Fits, Faints, Seizures and 'Funny turns'

Question 1

what is an epileptic seizure?

Answer 1

abnormal excessive hyper synchronous discharge from a group of (cortical) neurons

-A tendency to recurrent, unprovoked (spontaneous) epileptic seizures

Question 2

Investigation for epilepsy?

Answer 2

EEG

Question 3

Non-epileptic seizures and other mimics in children

Answer 3

Acute symptomatic seizures: due to acute insults eg. Hypoxia-ischaemia, hypoglycemia, infection, trauma

Syncope
Parasomnias eg. night terrors
Behavioural stereotypies
Psychogenic non-epileptic seizures (PNES)

Question 4

What mimic is common in toddlers?

Answer 4

Reflex anoxic seizure

Question 5

commonest cause of acute symptomatic seizure?

Answer 5

Febrile convulsion
- 3 months and 5 years of age, associated with fever but without evidence of intracranial infection or defined cause for the seizure

Question 6

Seizure types - what are they?

Answer 6

Jerk/ shake: clonic, myoclonic, spasms

Stiff: usually a tonic seizure

Fall: Atonic/ tonic/ myoclonic

Vacant attack: absence, complex partial seizure

Question 7

features of an absence seizure

Answer 7

abrupt

eye rolling up wards

Question 8

atonic seizure features

Answer 8

sudden and abrupt loss of tone

- significant injuries

Question 9

generalise tonic clonic seizure features

Answer 9

tonic> clonic

Question 10

how are epileptic fits chemically triggered?

Answer 10

Decreased inhibition (gama-amino-butyric acid, GABA)

• Excessive excitation (glutamate and aspartate)
• Excessive influx of Na and Ca ions

Question 11

Summation of a multitude of electrical potentials results in ?

Answer 11

depolarization of many neurons which can lead to seizures, can be recorded from surface electrodes (Electroencephalogram)

Question 12

the 2 types of seizures

Answer 12

focal - one hemisphere

Question 13

Stepwise approach to a diagnosis of epilepsy

Answer 13

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

Question 14

childhood absence seizure features

Answer 14

EEG- normal back gourd activity , 3 per second spike wave

Question 15

an EEG is useful for?

Answer 15

identifying seizure types, seizure syndrome and etiology

Question 16

In convulsive seizures what should you do?

Answer 16

EEG - long QT syndrome - arrhythmia

Question 17

anti-epileptic drug therapy use used to?

Answer 17

control not cure the epilepsy

- start with low dose and titrate up

Question 18

Drug treatment - generalised - first line .. what is preferred option

Answer 18

Sodium Valproate (not in girls- recent MHRA advice) or 
- Levetiracetam

Question 19

First line for focal epilepsy

Answer 19

Carbamazepine

Question 20

New drugs with better tolerability and fewer side effects?

Answer 20

Levatiracetam, Lamotrigine, Perampanel

Question 21

other therapies with drug refractory/resistant epilepsy ?

Answer 21

steroids, immunoglobulins and ketogenic diet

Question 22

Drug refectory epilepsy and frequent seizures - VNS surgery

Answer 22

manage seizure on palliative basis

• implanted under the clavicle
• sends shocks to vagus nerve
• afferent