Paroxysmal events SA: seizures and movement disorders

Question 1

What is a paroxysmal?

Answer 1

sudden attack or increase of symptoms of a disease that often occurs again and again

Question 2

What causes an epileptic seizure?

Answer 2

manifestation of excessive hypersynchronous usually self-limiting epileptic activity of neurons in the brain
seizures = ALWAYS FOREBRAIN

Question 3

What is the definition of epilepsy?

Answer 3

disease of the brain characterised by a predisposition to generate epileptic seizures
at least 2 unprovoked epileptic seizures over 24h apart

Question 4

What are the phases of an epileptic seizure?

Answer 4

aura: alteration in smell, taste, visual perception, hearing, emotional state

ictal: focal or generalised seizure or focal with secondary generalisation

post ictal: drowsiness, confusion

Question 5

What is a clustered seizure?

Answer 5

more than 1 in 24h

Question 6

What is a continuous seizure?

Answer 6

longer than 5min

Question 7

What are the signs of a generalised epileptic seizure?

Answer 7

both sides of body affected
animal loses consciousness
motor activity present
autonomic dysfunction: salivation, urination/defacation

Question 8

What are the 4 types of motor activity in generalised epileptic seizures?

Answer 8

tonic: sustained increased muscle contraction
clonic: prolonged, regularly and repetitive myoclonic contractions
myoclonic: sudden, brief, involuntary contractions of muscles or muscle grups. shock-like activity
atonic: sudden loss of muscle tone of a few seconds duration

Question 9

What are the characteristics of focal epileptic seizures?

Answer 9

lateralised and or regional

Question 10

What are the 3 types of focal epileptic seizures?

Answer 10

focal motor: motor events or automatisms. level of consciousness unaffected
focal sensory: behavioural seizure often involving limbic system (rage/agression, vocalisation, fly catching, tail chasing)
focal autonomic: rare, may present with vomiting, diarrhoea, drooling

Question 11

What are the types of causes of intracranial and extracranial seizures?

Answer 11

intra: idiopathic/functional, structural
extra: reactive

Question 12

What are the types of structural intracranial seizure causes?

Answer 12

vascular
inflammatary
infectious
traumatic
anomaly/degenerative
neoplastic

Question 13

What are the 2 categories of reactive extracranial causes for seizures?

Answer 13

environmnetal extrinsic: exogenous toxins
metabolic intrinsic: electrolyte imbalance, energy issue, systemic/organ dysfunction, vascular perfusion

Question 14

What are the usual findings in idiopathic epileptic animals?

Answer 14

6months to 6 years
normal in interictal period
normal physical and neuro exam
metabolically normal
most common in generalised tonic clonic

Question 15

What causes structural epilepsy?

Answer 15

intracranial/cerebral pathology

Question 16

What are usual findings in structural epilepsy animals?

Answer 16

6months to 6 years
abnormal neuro exam interical period for most
asymmetric/lateralising deficits
metabolically normal
focal or generalised

Question 17

What causes reactive seizures?

Answer 17

as a result of a toxic or metabolic insult
reversible when cause or disturbance is rectified
brain is normal: NOT a form of epilepsy

Question 18

What are the usual findings in reactive seizure animals?

Answer 18

any age
abnormal neuro exam consistent with diffuse, bilateral/symmetric forebrain involvment
signs may wax and wane
neuro signs may be preceded/accompanied by systemic signs
significantly higher risk of developing status epilepticus
most common causes: intoxications and hypoglycaemia

Question 19

Where do epileptic seizures originate?

Answer 19

ALWAYS in the brain
but cause can be elsewhere AKA seizures are symptoms

Question 20

What are the potential diagnostics needed for seizure animals?

Answer 20

physical and neuro exam
metabolic screening: haem, biochem, bile acids, urinalysis, b12)
anti-seizure drug trial if indicated

mri brain
csf
eeg

Question 21

When is a more extensive work-up (mri, csf) indicated?

Answer 21

inter-ictal neuro abnormalities consistent with intracranial neurolocalisation
status epilepticus or cluster seizure
previous presumptive IE dx and dru-resistance

Question 22

What is paroxysmal dyskinesia?

Answer 22

group of conditions characterised by episodes of abnormal self-limiting movement
dystonic movements (limbs and trunk)
tremors

conscious
no autonomic signs
no post-ictal phase
painless
beginning/end of movement is abrupt
can last seconds, minutes, hours

Question 23

What are the primary and secondary causes of paroxysmal dyskinesia?

Answer 23

primary: breed specific/inherited, normal neuro exam, most common

secondary/structural: intracranial lesions, drug induced, gluten sensitive, potentially abnormal neuro exam

Question 24

What is the diagnostic plan when suspecting paroxysmal dyskinesia?

Answer 24

physical and neuro exam
metabolic screening: haem, biochem, urinalysis

then depending: monitor, gluten free diet trials, gluten sensitivity test, advanced images?

Question 25

What is the tx for paroxysmal dyskinesia?

Answer 25

relatively refractory clonazepam acetazolamide fluoxetine diet management

Question 26

What is the prognosis for paroxysmal dyskinesia?

Answer 26

linked to underlying cause (primary or secondary) often refractory to meds usually benign and self-limiting

Question 27

How do we narrow down possible paroxysmal dx?

Answer 27

abnormal vs normal consciousness CS dx tools