FINALS: SEIZURES Flashcards
Which age groups have the highest incidence of acute symptomatic seizures?
Children under 1 year old and the elderly.
What is the estimated prevalence of epilepsy in the Philippines?
0.9%, approximately 900,000 individuals.
What are common precipitating factors for seizures?
Fever
Traumatic Brain Injury (TBI)
Cerebrovascular disease
Drug withdrawal
Infection
Metabolic insults
Define epilepsy based on the International League Against Epilepsy (ILAE).
Epilepsy is diagnosed if:
At least 2 unprovoked seizures >24 hours apart.
1 unprovoked seizure with at least a 60% probability of recurrence within 10 years.
Diagnosis of an epilepsy syndrome.
Differentiate between seizure, epilepsy, and convulsion.
Seizure: Transient symptoms due to abnormal brain activity.
Epilepsy: Two or more unprovoked seizures.
Convulsion: Intense, repetitive muscular contractions.
What is the most consistent predictor of seizure recurrence?
Documented etiology of the seizure.
Abnormal EEG (epileptiform or slow-wave patterns).
Describe focal impaired awareness seizures.
Impaired awareness during part or all of the seizure.
May involve motor or non-motor symptoms.
A person may have a vague idea of the event but not full awareness.
What are the two main phases of a generalized tonic-clonic seizure?
Tonic Phase: Sustained contractions, unconsciousness, cyanosis, cry/moan.
Clonic Phase: Alternating muscle contraction and relaxation, symmetric jerking.
Define Status Epilepticus (SE).
A seizure that is prolonged or repeated in brief intervals, causing enduring neurological changes.
What are the key features of the 2017 ILAE seizure classification?
Where the seizure begins in the brain.
Level of awareness during the seizure.
Motor and non-motor symptoms.
What is Sudden Unexpected Death in Epilepsy (SUDEP)?
Sudden, unexpected, non-traumatic death in epilepsy patients without a clear toxicologic or anatomical cause, potentially triggered by seizure-induced cardiorespiratory alterations.
What are the key features of a Generalized Tonic-Clonic seizure (Grand Mal)?
Abrupt loss of consciousness
Tonic phase: Bilateral tonic-clonic extension of trunk and limbs, epileptic cry
Clonic phase: Synchronous muscle jerking
Postictal state: Unarousable, lethargic, confused, often followed by sleep
What should NOT be done during a Generalized Tonic-Clonic seizure?
Do not restrain the patient
Do not put anything in their mouth
How can you recognize an Absence seizure (Petit Mal)?
Sudden interruption of consciousness
Motionless stare and arrest of ongoing activity
Fine clonic movements of eyelids or facial muscles may occur
EEG shows 3-per-second spike-and-wave pattern
What age group commonly experiences Absence seizures?
Rarely before 4 years or after puberty. Seizures often diminish during adolescence.
What is Juvenile Myoclonic Epilepsy?
Common in adolescents (~15 years old)
Myoclonic jerks typically occur in the morning
Associated with 4-6 Hz polyspike EEG bursts
Managed effectively with Valproic Acid
What are the characteristics of Myoclonic seizures?
Brief, brusque muscle contractions
Can affect one muscle, a limb, or the entire trunk
May be benign or part of a neurodegenerative disease
What happens during an Atonic seizure?
Sudden loss of muscle tone, which may be fragmentary or generalized.
What distinguishes Idiopathic epilepsy from Secondary epilepsy?
Idiopathic: No identifiable cause; presumed genetic origin, often resolves spontaneously.
Secondary: Has an identifiable structural or acquired cause, often progressive, and associated with neurological deficits.
What conditions can be mistaken for seizures?
Syncope (most common)
Psychogenic events
Breath-holding spells
Sleep and movement disorders
What are the steps in seizure first aid for generalized convulsions?
Lay the patient on the floor.
Place something soft under their head.
Loosen tight clothing around the neck.
Turn their head to the side.
Remove sharp objects from the vicinity.
Time the seizure.
What are indications for IV antiepileptic drugs?
Acute seizures or status epilepticus
Rapid initiation of therapy or correction of AED levels
Inability to swallow medication
When should an EEG be requested in epilepsy?
To confirm epilepsy diagnosis
Classify seizure type
Diagnose non-convulsive status epilepticus
Which imaging modality is better for epilepsy diagnosis: CT or MRI?
MRI: Higher sensitivity for structural anomalies (e.g., hippocampal sclerosis, congenital brain malformations).
CT: Preferred when MRI is unavailable or contraindicated (e.g., pacemakers).
What type of seizure is characterized by brief staring spells, a sudden “zoning out,” and 3-Hz spike-and-wave discharges on EEG?
Absence seizure (formerly called petit mal seizure).
What EEG finding is diagnostic for absence seizures?
Generalized 3-Hz spike-and-wave discharge during hyperventilation.
What is the typical prognosis for absence seizures in children?
The prognosis is generally good; most children outgrow the seizures by adolescence.
What is the first-line pharmacologic treatment for absence seizures?
Ethosuximide is the first-line treatment; valproic acid is an alternative.
