Epilepsy Flashcards
Seizure
occasional, sudden, excessive and rapid discharge of gray matter –> positive sx
Post-seizure –> negative sx (post-ictal period)
Posictal period mechanisms
neuronal exhaustion, inhibitory inputs to seizure area
Signs of epileptic seizures
paroxysmal change in behavior or movement, or altered consciousness
Partial seizure
begins in one area of cortex
remains localized or spreads (may spread to whole cortex –> grand mal seizure)
Generalized epilepsy
due to whole cortex hyper-irritability (genetic). Overreaction to deep gray matter inputs –> seizure
Difference between partial complex seizures and absence seizures
partial complex seizures –> postictal state
no postictal state in absence seizures
DDx of episodic epilepsy sx
Syncope/near syncope (circulatory, altered blood state like hypoxia), movement disorders (myoclonus, paroxysmal dyskinesia), fasciculation, stroke/TIA, Migraine, sleep disorder, psychogenic/behavioral
Focal seizures, consciousness preserved
motor signs (Jacksonian, aversive), somatosensory sx, autonomic s/sx, psychic sx
Focal seizures, loss/impaired conciousness
Partial onset –> impaired consciousness; OR impairment of consciousness on onset
Can evolve into convulsive seizure
Generalized seizures
tonic-clonic, tonic, atonic, myclonic, absence
Epilepsy
chronic disease of recurrent, unprovoked sizures. 2+ unprovoked seizures, more than 24h apart OR 1 seizure with studies suggesting further risk for seizures
Drug resistant epilepsy
36% of cases
symptomatic seizures
30% with structural abnormality (tumor, arteriovenous malformation). Half remit
Idiopathic seizures
genetic. Usually children
Benign epilepsy
easily treated, normal intelligence, normal tests.
Genetic, remission by teen years
Catastrophic epilepsy
Med resistant. Affects development –> mental retardation, shortened lifespan of child
Abnormal EEG, MRI. Symptomatic seizures
Febrile seizures
age 6mo-3y. seizure c fever without evidence of intracranial infection or defined cause
Simple seizure
generalized, less than 10-15min, do not recur in less than 24h
Complex seizure
focal, > 10-15 min, recur in less than 24h. 30% of febrile seizures
Timing of febrile seizures
within first 24h of illness
Risk factors for recurrence of febrile seizure
less than 1 yo, family hx, low grade fever, brief fever
Seizure’s effect on cognition
nearly all children have normal cognition. prolonged or complex seizures –> increased risk of cognitive problems (most do well)
Tendency for sleep problems
Risk factors for developing epilepsy
Complex febrile seizure, neurologically abnormal prior to seizure, family hx of afebrile seizures
Treatment of seizure now
DOES NOT prevent later epilepsy
Lennox Gastaut syndrome
Generalized seizures, cognitive dysfunction (may evolve later), usually children 1-7y
Causes of Lennox Gastaut syndrome
malformations, hypoxic-ischemic injury, encephalitis, meningitis, TUBEROUS SCLEROSIS
30% of pts with infantile spasms –> LGS
When do you treat seizures?
after someone has 2 seizures or if there is an acute reason for seizure (tumor, stroke, etc) –> anticonvulsants
How long should a patient be seizure free before we consider weaning off meds?
2 years
Myoclonic seizure tx
lamotrigine
Generalized seizure tx
phenytoin, carbamazepine, oxcarbazepine, gabapentin
valproic acid contraindications
teen girls (polycystic ovarian disease), pregnant women, children
Topiramate and zonisamide contraindications
acidosis
Old, partial seizure meds
phenytoin, carbamazepine
Old, broad spectrum seizure meds
phenobarbital, valproic acid, ethosuxamide, benzodiazepines
New partial antiseizure meds
Tiagabine, Oxcarbazepine, gabapentin, pregabalin, lacosamide, exogabine, eslicarbazepine
New broad seizure meds
lamotrigine, zonisamide, topiramate, levoteracetam, felbamate, clobazam, rufinamide, perampanel
“Special” seizure meds
Vigabatrin, ACTH
Ketogenic diet
starvation –> ketone bodies –> antiepileptic effect
Diet (creams and MCT oils) continues ketosis (enough calories and protein to grow)
Children > adults
Used with generalized > partial seizures
Ketogenic diet adverse effects
hunger, hypoglycemia, drosiness, lethargy, irritability, acidosis (excessive ketosis)
Serious: kidney stones, prolonged QT, increased bruising with bleeding, pancreatitis, immunosuppression
Vagal nerve stimulation
pacemaker implanted in left chest wall –> stops seizures
For chronic intractable seizures, stopping clustered/prolonged seizures
vagal nerve stimulation side effects
temporary hoarseness, ticking in throat, dyspnea
Epilepsy surgery
for partial epilepsies
Epilepsy surgery in adults
temporal lobe
Epilepsy surgery in children
extratemporal, hemispherectomy
Focal epilepsy surgery
lesionectomy, lobectomy, corticectomy, multiple subpial transection
Generalized epilepsy surgery
corpus callosotomy for drop
Indications for epilepsy surgery
Drug-resistant with poor prognosis and natural hx (Rassmussen’s, Sturge Weber, hemimegalencephaly, focal cortical dysplasia, hippocampal sclerosis), rapid regression of development status, lesion/focus in area not critical for function, predominant seizure type and frequency
