Epilepsy Flashcards
What are the classifications of seizures?
Generalised: discharge arises from both hemispheres, includes absence, myoclonic, tonic, tonic-clonic, atonic. May be incombination or in sequence. LOC, no warning, symmetrical.
Focal: Where seizures arise from one or part of one hemisphere. May have aura, may or may not be associated with LOC.
What are the different types of focal seizures and how do they present?
Frontal seizures: MOTOR
involve the motor or pre-motor cortex
May lead to clonic movements which may travel proximally (Jacksonian march) or a tonic seizure with both UL raised high for several seconds. Asymmetrical tonic seizures can be seen which may be bizarre and hypermotor.
Temporal lobe seizures: AUDITORY SMELL TASTE
May result in strange warning feelings or aura with smell and taste abnormalities and distortions of sound and shape. Lip smacking and plucking at ones clothing and walking in non-purposeful manner (automatisms) following spread to the pre-motor cortex.
Deja-vu feelings.
Consciousness can be impaired
Occipital seziures VISUAL
Visual hallucinations
Parietal lobe seizures SENSATION (dysaesthesia)
Contralateral altered sensations or distorted body image.
describe consciousness in a focal seizure.
Consciousness may be retained lost or the seizure may evolve to a secondarily generalised tonic-clonic seizure.
Describe absence seizures
Transient LOC with an abrupt onset and termination, unaccompanied by motor phenomena except for some flickering of eyelids and minor alteration in muscle tone.
Can be precipitated by hyperventilation
Describe myoclonic seizures
Brief, often repetitive jerking movements of the limbs, neck or trunk.
Non-epileptic myoclonic movements are also seen physiologically in hiccoughs (myoclonic of the diaphragm) or on passing through stage II sleep.
Describe tonic seizures
Generalised increase in tone
Describe tonic-clonic seizures
Rhythmical contraction of muscle groups following the tonic phase.
In the rigid tonic phase, children may fall to the ground, sometimes injuring themselves.
They do not breathe and become cyanosed.
Followed buy clonic phase with jerking of limbs. Irregular breathing, cyanosis persists and saliva may accumulate in mouth
Tongue biting
Incontinence of urine
Seizure lasts from few seconds to minutes followed by unconsciousness or deep sleep for up to several hours.
Describe atonic seizures
Often combined with myoclonic jerk, followed by a transient loss of muscle tone causing a sudden fall to the floor or drop of the head.
How is epilepsy diagnosed?
Detailed history from child and eyewitnesses with video if available.
Focus on any specific triggers and if the child has any impairments, educational, psychological or social problems.
Clinical exam for checking for skin markers of neuro-cutaneous syndrome or neurological abnormalities
What investigations for epilepsy?
ECG for potential convulsive syncope due to arrythmia - long QT syndrome
Inter-ictal (during seizure) EEG - can help categorise the epilepsy type and severity
24h ambulatory EEG
MRI and CT brain scans
Routinely required
For potential epileptic surgery
Metabolic investigations
genetic testing
What factors influence whether to treat epilepsy?
Risk of recurrence How dangerous or impairing How upsetting further seizures would by in context Seizure type Epilepsy type Frequency Social and educational consequences of seizures Considering side effects of AEDs
First line for tonic-clonic seizures?
Valproate
Carbemazepine (AVOID in absence, myoclonic seziures or juvenile myoclonic epilepsy)
Lamotrigine
First line for absence seizures
Valproate
Ethosuximide
Lamotrigine
First line for myoclonic seizures
Valproate
Topiramate
Levetiracetam
First line for focal seizures
Carbemazepine
Valproate
Levetiracetam
Lamotrigine
