epilepsy Flashcards
what is epilepsy defined as?
- two or more unprovoked seizures with no identifiable cause
what are the causes of epilepsy in childhood?
what can triggers be?
- malformations (Tuberous sclerosis and other NMDs)
- infections
- electrolyte disturbances
- trauma
- metabolic disorders
- watching TV, flashing lights and lack of sleep
what is the age of onset of absence seizures?
describe absence seizures
- 4-12 years old
- short episodes <20 seconds during which child stares and blinks with no apparent awareness of surroundings
- lip smacking or eyelid flickering as well
- no aura or post-ictal phase
- presents as day dreaming in class or a poor school performance, usually undergo spontaneous remission in adults
how many times can absence seizures occur in a day?
what does the EEG show?
what is the treatment for absence seizures?what shouldn’t be given?
- > 100x a day
- burst of 3 second spike and waves
- sodium valproate
- carbamazepine
what age group does myoclonic epilepsy occur in? what sex is it more common in?
what tends to be the triggers for myoclonic seizures?
- 8-26 years
- girls
- alcohol, sleep deprivation and flashing lights
what is the typical juvenile myoclonic epilepsy picture?
what is the treatment for JME?
- early morning myoclonic jerks, absence seizures and generalised tonic-clonic seizures
- life long sodium valproate
what age does benign rolandic epilepsy occur in ?
describe them
- 3-12 years (peak age 9)
- nocturnal seizures with unilateral facial paraesthesia/ twitching, drooling and aphasia
- rarely have daytime tonic-clonic seizures
how is benign rolandic epilepsy treated?
- resolves in puberty, AEDs rarely needed
what is atonic epilepsy?
who does it usually occur in?
- consists of brief loss of postural tone, often resulting in falls and injuries
- this seizures type occurs in people with significant neurological symptoms
What is the triad you get in lennox-gastaut epilepsy?
what does the EEG look like?
- infantile spasms
- atonic atypical absences
- tonic
- chaotic pattern on EEG
what is the prognosis for lennox-gastaut epilepsy?
- 5% mortality, associated with significant developmental regression and learning disability
what is a simple-partial seizure?
- preserved consciousness
- localised tonic or clonic movements
- may have sensory, motor, autonomic or psychic experiences
what is a complex partial seizure?
partial seizure with secondary generalisation?
- reduced consciousness
- focal seizure followed by a GTCS
what can be in the differential diagnosis when a patient comes with an epilepsy/ seizure type history
- syncope
- night terrors (kids ages 6-8 who suddenly wake from sleep inconsolable and can’t remember it)
- reflex anoxic seizures
- febrile convulsions
- fabricated or induced illness
- cardiac arrhythmias
- migraine
- infection
what investigations would you perform?
- EEG: epileptiform spike and wave activity correlates with different forms of epilepsy
- MRI: rules out certain tumours/ pathology
- LP (infective causes)
- ECG/ ECHO/ lying standing BP
what is the general concept with giving epilepsy medications?
- therapy should be initiated at lowest limit and gradually increased
- if that doesn’t work then decrease and increase another one
- if sedative effect then give at night
what is the treatment for lennox-gastaut syndrome/ infantile spasms?
what is the treatment for absence seizures? what should you not be giving?
- vigabatrin + ACTH
- sodium valproate or ethosuxamide, do not give carbamazepine
what lifestyle advice needs to be given with regards to children and epilepsy?
- attendance responsible when child is bathing and swimming
- ketogenic diet: high in fat but low in carbs and protein
- vagal nerve and deep brain stimulation
what are the SEs of valproate?
SEs of phenytoin?
- vomiting, anorexia, lethargy, hair loss, hepatotoxicity
- gum hypertrophy, hirsutism, ataxia, skin rash
what are the side effects of ethosuximide?
side effects of carbamazepine?
- abdo discomfort, skin rash, liver
- dizziness, drowsiness, diplopia liver dysfunction, anaemia
