Epilepsy Flashcards
1
Q
What is a seizure?
A
- Transient occurence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain
2
Q
What is the definition of epilepsy?
A
- Epilepsy is defined by any of the following:
- At least two unprovoked seizures occurring more than 24 hours apart
- One unprovoked seizure and a probability of further seizures similar to the general recurrence risk after two unprovoked seizures (around 60%)
- At least two seizures in a setting of reflex epilepsy
NB - Epilepsy is considered no longer present for individuals who had age-dependent epilepsy syndrpome but are not past the applicable age for those who have remained seizure free for at least 10 years off medication.
3
Q
What are focal (partial/localisation related) seizures?
A
- Area of abnormality in otherwise normal brain
- Caused by head injury, stroke, hypoxia, infection, vascular malformations and birth injuries
- Localised gliosis
- Can stay localised or can spread
4
Q
What are generalised tonic-clonic seizures?
A
- Whole brain is affected
- Way they metabolise neurotransmitters, ion-channelopathy, difference in binding sites
- Result of genetic problems
- Genetic Generalised Epilepsy (GGE)
5
Q
What are the features of focal seizures?
A
- Can be aware or have impaired awareness
- History of trauma or birth injury
- Focal aura/sequalae (gustatory/sensory/motor)
- Post-attack confusion/drowsiness
- Nocturnal events
- Motor onset:
- Automatisms
- Atonic
- Clonic
- Epileptic spasms
- Hyperkinetic
- Myoclonic
- Tonic
- Non-motor onset:
- Autonimic
- Behaviour arrest
- Cognitive
- Emotional
- Sensory
6
Q
What are the features of GGE?
A
- Photosensitivity
- Age of onset 8-26yrs
- Alcohol
- Sleep deprivation
- Lack of aura
- Seizures within 2 hrs of awakening
- FHx of IGE
- Abnormal EEG
- Motor
- Tonic-clonic
- Clonic
- Tonic
- Myoclonic
- Myoclonic-tonic clonic
- Myoclonic-atonic
- Atonic
- Epileptic spasms
- Non-motor (absence)
- Typical
- Atypical
- Myoclonic
- Eyelid myoclonia
7
Q
What can EEG be used for in epilepsy?
A
- EEG can be used to classify epilepsy and is useful to tell you the risk of recurrence
- Cannot be used for undiagnosed blackouts
8
Q
How is focal epilepsy treated?
A
- Lamotrigine
- Carbamazepine
- Levetiracetam
9
Q
How is generalised epilepsy treated?
A
- Valproate
- Levetiracetam
- Lamotrigine
10
Q
How is status epilepticus managed?
A
- General measures
- ABCDE
- Establish aetiology
- Alert anaesthetist/ITU it established
- Transfer to ICU if refractory
- AED therapy
- Prehospital
- Diazepam 10-20mg PR or Midazolam 10mg bucally
- Early status
- Lorazepam IV 0.1mg/kg repeated after 10-20 minutes
- Give AED if already on treatment
- Established status
- Phenytoin infusion
- Refractory status
- Propofol
- Midazolam
- Thiopental sodium
- Continue 12-24 hrs after last clinical seizure or elctrographic seizure
- Prehospital
11
Q
Dravet syndrome
A
- An epilepsy with a genetic cause
- Onset in 1st yer of life with febrile seizures (typically 3-9 months)
- Prolonged unilateral or generalised clonic seizures
- Other seizure types by 1-4 years
- Myoclonus
- Focal seizures
- Atypical absences
- Hyperthermia often precipitant (bathing, fever)
- Onset in absence of an infection or structural brain lesion
12
Q
Classification of non-epileptic seizures and events
A
- Syncopes
- Psychological/behavioural events
- Sleep related events
- Paroxysmal movement disorders
- Migraine and disorders possibly related to migraine
- Miscellaneous neurological and non-neurological events
13
Q
Reflex anoxic seizure/reflex asystolic syncope
A
- Syncope triggered by an unpleasant event, often a bump on the head, scratch, seeing blood
- Neurogenic syncope with profound bradycardia and asystole
- Child goes white as a sheet, may have an anoxic seizure, children may sleep for a while after event
14
Q
Prolonged expiratory apnoea/breath holding
A
- Anoxic seizure after not breathing back in following an unpleasant stimulus/crying
- Child goes progressively blue
- May become cyanosed and then have an anoxic seizure
15
Q
Behavioural events
A
- Often defined as involuntary, patterend, coordinated, repetitive, often rhythmic, non-reflexive movements that are goal directed and ocur in the same fashion with each repitition
