Epilepsy_Status_Epilepticus_Flashcards
What is epilepsy characterized by?
A disease characterised by an enduring predisposition to generate epileptic seizures and by the neurobiological, cognitive, psychological and social consequences of the condition.
What is a seizure?
A transient occurrence of signs or symptoms due to abnormal excessive or synchronous activity in the brain.
What are the two main types of seizures?
Focal (partial) and Generalised.
What are the risk factors for epilepsy?
Genetic predisposition, Perinatal asphyxia, Trauma, Structural CNS abnormalities, Metabolic disorders, Complex febrile seizures.
What is the new classification according to International League Against Epilepsy 2017?
- Where seizures begin in the brain, 2. Level of awareness, 3. Other features of seizure.
What are the categories under the new classification for where seizures begin in the brain?
Focal and Generalised.
What are the categories under the new classification for level of awareness?
Focal aware (awareness intact), Focal impaired, Awareness unknown (unwitnessed), Generalised (presumed to affect awareness), Unknown.
What are the categories under the new classification for other features of seizure?
Focal to bilateral, Focal onset (Motor onset and Non-motor onset), Generalised onset (Motor and Non-motor).
What are the signs and symptoms of generalised non-motor (absence) seizures?
Brief impairment of consciousness, 5-10 seconds, Behavioural arrest or staring – interrupting normal activity.
What are the signs and symptoms of tonic-clonic seizures?
Patient falls unconscious ± preceding aura, Violent muscle contractions and shaking, Eyes may roll back, tongue biting, incontinence, Post-ictal phenomena.
What are the signs and symptoms of myoclonic seizures?
Brief arrhythmic muscular jerking movements, Last a few seconds, sudden jerking or twitching.
What is Benign Rolandic Epilepsy (BRE)?
Most common childhood epilepsy. Seizures of face/upper limbs during sleep with hypersalivation & speech arrest. Also known as Sylvian seizures. Occurs in childhood (age 3-12yo) and is outgrown at end of puberty.
What are the characteristics of Juvenile Myoclonic Epilepsy?
Usually involves neck, shoulders, upper arms, most occur after waking up. Begins around puberty.
What are the characteristics of Progressive Myoclonic Epilepsy?
Rare syndromes, Combination of myoclonic and tonic-clonic, Patient deteriorates over time.
What is the role of the multidisciplinary team (MDT) in epilepsy management?
Includes paediatrician, neurologist, SN (epilepsy nurse), school nurse, GP.
When should a child be referred to a neurologist?
If it is the first fit (‘first fit clinic’).
What advice should be given to parents while waiting for a neurologist referral?
How to recognise a seizure, Video record future seizure, Avoid dangerous activities (i.e. swimming), Seek help if another seizure occurs before referral.
What factors influence the decision to treat epilepsy with antiepileptic drugs (AEDs)?
Based on seizure types, epilepsy type, frequency. Needs to be weighed against the possibility of side effects from antiepileptics.
When is treatment NOT usually given for epilepsy?
Treatment is NOT usually given for Benign Rolandic Epilepsy.
How should an appropriate AED be chosen?
Choose an appropriate AED for seizure and epilepsy type (as some can make seizures worse).
What is the recommended approach for AED therapy?
Monotherapy at the lowest dose possible to avoid potential adverse side effects. Can use adjuncts to monotherapy but aim for lowest dose possible.
What is the rescue therapy for prolonged epileptic seizures?
Buccal midazolam.
When can AED therapy be discontinued?
AED therapy may be discontinued after 2 years free of seizures.
What are the first-line treatments for generalized tonic-clonic seizures?
Valproate.
What are the first-line treatments for absence seizures?
Valproate, ethosuximide.
What are the first-line treatments for myoclonic seizures?
Valproate.
What are the first-line treatments for focal seizures?
Carbamazepine, lamotrigine.
What are some side effects of valproate?
Weight gain, hair loss, rare idiosyncratic liver failure.
What are some side effects of carbamazepine?
Rash, neutropoenia, hyponatraemia (SIADH), ataxia, inducer.
What are some side effects of lamotrigine?
Severe skin rash (SJS).
What are some side effects of levetiracetam?
Sedation (rare).
What are other treatment options for children with intractable epilepsies?
Ketogenic diets (low carb, fat based), Vagal nerve stimulation, Surgery (only in children with epilepsy that has a well-localised structural cause).
