neuro - epilepsy, seizures etc

Question 1

what is a seizure

Answer 1

paroxysmal abnormality of motor, sensory, autonomic and or cognitive function due to transient brain dysfunction

Question 2

what is epilepsy

Answer 2

a brain disorder that predisposes the patient to have unprovoked epileptic seizures

can be recognised after two unprovoked seizures

Question 3

acute symptomatic epileptic seizures

Answer 3

an epileptic seizure which is triggered by an acute brain injury (ie from a stroke, meningitis etc)

do not constitute an epilepsy

Question 4

febrile seizure

Answer 4

seizure with a fever but no infection intracranially

occurs early in virus when fever is rising
brief generalised tonic clonic seizures
simple ones give kids the same chance of epilepsy as any other kids
but complex seizures (focal, prolonged, repeated in the same illness) increase epilepsy risk

infection screen

Question 5

what age is most likely to have febrile seizures

Answer 5

6months - 6 years

Question 6

what are blue breath holding spells

Answer 6

in toddlers who are crying/angry

cant catch their breath - go blue and stiff then limb, with rapid recovery

Question 7

what is reflex asystolic syncope

Answer 7

caused by sudden pain/surprise

stops breathing, goes pale - stiff +brief convulsions

Question 8

infantile spasms
age of onset
seizure pattern

Answer 8

3-12 months
flex head/trunk then extend arms
Rx vigabatrin +/- steroids

Question 9

childhood absence epilepsy
age
characteristics

Answer 9

4-12 years
unresponsive stare and stops doing anything, may realise they have missed something and be puzzled after
can interfere with school
can be induced by hyperventilation

some evolve into juvenile absence or juvenile myoclonic epilepsy but most remit 80%

Question 10

benign rolandic epilepsy

age etc

Answer 10

4-10 years
tonic clonic seizures in sleep
tongue feels odd, face distorts

Question 11

juvenile absence epilepsy

Answer 11

10-20 years old
absences and generalised tonic clonic seizures
often with photosensitivity

Question 12

juvenile myoclonic epilepsy

Answer 12

10-20 years old
myclonic seizures
absence seizures - mostly after waking (clumsy)
generalised tonic clonic seizures

Question 13

investigation for ?epilepsy?

Answer 13

EEG

Question 14

treatment for epilepsy first line?

Answer 14

sodium valproate

Question 15

valproate side effects

Answer 15

weight gain, hair loss, liver failure

Question 16

carbamazepine

would you use it for a GTC or absence?

Answer 16

for generalised tonic clonic yes, but not for an absence, - makes it worse
good for focal seizures

Question 17

can you ever come off medication?

Answer 17

yes after 2 years of no seizures

apart from juvenile absence or juvenile myoclonic

Question 18

non drug treatment?

Answer 18

ketogenic diet - high fat low carb
vagal nerve stimulation
epilepsy surgery