Seizure Disorders Flashcards
Seizures: (Gradual or Sudden?) , ______________ of cerebral neurons, which produces an involuntary and _____________ alteration or behaviour or function. (The term refers to the whole range of paroxysmal events that follow the abnormal discharge).
Synonyms: ______________, ______________, Fits.
Sudden; abnormal discharge
time limited
Convulsion ; Epilepsy
Convulsion: __________ that include __________ phenomena (__________, __________, __________).
Epilepsy: __________ __________.
Seizures ; motor
Recurrent seizures.
Status epilepticus: repeated ____________ __________ without a __________ interval OR __________ that last longer than __________.
tonic-clonic seizures
lucid
tonic- clonic seizures
30 minutes.
Pathophysiology
Excitatory neuro- transmitters
List 3
Inhibitory neuro- transmitters
List 1
Glutamate
Acetyl-choline
5-hydroxytryptamine (5HT)
Gamma-amino butyric acid (GABA)
AETIOLOGY 1
________
CNS ________
________ diseases
Head ________
Brain ________
High ________
Idiopathic
CNS Infections
Cerebro-vascular diseases Head injury
Brain Tumours
High fever
AETIOLOGY of seizures
Neuro-cutaneous syndromes
_____________
Neurofibromatosis
_____________ syndrome
Cerebral _____________
Nutritional disorders
_____________ deficiency
Poisonings
_____________
Drugs (phenothiazines, _____________)
Tuberous sclerosis ; Sturge-Webber’s
malformations ; Pyridoxine deficiency
Lead; amphetamines
AETIOLOGY 3
Metabolic
___________, ___________ , hypomagnesaemia,
inborn errors of metabolism (e.g. ________)
Atrophic brain lesions
Post-anoxic, -traumatic, -infectious
Degenerative brain diseases
___________, ___________, gangliosidoses etc
Hypoglycaemia, hypocalcaemia,
PKU
Tay-Sachs, Neiman-Pick
CLASSIFICATION (ILAE) 1
PARTIAL
Simple partial with
_________ signs (_________)
_________ signs (_________ seizures)
_________ signs (_________ epilepsy)
Complex partial (_________ epilepsy)
Partial with _________ _________
motor signs ; Jacksonian
sensory ; sensory
autonomic ; abdominal
Temporal lobe ; secondary generalisation
CLASSIFICATION (ILAE) 2
GENERALISED
__________
Typical (__________ epilepsy)
Atypical (Lennox-Gastaut syndrome)
__________ (__________)
__________ (__________ attacks)
__________
__________
__________ (__________ epilepsy)
UNCLASSIFIED
__________ seizures, __________ __________.
Absence
Typical (Petit Mal epilepsy)
Myoclonic (myoclonic jerks)
Atonic (drop attacks)
Tonic
Clonic
Toni-Clonic (Grand Mal epilepsy)
Neonatal seizures, Infantile spasms.
PRESENTATION
________ (commoner with ________ seizures)
Seizure type
________ (faecal or urinary)
________ ________
Paralysis (Todd’s)
________ between seizures
Aura ; partial
Incontinence ; Post-ictal sleep
Loss of consciousness
NEONATAL SEIZURES
Seizures occurring in the ___________________
Aetiology: A cause can be found in up 70% of cases and include:
_______________ (60%)
_______________ (20%)
_______________, _______________, _______________ (20%)
Intracranial _______________ (15%)
Drug withdrawal
first 28 days of life.
Hypoxic-ischaemic encephalopathy (60%) Infection (20%)
Hypoglycaemia, hypocalcaemia, hypomagnesaemia (20%)
Intracranial haemorrhage (15%)
Clinical features of neonatal seizures (mainly _______)
__________ repeatedly
__________ movements of the mouth
__________ attacks
Jitteriness and tremulousness
Blinking
Chewing
Apnoeic
Investigations of neonatal seizures
Sepsis screen (______ , ______ + Triple tap [ ______,_____ ,______] culture)
E/U + Glucose, Ca and PO4
Neuro-imaging (________ and ________)
FBC ; ESR ; blood, CSF, Urinary bladder
EEG ; transfontanelle USS)
Treatment of neonatal seizures
______ ______ (3-5 mg/kg/D)
______ ______ if seizures are refractory.
Prognosis of neonatal seizures
50% will ______
20% will ______
30% will have ____________________ (mental retardation, cerebral palsy, epilepsy)
Oral phenobarbitone
IM pyridoxine
resolve ; die
residual neurological deficit
FEBRILE CONVULSION
Definition
____________ seizures following a (gradual or rapid?) _______________
Generalised tonic-clonic
rise in body temperature.
Febrile convulsions
Clinical and Diagnostic criteria
_________ up to _________
Fever at time of seizure > ____oC
Seizures < _________
No _________
No _________ in between seizures
There is a positive family history in 60 – 70% of children.
3 months ; 6 years
38oC ; 15 minutes
CNS infection ; neurological abnormality in between seizures
Aetiology of febrile convulsions
Aetiology
__________
__________
Tonsillitis
__________
UTI
__________ etc
Investigations
FBC, ESR, MP Lumbar Puncture
Malaria
Otitis media
Pneumonia
Septicaemia etc
Treatment of febrile convulsions
Principles involve the:
________ of seizures and appropriate management of childhood ________
treatment of the underlying cause
prevention of febrile convulsions. Drug of choice is ___________ 0.2 – 0.5 mg/kg/D 12 hourly from the onset of fever until it subsides.
control ; fevers
diazepam
Risk factors for recurrence of febrile convulsions
Age < __________
_________ in first degree relatives
_________ in first degree relatives
One or more _________ in the first convulsion
Many subsequent febrile episodes
_______ factors 80-100% recurrence
_____ factor 25%
_____ factor 12%
Prognosis
2 –7% will progress to __________
15 months; Epilepsy
Febrile convulsion ; complex features
3 – 5 ; factor; No factor
epilepsy
INFANTILE SPASMS
Definition
____________________ spasms characteristically occurring in _________. Syn. West’s syndrome, Salaam attacks etc.
Classified into ___________ and __________ (18% associated with neonatal ______________).
Mixed flexor-extensor
series
Idiopathic; symptomatic
Clinical features of infantile spasms
Age __________ – __________
Typically there is sudden __________ of the __________ and __________ with __________ and __________ of the __________ + __________ and __________. This is followed by relaxation. It occurs repeatedly.
_____________________ is common as there is underlying structural or metabolic abnormalities.
8 months – 2 years
flexion; head ; trunk
flexion ; adduction ; arms
cry ; loss of awareness.
Regression of milestones
Investigations of infantile spasms
_______ which shows _________ pattern.
Treatment
Control of seizures with _________ or _________ (for _________) or nitrazepam.
Prevention aims at preventing _________, encouraging _________ and the prompt treatment of _________.
EEG ; hypsarrythmia
ACTH ; prednisolone ;4 weeks
intrauterine malnutrition
early feeding ; neonatal hypoglycaemia.
Prognosis of infantile spasms
Normal mentality in 12–25% of those with symptomatic IS and up to 44% in those with idiopathic IS.
Other seizures present in up to ______% even after the IS type seizures have resolved.
60%
ABSENCE seizures
Definition
________ seizures characterised by ___________.
Clinical features
Age 5 – 15 years
(Boys or Girls?) more affected than (boys or girls ?) 2:1
Repeated episodes of _________ or _________
Generalised
poor school performance.
Girls ; boys
staring blankly ; day dreaming.
Investigations of Absence seizures
EEG shows classical __________ wave form in all the leads.
Treatment
__________ or __________
classical 3/sec. spike wave
Sodium valproate ; ethosuximide
Prognosis of absence seizures
80% will _________ the seizures
10% will _________
10% will _____________
outgrow
continue
progress to tonic-clonic seizures
MANAGEMENT of seizures
Principles of management ABCD
Maintain __________ and __________
Control of seizures (__________ or __________)
Drugs for status epilepticus: __________ (1- 2ml/kg IV), then IV __________ (0.1-0.25 mg/kg), then IV __________ (5-10 mg/kg over 10 minutes), then repeat diazepam, then intubate and give IV pancuronium, then GA.
Draw blood for tests (E/U, Ca, PO4 etc)
Airway ; Breathing
diazepam ; paraldehyde
10% D/W ; IV Diazepam
IV phenobarbitone
MANAGEMENT of seizures
History: Eye witness account, Seizures ______,______,________ and _______.
History of ___________ , ___________.
____________________ in child or family. Predisposing/ Trigger factors. What interventions?
Physical Examination: Proper neurological examination, OFC, skin, eyes.
time, type, number and duration.
incontinence ; loss of consciousness
Past history of seizures
Investigations of seizures
________
E/U + _______ , _______ and PO4
_______
Skull _______
FBC and _______
CT scan
Metabolic studies (serum or urine amino-acids etc)
Choice depends on the ______ and the ______ at presentation.
EEG
Glucose ;?Ca
LP
X-Ray
genotype
age ; signs
Drug Therapy for seizures
First line drugs
List 4
Carbamazepine
Sodium valproate
Phenobarbitone
Phenytoin
Drug Therapy for seizures
Specific drugs
Atypical Absence seizures : ??
Typical Absence seizures:??
Infantile spasms:??
Complex partial seizures :??
Clonazepam
Sodium valproate; ethosuximide
ACTH; prednisolone; Sodium valproate; Clonazepam
Carbamazepine; sodium valproate; phenytoin
PROGNOSIS
Poor if:
Long duration between _______ and _________ of seizures
Age > ___________
____________ intelligence
Abnormal findings on CNS examination
_________ seizure types
onset and control
11 years
Subnormal
Multiple
Seizure Drugs that can cause Steven Johnson syndrome
Phenobarbitone
Phenytoin
Seizure Drugs that can cause bone marrow depression
Sodium valproate
Seizure Drugs that can cause drowsiness
Clonazepam
Ethosuximide
Seizure Drugs that can cause depressed cognitive function
Phenobarbitone
