenic diet
- Epileptic surgery
- Vagus nerve stimulation
SUDEP - tell me about it
- Not in the context of a seizure
- Nocturnal is the worry
- Occurs in benign circumstance
Risk factors: epilepsy not being treated, that’s symptomatic, resistant to treatment, ID/Developmental delay, Polytherapy etc…
What is NOT epilepsy
- Tics
- Febrile seizures (6months to 6 years only, seizures only occur in high temps., generally short GTCS less than 5 mins), normal development
- Staring in ASD
- Syncope (fainting)
- Functional Neurological Disorder
- Infantile gratification
What are some co-morbidities of Epilepsy
- Mental health
- Behavioural issues
- IDs
- Sleep disturbance
- Bone health - due to drugs
Tell me about genetics in Epilepsy
- Karyotype – an individual’s complete set of chromosome
- Microarray – is there a bit missing or a bit added to our genes
- Single gene testing – one spelling mistake in one gene
- Gene panel
- Whole exome/genome sequencing
Tell me about an EEG
Painless, 1 hour, electrodes placed on scalp, +/- sleep deprivation, Hyperventilation and photic stimulation to evoke a seizure
Some facts about epilepsy
- most common neurological condition in children - 1 in 200 children
- 50-60 % out of it by adulthood
What is the treatment for Childhood absence seizures
Ethosuximide
What is the treatment for infantile spasms
Steroids and Vigabatrin
Clinical features of epilepsy
Alterations in consciousness, motor/sensory/autonomic or cognitive event
Describe Tonic Clonic seizures
Starts with a cry
Sudden fall to the ground with bilateral stiffening and jerky movements, +/- tongue biting or incontinence
Describe Absence seizures
5-10 seconds staring and impaired consciousness with eye blinking and lip smacking
Generalised
