Fits, Faints and Funny Turns Flashcards
What are definitions of:
- seizure/fit
- syncope
- convulsion
- epileptic seizure
- 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
Epilepsy - pathology
- An abnormal excessive hyper synchronous discharge from a group of cortical neurons
Epilepsy - presentation
- 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
What do the clinical manifestations of epilepsy depend on?
- Depends on
- Seizure location, degree of anatomical spread over cortex, duration
What are different kinds of non-epileptic seizures and other mimics in children?
- 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)
What are febrile convulsions?
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
What is febrile convulsions associated with?
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
What is the commonest cause of acute symptomatic seizure in childhood?
Febrile convulsions
What are some terms people might use to describe a seizure, and what type of seizure do they correlate with?
- Jerk/shake
- Clinic, myoclonic, spasms
- Stiff
- Tonic seizure
- Fall
- Atonic/tonic/myoclonic
- Vacant attack
- Absence, complex partial seizure
Epilepsy - aetiology
- Majority are idiopathic
- Mostly familial
What is the most common kind of epileptic seizure?
- Most are generalised seizures
Describe the mechanism of the fit in epilepsy?
- 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)
What can record the depolarisations of neurons causing seizure?
Electroencephalogram (EEG)
What is an epileptic fit chemically triggered by?
- Chemically triggered by
- Decreased inhibition (gama-amino-butyric acid, GABA)
- Excessive excitation (glutamate and asparate)
- Excessive influx of Na and Cl ions
In an epileptic fit, what causes the:
- decreased inhibition
- excessive excitation
- Chemically triggered by
- Decreased inhibition (gama-amino-butyric acid, GABA)
- Excessive excitation (glutamate and asparate)
- Excessive influx of Na and Cl ions
What are the different types of epileptic seizures in regard to where they occur in the brain?
- Partial (focal) seizure
- Restricted to one hemisphere, or part of one hemisphere
- Generalised seizure
What is a partial (focal) seizure?
- Partial (focal) seizure
- Restricted to one hemisphere, or part of one hemisphere
- Generalised seizure
Describe the stepwise approach to diagnose epilepsy?
- 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?
Epilepsy - investigations
- 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
Epilepsy - management
- 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
What is the first line anti-epileptic drug for:
- generalised epilepsy
- focal epilepsy
- Generalised
- Sodium vaproate
- Focal
- Carbamazepine
