Epilepsy Flashcards
Epilepsy
Psychic /physical changes that occur associated with abnormal electrical activity
Provoked fever, illness medication ( eg high dose paradox)
Epilepsy is rpt unprovoked seizures
Definition
2 unprovoked seizures occurring >24hours apart
OR
One unprovoked seizure and high Probability of further seizure
OR
Diagnosis of epilepsy syndrome
Epilepsy resolved
1 an age dependent epilepsy now past that age
Or
2 remained seizure free for at least 10years and off anti seizure meds for the last 5 years
Epilepsy is treatment responsive in what %
70% of kids responds to treatment with epilepsy
Incidence of Epilepsy
5/1000
10% of pt in developed countries DONT get treatment
30-90% Don’t get treatment in developing countries
Epilepsy
Higher unemployment/
2-3x depression / suicide
School and workplace
Social withdrawal
Co morbidities of Epilepsy
1 learning disorders ID
2 ASD
3 anxiety and depression 2-3x incidence of general population
4 motor dysfunction
Mortality of E
Young child with E about the same as other children
Adolescent with poorly controlled Epilepsy
1. SUDEP sudden unexplained death with epilepsy
2 status epilepticus
HI drowning burns with epilepsy
Classification of E
1 Focal/ generalized
2Genetic ( idiopathic ) / Symptomatic ( secondary to something wrong with the brain eg TS, NF1, Retts trisomy 21, fragile x
3 unknown etiology (30-40% of all Epilepsy)
Genetic single gene disorder
Or complex inheritance eg JME
If you know the diagnosis you can work out the prognosis
DD of E
Neurological epilepsy,migraines, episodeic ataxia
Movement disorder
Other Faint Cardiac prolonged QT syndrome Normal behavior ( esp <2year) GIT metabolic Psychological
Syncope VS epilepsy
1 triggers Syncope FREQ. ( rare in epilepsy
2 preceding symptoms
Faint N,V, blurring of vision headache
Epilepsy. AURA sensory somatic
3 blanks. Faint ‘fading away’
Epilepsy abrupt loss
4 fall fluid ,slow faint
Epilepsy fast and tonic
Fit
faints can fit brief irregular jerking
Epilepsy tonic clonic and tonic
Duration
15-30Sec in a faint
Epilepsy 30S -5mins
Post ictal
Faint tired and headache
Epilepsy. Confusion / headaches
Triggers in syncope
Mictuiciton Defecation Trumpet playing Cough Post prandial Sneezing Diving Crowded places Standing too long
Benign rolandic epilepsy
Commonest school age Epilepsy
Age 3-13year
Simple focal seizure awareness can be preserved and then become GTCE
Often have oral /facial symptoms
Unilateral or Tonic clonic face and then spread generalized TCE
Speech arrest
Lots of saliva
Preservation of consciousness
Characteristics EEG
EEG changes can be seen in kids with no seizures
Status E is rare
Nocturnal Seizures >50%
Prognosis EXCELLENT
Childhood absence Epilepsy
2nd most common in childhood Onset 5-7years EEG characteristic 3 pcs spike wave Short 5-20s Abrupt onset and termination (eg stop walking/stop eating) They are unaware Remission about 80% by puberty 20% don’t can go on the GTCE May be associated with poor social achievement and cognitive difficulties
FRONTAL lobe epilepsy
2x more common than temporal lobe epilepsy
Brief multiple often NOCTURNAL seizures
Treatment of epilepsy
1 patient factors Epilepsy type Weight Comorbities Sex females Compliance once a day Vs tds
2 drug factors
Side effects ( most drugs being stopped because of side effects)
Toxicity
Efficacy old vs the new about same effectiveness
Different side effects
Side effects weight and cognitive issues important and behavioral effects
Stopping / discontinuing medications
Recommendation is seizure free >= 2 years
Overall60% chance of successful withdrawal
Therapeutic options for sever childhood epilepsy
Ketogenic diet good alternative esp <5yr bad epilepsy
Surgery good outcomes in well chosen pt
Vagal nerve stimulation palliative does decrease number of fits
New AEDs
Juvenile myoclonic epilepsy JME
Common
Onset 13-15 years
90% present with GTC seizure
<10% abscences
Treatment
Males is valproate
Females NOT VALPORATE because 15X more likely to have fetal malformations and learning difficulties (keppra)
Baby with a funny turn
Benign neonatal sleep mycolonis Only in sleep Goes away when they wake up 95% of cases Normal development Grow out of them by 6/12 Can startle /jerkers with noise or tactile stimulus
Infantile spasm
2-12/12 of age
DEVELOPMENTal regression ( if child normal development NOT likely infantile spasm
Cause chromosome or lesion in head
Investigations urine metabolic scree FBC/Elfts EEG ca++ Mg++ Phophae
B12 <2year TREATABLE cause
AVOID VALPORATE in children <2year
Could have a mitochondrial cause and adding VALPORATE will kill them
NonEpiletic episodes in children funny turns
20-25% of children referred with diagnosis of epilepsy don’t have it Common ones Staring 35% Sleep changes 30% Movement disorders 30% shuddering tremor dystopia Migraine normal movement Masturbation Aponea CVS problem
Paroxysmal non epileptic disorders
Syncope Movement disorders Psychological pseudo seizures Migraines Toxic/metabolic Sleep problems Others
Syncope
Common 30-50% of people have them Peak in adolescence CARDIAC causes needs to be ? Family history of sudden death /arryhthmia /cardiomyopathy Can be triggered lots of stress/ exercise Supine posture Swimming/diving breath holding Investigations ECG and EEG
Infant fainting. 5% of children who are well
Family history 20-35%
Cyanotic 54% breathholding
Can try iron supplementation may help
Sleep related events
Epilepsy
Arousal disorders ( night terrors sleep walking)
Sleep wake transition-disorder ( jerking, rhythmic movement disorder
REM sleep disorders eg nightmares
Night terrors Sudden onset unresponsive inconsolable usually <15mins ( but can be up to 30m) 1-5% 5-7 years of age May sleepwalk >90% have a family history Ppt by stress, fatigue,medications
Rhythmic movement disorder of sleep Stereotype rpt movements body and head Occurs between sleep wake transition Onset <18/12 of age Child will h ave a normal healthy life
Blank staring episodes
Focal epilepsy brief freq interrupt play/speaking/eating
Absence epilepsy (warning, longer events, stereotype sequence)
Daydreaming happen in low stimulation environments
Diagnosis video the events
Routine EEG
Movement disorders
Jitters ( common in infants)
Shuddering
GOR ( arching back neck ext)
Remor
Stereotypes
Repetitive purposeless movements body rocking flapping
See in development delay ASD normal
Body rocking head banging head rolling
In normal children has a good prognosis
Pseudoseizures
Marker of stress trauma sexual abuses
Dd movement disorder frontal lobe epilepsy
Clues Gradual onset Prolonged duration Eyes closed Failure to respond to medication Temporal relationship to stress
Non epileptic events do require investigation T/F
Sometimes need investigations eg cardiac causes
GORD migraine vertigo
Evaluating a seizure in an adolescent
Who wittnessed
When did it happen? Day/night
Did it happen during drowsiness or sleep or wakefulness
Assoc with sleep depreciation JME
Drugs/alcohol JME
Provoking factors loud noise/ flickering lights emotion
Aura ( ask about early morning days weeks before the turn lightening like jerks or arms and legs JME)
Assoc injury/ Urineary incontinence
Weakness confusion post ictal
