IC6 Flashcards
Epilepsy: Age distribution (peaks)
infants < 1y/o and in people > 60 y/o
Mean age of first seizure onset
~11.1y/o
Prevalence of seizure in SG ethnic groups - high to low
Indians, chinese, malay
Definition of epilepsy
Disease of brain defined by any of following:
1) >/= 2 unprovoked seizure spaced > 24h apart
2) 1 unprovoked seizure + probability of further seizure (60%) after 2 unprovoked seizures, in next 10yrs
3) Diagnosis of epilepsy syndrome
Definition of acute symptomatic seizure
Seizure that occur from an immediately recognisable stimulus (about 1 week) with an acute brain insult
Definition of unprovoked seizure
Seizure that occur in the absence of a potentially responsible clinical condition or beyond interval estimated for occurrence of acute symptomatic seizure
Definition of dissociative seizure
Abnormal paroxysmal psychic, sensory and/or motor manifestations which resemble epileptic seizures but are not related to abnormal epileptiform discharges (meaning, EEG looks normal)
Etiology of epilepsy
- Structural
- Genetic/presumed genetic
- Neurodegenerative
- Metabolic
- Infectious
How does Focal onset occur
seizures begin only in one hemisphere
Generalized onset
seizures begin in both hemispheres
Secondarily generalized
seizure being in one hemisphere, then spread to the other
Focal onset seizures (without dyscognitive features) seizures is known as ____ seizure
simple partial seizures
Focal onset seizures (with dyscognitive features) seizures is known as ____seizure
complex partial
Early ictal indicates the ___ phase
Aura
Which phase indicates the seizure?
Ictal phase
Main symptoms in focal onset (simple partial)
Motor, autonomic, sensory & psychic (somatosensory) symptoms
‘Grand Mal’ refers to which seizure?
Generalised tonic-clonic seizure
Which seizure requires immediate medical attention?
Generalised tonic-clonic seizure
How long is full recovery for simple partial seizure
Several mins - hours
Which is the Characteristic and defining seizure type in the Lennox – Gastaut syndrome?
tonic seizure/ atonic seizure
‘Petit Mal’ refers to which seizure?
Absence seizure
Population affected by clonic seizure the most
Most frequent in neonates, infants or young children
Population affected by absence seizure the most, and usual onset
More common in children than adults; first onset 4-12 y/o (rarely aft 20 y/o)
Characteristics of absence seizure which differentiates it from complex partial seizure
- Never preceded by auras
- Lasts seconds (rather than mins)
- Begin frequently and end abruptly
- Produce characteristic EEG pattern (3 Hz spike waves)
What is classic drop attack
postural tone is suddenly lost, causing collapse to the ground like a rag doll
Do all epileptic patients have abnormal EEG?
No
Can EEG be abnormal for normal people?
Yes, false positive 0.5-1%
How many years after 1st seizure would the recurrence risk be highest?
2 years
In what situations would seizure recurrence risk be higher after 1st seizure?
- epileptiform abnormalities on EEG
- Prior brain insult (e.g. stroke, brain trauma)
- Structural abnormality in brain imaging - - Nocturnal seizure
After 2 unprovoked seizures, risk of recurrent seizures at 4 years is ____
~ 70%
Based on FIRST and MESS study, treatment after 1st seizure showed…
- Reduced risk of 2nd seizure
- No effect on long-term prognosis
- No evidence of higher risk of death, injuries, or status epilepticus in patients allocated to deferred treatment
Treatment goals in epilepsy treatment
- Absence of epileptic seizures
- Absence of ASM-related side effects
- Attainment of optimal quality-of-life
About ___ of patients are able to achieve seizure-freedom after treatment
two-thirds
_____ is the most common comorbidity in children with epilepsy (30–40%)
Intellectual disability
Most common psychiatric comorbidities in patients with epilepsy
depression (23%) and anxiety (20%)