Epilepsy II

Question 1

epilepsy

Answer 1

a disorder of recurrent, spontaneous seizures

2 or more unprovoked seizures separated by
greater than 24 hours or 1 seizure with studies
suggesting further risk for seizures

• 10% of pop have sz in life
• 1-2% of pop has epilepsy

-can be classified by generalized and partial syndromes or by etiologies.

Question 2

intractable epilepsy

Answer 2

seizures which do not respond to a trial of at least 3 anticonvulsants
-approximately 30% of new onset seizure patients may develop intractable epilepsy.

Question 3

status epilepticus

Answer 3

• medical emergency

- ——

Question 4

febrile sz definition and risk of recurrence

Answer 4

• usually between 3 months and 5 years
  of age, associated with fever but without evidence of intracranial infection or defined cause
• most common childhood seizure
• 2-4% in US
• usual: 6 mo to 3 y

20-30% of febrile sz are complex:
Simple
– Generalized
– Less than 10 – 15 minutes
– Do not recur with in 24 hours
Complex
– Focal in nature at onset or during
– Longer than 10 – 15 minutes
– Recur in less than 24 hours

timing:
Usually within first 24 hours of illness
• Not been shown to be rapid rise of fever
• No proof of occurrence with rise in fever
• Many children go on to tolerate higher
fever in the course of the illness

25-40% will have a recurrent febrile
seizures
RFs for recurrence:
-less than 1 yr
-positive FH
-low grade fever
- brief fever
-Epilepsy in first degree relative
-Complex febrile seizure
-Baseline neurodevelopment abnormalities
-Day care attendance

Question 5

seizures

Answer 5

episodic events which are unexpected
and sudden resulting from abnormal and
excessive activity of neurons
– Involves the electrical functions of the brain

Question 6

seizure classification scheme

Answer 6

Partial (focal–networks ltd to one hemisphere): can be simple or complex

Generalized: absence, myoclonic, tonic-clonic, tonic, atonic

Unknown

Question 7

Etiology of epielpsy

Answer 7

-symtpomatic–known etiology: 30% w/ structural abnorm (tumor or AVM); 1/2 with symptomatic remit

idiopathic: genetic predisposition
- most affect children

Cryptogenic: thought to have an etiology that is not yet proven

Question 8

benign vs catastrophic epilepsy (not used anymore)

Answer 8

benign:
-Easily treated with medications
– Normal intelligence
– Most often tests are normal and we don’t know why someone has
seizures
– Genetic predisposition
– Remission after a certain age (usually teens)

Catastrophic:
Intractable to medications
– Affect development with mental retardation and shortens
lifespan of child
– EEG, MRI and other tests are abnormal
– Often will have symptomatic reason for seizure

Question 9

risk of epilepsy w/ febrile sz

Answer 9

-increased risk w/ complex febrile sz, neurologically abnormal prior to sz, FH of afebrile sz
(increased risk with more RFs)

Treating now DOES NOT prevent later epilepsy

Question 10

When do you treat sz?

Answer 10

• if someone has >2 sz or if acute reason for sz (tumor, stroke) then treat w/ anticonvulsant.
• attempt for monotherapy
• keep on meds for 2 years sz free before consider weaning off.

Question 11

phenytoin and carbamazepine

Answer 11

good for generalized sz

Question 12

valproic acid

Answer 12

• do not give to teen girls due to polycystic ovary disease and potential fetal issues
• not for kids