Epilepsy Flashcards
Epileptic seizure
Episode of abnormal and excessive neuronal activity in the brain that is apparent to subject or observer
May manifest as motor, sensory, autonomic, cognitive or psychic disturbance
Note: can be provoked in people who do not have epilepsy - fever, hypoglycaemia, hypoxia)
Epilepsy
Chronic disorder characterised by recurrent, unprovoked epileptic seizures
Generalised
Absence Myoclonic Clonic Tonic Tonic-clonic Atonic
Partial simple
Conciousness not impaired May be: With motor symptoms (Jacksonian) With somatosensory or special sensory symptoms With autonomic symptoms With psychic symptoms
Partial complex
Impairment of consciousness May be: Beginning with partial simple With only impairment of consciousness With automatisms Note: partial seizure with secondary generalisation
Diagnosis
Careful history: detailed description, FH, predisposing event
Examination frequently normal
EEG
Neuroimaging
Management
Child and parent education
Psychological and educational support
Anti-epilepsy drugs (AEDs)
Anti-epilepsy drugs (AEDs)
Sodium valproate for generalised
Carbamazepine for parital
Monotherapy achieves control in 70% children
Newer entiepileptics may be appropriate for adjunctive therapy
Status epilepticus definition
Continuous seizure lasting more than 30 minutes
Note: not necessarily epilepsy
Status epilepticus complications
Hypoxia => brain damage or death
Cerebral blood flow and O2 consumption increase 5-fold to meet extra metabolic demand; O2 delivery impaired if inadequate ventilation or if hypotensive
Status epilepticus management
1) Airway maintenance; highflow O2; check glucose
2) IV access: lorazepam IV/IO; no IV access: buccal midazolam or rectal diazepam (no more than twice - resp depression!)
3) Paraldehyde rectally 10% solution 1ml/year of age
4) Summon senior anaesthetic help
5) IV phenytoin - infusion under ECG and bp monitoring
