Epilepsy Exam Cram Flashcards
What kind of seizure?
3Hz spike wave
Absence
What kind of seizure?
Centrotemporal sharp waves
Benign epilepsy with centrotemporal spikes / Benign Rolanic Epilepsy
What kind of seizure?
Frequent right occipital spikes
Occipital epilepsy of childhood (Gastaut type)
What kind of seizure?
High amplitude sharp and slow complexes mostly occipital?
Benign Occipital Epilepsy (Panayiotopoulos type)
What kind of seizure?
Hypsarrhythmia
Infantile spasm
What kind of seizure?
Burst suppression
Normal in preterm infant
Late pre-term baby, apgars 9,9 with focal seizure with apnoea day 5 of life. No further seizures since. Normal neuro exam. Normal labs, CSF & neuroimaging. What kind of epilepsy?
Benign neonatal seizures
Neonate with multifocal clonic or tonic seziures in first week of life. FHx of neonatal seizures. What kind of epilepsy?
Benign familial neonatal seizures
Mutation causing benign familial neonatal seizures?
KCNQ2 and KCNQ3
Encephalopathic ex-term baby with erratic myoclonus. EEG shows burst suppression mostly during sleep. What epilepsy?
Early myoclonic epilepsy
2-3mo baby with dev delay, soasticity and focal motor seizures. MRIB shows structural brain abnormality. What epilepsy?
Early infantile epileptic encephalopathy
50% death, 50% severe neurological impairment
Ex prem baby.Normal neuro exam. Milestones not delayed for corrected age. EEG shows burst suppression. What epilepsy?
Normal baby.
Burst suppression normal variant in pre-term babies.
6mo with epileptic spasms usually after waking and developmental regression. EEG shows hypsarrhythmia. What kind of epilepsy?
Infantile spasms / West Syndrome
Most common cause of infantile spasms?
Focal cortical dysplasia
Other aetiologies:
TS / neurocutaneous disorders
T21 / chromosomal disorders
Inborn errors of metabolism
Peri/post-natal insults
Investigations of choice for infantile spasms?
EEG
MRIB
Metabolic workup
Treatment of choice for infantile spasms?
ACTH
Corticosteroids
Vigabatrin (first line in TS)
<18mth infant presenting with febrile status epilepticus, parents reporting developmental regression/plateau?
Dravet Syndrome
Mutation in Dravet Syndrome?
SCN1A
Treatment of choice for Dravet syndrome?
Drugs to avoid?
Valproate
Adjunctive clobazam
AVOID sodium channel blockers in carbamazepine
Afebrile seizures in infancy, ceasing by age 2 with no developmental concerns?
Benign familial epilepsy if FHX
Benign focal epilepsy
8 year old presenting w generalised tonic-clonic seizure during sleep, also has seizures involving the face/tongue/upper limb. EEG demonstrates centrotemporal spikes activated by sleep. What epilepsy?
Benign epilepsy with centrotemporal spikes / Rolandic epilepsy
Management of Rolandic / BECTS ?
No need for AEDs if seizures non-compromising
First line valproate
4 year old presenting with night time seizure with autonomic symptoms lasting >5min. EEG shoes occiptal/multifocal discharges. What epilepsy?
Benign occipital epilepsy - early onset (Panayiotopolous)
Management of benign occipital epilepsy?
50% of patients only have 1 seizures
If AED req -> carbamazepine first line
9 year old presenting with day time seizure involving vision, without loss of consciousness. EEG shows occipital spike wave complexes activated by eye closure. What epilepsy?
Occipital epilpesy - late onset - Gastaut
Treatment of late onset occipital epilepsy (Gatsaut)?
Carbamazepine
Frequent absence seizures in pre-school/primary school aged child. In your clinic you can induce absence seizure with hyperventilation. EEG shows 3Hz spike waves during episode with normal background activity. What epilepsy?
Childhood absence epilepsy
Management of childhood absence epilepsy?
Ethosuxamide, sodium valproate
Lamotrigine second line
AVOID carbamazepine, keppra (ineffective)
5yo with daily severe seizures. Seen in your clinic wearing a helmet. Was neurodevelopmentally normal prior to first seizure but now plateau/regressed. EEG shows inter-ictal pattern of slow spike and wave <2.5Hz. What epilepsy?
Lennox-Gastaut
4yo with generalised epileptic seziures with a significant family history of same. Wearing a helmet when presented to your clinic. EEG shows 4Hz theta bursts, fast generalised spike waves and photosensitivity. What epilepsy?
Myoclonic-atonic epilepsy
Management of myoclonic-atonic epilepsy / Doose syndrome?
Ketogenic diet
5 year old presents with regression of language starting age 3.5-4. Parents initially thought hearing was impaired but had a normal hearing screen. EEG demonstrates continuous epileptiform (electrical status) during sleep. What epilepsy?
Landau-Kleffner
Teenager presenting with myoclonic jerks after waking in the morning/absence seizures. Usually worse after staying up all night playing video games or going to a party with friends. There is a family history of epilepsy. What epilepsy?
Juvenile myoclonic epilepsy
Management of juvenile myoclonic epilepsy?
Valproate
Seizure involving sudden laughing or crying?
Gelastic seizure
Hypothalamic harmatoma
Metabolic test for neonatal seizures onset 1mo - 4mo? Seziures might be increased before feeding time.
GLUT1
What drugs to void in absence epilepsies?
Carbamazepine (worsens)
Keppra (ineffective)
Common choice of AED for most childhood epilepsies?
Valproate
Common choice of AED for neonatal seizures?
Phenobarb
SEs of Carbamazepine?
Rash, SJS, leukopenia, hyponatremia
Dipolpia sign of toxicity
SEs of valproate?
Weight gain, hair loss, pancreatitis, liver failure
SEs of phenbarb?
Rash
SEs of phenytoin?
Rash, serum sickness, hirsutism, gum hypertrophy, osteoporosis
SEs lamotrigine?
Rash, SJS, hypersensitivity
Allele screening recommended prior to commencing AED in people of Asian descent? Why?
HLA-B15:02
Increased risk of SJS/TEN in carbamazepine, phenytoin, oxcarbazine
AEDs associated w low bone density and osteoporosis?
Valproate, phenytoin, topiramate
Risk of teratogenicity with valproate?
10%
Risk is reduced if dose <900mg/day
Neural tube defects
CYP450 inducers? Cause increased clearance and decreased steady state of other drugs?
Phenobarbitone
Phenytoin
Carbamazepine
Topiramate
CYP450 inhibitors? Cause idecreased clearance and increased steady state of other drugs?
Valproate
Na+ channel blockers?
Phenytoin
Carbamazepine
Oxcarbazepine
Valproate
Topiramate
Lamotrigine
GABAergic drugs?
Phenobarb
Benzos
Vigabatrin
Valproate
Risk factors for pharmacologically resistant epilepsy?
Cryptogenic epilepsy
Early onset <1yr
High number of seizures prior to commencing AED
Failures of 1st and 2nd AED
Predictors of good response in AED therapy?
Age <12
Most teratogenic AED?
Safest AED for pregnancy?
Valproate most teratogenic
Lamotrigine or Leveciracetam preferred
Genetic mutation in juvenile myoclonic epilepsy?
GABRA1
