Fits, Faints and Funny Turns Flashcards

1
Q

What are definitions of:

  • seizure/fit
  • syncope
  • convulsion
  • epileptic seizure
A
  • Seizure/fit
    • Any sudden attack from whatever cause
  • Syncope
    • Faint (neuro-cardiogenic mechanism)
  • Convulsion
    • Seizure where there is prominent motor activity
  • Epileptic seizure
    • An electrical phenomenon
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2
Q

Epilepsy - pathology

A
  • An abnormal excessive hyper synchronous discharge from a group of cortical neurons
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3
Q

Epilepsy - presentation

A
  • Does not always have clinical manifestations
  • Depends on
    • Seizure location, degree of anatomical spread over cortex, duration
  • Paroxysmal change in motor, sensory or cognitive function
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4
Q

What do the clinical manifestations of epilepsy depend on?

A
  • Depends on
    • Seizure location, degree of anatomical spread over cortex, duration
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5
Q

What are different kinds of non-epileptic seizures and other mimics in children?

A
  • Acute symptomatic seizures
    • Due to insults such as hypoxia-ischaemia, hypoglycaemia, infection, trauma
  • Reflex anoxic seizure
    • Common in toddlers
  • Syncope
  • Parasonias
    • Such as night terrors
  • Behavioural stereotypes
  • Psychogenic non-epileptic seizures (PNES)
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6
Q

What are febrile convulsions?

A

A seizure occurring in infancy/childhood:

  • Usually between 3 months and 5 years
  • Associated with fever but without evidence of infection or defined cause for seizure
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7
Q

What is febrile convulsions associated with?

A

A seizure occurring in infancy/childhood:

  • Usually between 3 months and 5 years
  • Associated with fever but without evidence of infection or defined cause for seizure
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8
Q

What is the commonest cause of acute symptomatic seizure in childhood?

A

Febrile convulsions

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9
Q

What are some terms people might use to describe a seizure, and what type of seizure do they correlate with?

A
  • Jerk/shake
    • Clinic, myoclonic, spasms
  • Stiff
    • Tonic seizure
  • Fall
    • Atonic/tonic/myoclonic
  • Vacant attack
    • Absence, complex partial seizure
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10
Q

Epilepsy - aetiology

A
  • Majority are idiopathic
    • Mostly familial
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11
Q

What is the most common kind of epileptic seizure?

A
  • Most are generalised seizures
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12
Q

Describe the mechanism of the fit in epilepsy?

A
  • Chemically triggered by
    • Decreased inhibition (gama-amino-butyric acid, GABA)
    • Excessive excitation (glutamate and asparate)
    • Excessive influx of Na and Cl ions
  • This produces electrical current
  • Summation of electrical potentials results in depolarisation of many neurons which can lead to seizures that can be recorded from surface by electroencephalogram (EEG)
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13
Q

What can record the depolarisations of neurons causing seizure?

A

Electroencephalogram (EEG)

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14
Q

What is an epileptic fit chemically triggered by?

A
  • Chemically triggered by
    • Decreased inhibition (gama-amino-butyric acid, GABA)
    • Excessive excitation (glutamate and asparate)
    • Excessive influx of Na and Cl ions
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15
Q

In an epileptic fit, what causes the:

  • decreased inhibition
  • excessive excitation
A
  • Chemically triggered by
    • Decreased inhibition (gama-amino-butyric acid, GABA)
    • Excessive excitation (glutamate and asparate)
    • Excessive influx of Na and Cl ions
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16
Q

What are the different types of epileptic seizures in regard to where they occur in the brain?

A
  • Partial (focal) seizure
    • Restricted to one hemisphere, or part of one hemisphere
  • Generalised seizure
17
Q

What is a partial (focal) seizure?

A
  • Partial (focal) seizure
    • Restricted to one hemisphere, or part of one hemisphere
  • Generalised seizure
18
Q

Describe the stepwise approach to diagnose epilepsy?

A
  • Is the paroxysmal event epileptic in nature?
  • Is it epilepsy?
  • What seizure types are occurring?
  • What is the epilepsy syndrome?
  • What is the aetiology?
  • What are the social and educational effects on the child?
19
Q

Epilepsy - investigations

A
  • EEG
    • Should be used with clinical findings
    • Might be normal between seizures and so not always diagnostic
    • Also has false positives
    • Good for distinguishing between focal and generalised seizures
  • MRI brain
    • To determine aetiology
  • Genetics
  • Metabolic tests
20
Q

Epilepsy - management

A
  • Anti-epileptic drugs (AED)
    • Only if diagnosis is clear
    • Effect is to control seizure, not to cure epilepsy
    • Side effects – drowsiness, effect on learning, cognition and behavioural
    • Sodium valproate
      • First line for generalised epilepsy
      • Contraindication – girls
    • Carbamazepine
      • First line for focal epilepsy
  • Other drug therapies
    • Steroids, immunoglobulins and ketogenic diet
    • For drug resistant epilepsies
  • Surgery
    • Vagal nerve stimulator
21
Q

What is the first line anti-epileptic drug for:

  • generalised epilepsy
  • focal epilepsy
A
  • Generalised
    • Sodium vaproate
  • Focal
    • Carbamazepine