Seizures Flashcards
Genetics for Neurofibromatosis Type 1
Autosomal Dominant
Chromosome 17
Affects 1/4000
Neurofibromas Cafe-au-lait spots Axillary freckling (Crowe's sign) Liche nodules (Iris hamartomas) Developmental delay Scoliosis Pheochromocytomas
Neurofibromatosis Type 1
Genetics for Neurofibromatosis Type 2
Autosomal Dominant
Chromosome 22
Affects 1/ 100,000
Multiple intracranial schwannomas
- Bilateral acoustic neuromas
Meningiomas
Ependymomas
Neurofibromatosis Type 2
Genetics for Tuberous Sclerosis
Autosomal dominant
TSC1 Gene: Hamartin protein
TSC2 Gene: Tuberin protein
Poliosis (patch of grey hair) Angiofibromas (Adenoma sebaceum) - Butterfly rash of small spots Ash leaf spots (depigmented lesions) - Fluoresce under UV light (Wood's lamp) Shagreen patches (rough skin over lumbar spine) Sub/peri-ungal fibromata (under nails) Cafe-au-lait spots Developmental delay
Tuberous Sclerosis
Tuberous Sclerosis is associated with
Seizures
Rhamdomyomas in heart
Gliomas in brain
PCKD
Hamartomas in retina
- dense white areas (phakomata)
Lymphangioleiomyomatosis in lungsAge 4-8 months
Repeated flexion + extension (salaam attacks)
- up to 50
- Last a few seconds
Infantile spasms (West Syndrome)
Investigations for infantile spasms
EEG: dramatic hypsarrhythmia
CT: diffuse or localised brain disease
- tuberous sclerosis
Management for infantile spams (West syndrome)
Poor prognosis
Vigabatrin
ACTH
Teenage girls
Infrequent generalised seizures (morning)
Daytime absences
Sudden shock like myoclonic seizures
Juvenile myoclonic epilepsy (Janz syndrome)
Management for Juvenile myoclonic epilepsy (Janz syndrome)
Sodium valproate
Paraesthesia upon waking up
- usually unilateral face
Benign rolandic epilepsy
1-5 years old
Hx of infantile spasms
Severe mental disability
Atypical absences, falls and jerks
Lennox-Gastaut Syndrome
Investigations for Lennox-Gastaut Syndrome
EEG: Slow spike
Management for Lennox-Gastaut Syndrome
Ketogenic diet may help
Signs favouring pseudo-seizures
Pelvic thrusting Crying post seizure Gradual onset Doesn't occur when alone FHx of epilepsy Female
Widespread convulsions with absence of decreased consciousness
Pseudo-seizure
Investigation for pseudo-seizure
Video recording
Prolactin should be low (prolactin is raised in true seizures)
Febrile convulsions are associated with
Acute epiglottis
Roseola infantum
Tonic clonic seizure in 6 months - 5 year olds
- occur early in viral infections
Febrile convulsion
- 3% of kids
- 30% reoccur
Management of febrile convulsions
> 5 mins or first seizure = call 999
If recurrent: Rectal diazepam
Buccal midazolam
Seizure > 5 mins
2 seizures within 5 mins
Status epilepticus
Management of status epilepticus in community
Buccal midazolam (mouth) Rectal diazepam (derrière)
Management of status epilepticus in hospital
IV Lorazepam
- repeat every 10 mins
IV Phenytoin
- start cardiac monitoring
When can you stop taking medication for epilepsy
Seizure free for > 2 years + meds being stopped for 2-3 months
Stiff seizure
tonic
Jerky seizure
Clonic
2 main types of seizures
Generalised (primary)
Focal
5 types of Generalised seizures (primary)
Absence Myoclonic Tonic-Clonic Tonic Atonic
3 - 10 year olds
Female
Unresponsive staring multiple times a day
Hx of stress/ hyperventilation
Absence seizure
- “Petit mal”
Contraindicated in Absence and Myoclonic seizures
Carbamazepine - worsens seizure
EEG in Absence seizures
Bilateral spike pattern
Management of Absence seizures
- Sodium valproate
- Ethosuximide
Self resolve in adulthood
Muscle jerk seizures
Myoclonic seizure
Management of Myoclonic seizures
- Sodium valproate
- Clonazepam
Lamotrigine
Tongue biting
Groaning
Incontinence
Post-ictal period
Tonic-clonic seizure
Management for tonic-clonic seizures
- Sodium valproate
- Lamotrigine
Carbamazepine
Drop attack seizures
Atonic seizures
Activity in both sides of the brain
Consciousness is lost
Primary generalised seizures
Management for primary generalised seizures
- Sodium valproate
2. Lamotrigine
Activity in one side of the brain
Focal seizure
Management for focal seizures
- Carbamazepine
Lamotrigine - Levetiracetam
Oxcarbazepine
Sodium valproate
Consciousness is not lost = aware
No control over movement (twitching of hand)
Memory flashbacks
Post-ictal weakness (Todd’s Paresis)
Focal seizures
Non-motor focal seizures
Deja vu
Jamais vu
Motor focal seizures
Jacksonian march
Starts on one side of the brain then moves to both sides
Focal > generalised seizure
Secondary generalised seizure
- common for focal impaired awareness seizures
Smacking lips (automation) Memory of seizure is unclear/ altered
Focal impaired awareness seizure
- can progress to secondary generalised seizure
Sensory seizures are located in
- parasthesia
Parietal lobe
Visual seizures are located in
- floaters
- flashes
Occipital lobe
HEAD seizures are located in
Hallucinations
Epigastric/emotional
Automatisms
Deja vu/ dysphagia (post-ictal)
Temporal lobe
Motor seizures are located in
- Movements
- Posturing
- Post-ictal weakness (Todd’s paresis)
- Jacksonian march
Frontal lobe
Driving: First unprovoked seizure
if no abnormalities: 6 months off
if abnormalities: 12 months off
Driving: Established epilepsy
1 year seizure free = can drive
Driving: Stopped epilepsy medication
6 months off
Driving: Any seizures in HGV driver
10 years off
