Seizures Flashcards
Definition of convulsions
Convulsion is a sudden, violent, irregular
movement of the body, caused by involuntary
contraction of muscles.
Definition of a seizure
A paroxysmal involuntary disturbance of brain function,
manifested as
- Impairment or loss of consciousness. - Abnormal motor activity. - Sensory disturbances. - Behavioral abnormalities. - Autonomic dysfunction
Epilepsy is a repeated seizures.
Epilepsy is usually diagnosed after at least two seizures that were not caused by known medical condition.
Patho
Normally, the brain continuously generates tiny electrical impulses in an orderly pattern. These impulses travel along neurons and throughout the whole body via neurotransmitters.
-In seizures, the normal electrical pattern is disrupted by sudden bursts of electrical energy that may briefly affect the consciousness, movements or sensations.
Epilepsy Risk Factors
Epilepsy Risk Factors
1-Premature birth or low birth weight. 2-Trauma during birth (such as lack of oxygen). 3-Seizures in the first month of life. 4-Abnormal brain structures at birth. 5-Bleeding into the brain. 6-Abnormal blood vessels in the brain. 7-Brain tumors. 8-Infections of the brain such as meningitis or encephalitis. 9-Cerebral palsy. 10-Family history of epilepsy.
ABNORMAL MOVEMENTS THAT MIMIC SEIZURES
ABNORMAL MOVEMENTS THAT MIMIC SEIZURES
1- Jitteriness and Benign Myoclonus of early infancy. A rare condition of nonepileptic spasms that may resemble the epileptic spasms seen in West’s syndrome. The spells here begin before age 1 year and are self-limited. The(EEG) is normal, and neurologic development is not affected
2- Benign paroxysmal torticollis. 3- Tics and ritualistic movements. 4- Syncopal attacks (breath holding syndrome). 5- Vasovagal attacks. 6- Sandifer’s syndrome:
Sandifer’s syndrome
Sandifer’s syndrome
The Episodes last for 1-3 minutes, they are usually
associated with the ingestion of food. It is a
paroxysmal dystonic movement disorder occurring in
association with gastro-oesophageal reflux, or hiatal
hernia. It occurs during infancy or early childhood
and is characterised by abnormal posturing of the
head and neck (torticollis) and severe arching of the
spine
Partial Seizures (Focal) -1
Partial Seizures (Focal) -1 # 1- Simple partial 30s ( normal conscious ). ......Motor .......Sensory ....... Autonomic # 2- Complex partial (disturbed level of conscious). # 3- Partial with secondary generalization (spreading of the epileptic focus).
Generalized seizures-2
Generalized seizures-2
1-Tonic-clonic seizure (grand mal). 2-Clonic seizure. 3-Myoclonic seizure (Short jerking in parts of the body). 4-Atonic seizure. 5-Absence (petit mal)
What are Epilepsy Syndromes
An epilepsy syndrome is a collection of
symptoms and signs that often co-exist. It determines the likely prognosis and guides
management. The components of an epilepsy syndrome:
Seizure type EEG findings Age of onset Developmental history Family History
Causes of convulsions
1- Epilepsy. 2- Febrile convulsion. 3- Cerebral causes: 1- congenital malformation e.g. AV fistula 2-Trauma (subdural hematoma trauma) 3-Infection (meningitis or brain abscess) 4-Neoplasm 5-Vascular (Vasculitis–hypertensive encephalopathy), Degenerative brain diseases
4- Metabolic causes Decreased Ca level Decreased Mg level Decreased glucose level Increased bilirubin level 5- Drugs as theophylline. 6- Toxins e.g. lead , tetanus , shegilla
Differential diagnosis
convulsions
1- Seizure 2- Syncope (is a temporary loss of consciousness usually related
to insufficient blood flow to the brain.)
3- Breath holding spell ( are brief periods when young children stop breathing for up to 1 minute. These spells often cause a child to lose his consciousness. It happened in Angry frustrated child. 4- Motor tics involves brief, uncontrollable, spasm-like movements
5- Gastroesophageal reflux as Sandifer syndrome. 6- Benign sleep myoclonus 7- Familial hemiplegic migraine : migraine- triggered seizures
Hx of convulsions
History
Preictal
what was the child doing before the attack:
sleeping or sleep deprived, any aura as “unpleasant sensation”,
any trigger, well or unwell, any fever, medications taken
or recent vaccine
Ictal
ask about the description of the attack, conscious or
nonresponsive, any repetitive movement, local or generalized
seizures, up rolling eyes or fixed gaze, any cyanosis,
incontinence, and for how long, how many episodes and how
frequent
Postictal
Confused, sleepy or tired, headache, how long did the
patient take to go back to his baseline activity .
Any previous similar attack or febrile convulsions. Any chronic diseases. Medication history. Developmental delay. School performance . Family history of epilepsy or febrile convulsion, or
chronic disease.
PE of convulsions
Physical examination
Full neurological examination. Dysmorphic features . Growth parameters. Vital signs. Signs of meningism. Fundus examination.
Investigations
CBC Electrolytes and serum glucose Lumber puncture if indicated Toxicology Drug level EEG Neuroimaging (CT or MRI)
Treatment of epilepsy
Treatment of epilepsy
Education of the parents
About etiology, medications, follow up.
Emergency plan.
Restriction of physical activity is unnecessary but
swimming should be under direct observation. Ketogenic diet
Most calories are provided from fat with restriction of
carbohydrate and protein. The mechanism is unknown.
Anticonvulsant drugs
The goal is to use mono-therapy which is most
effective and least toxic. No abrupt withdrawal of antiepileptic Drug can be weaned over 3-6 months if the patient is,
seizure free, for 2 years without risk factors . If there is risk factors (age more than 12 years,
neurological dysfunction, history of neonatal seizure,
or numerous seizures before achieving control)
patient should use medication for life.
Myoclonic seizure
Valporate or
lamotrigine
Stevens Johnson syndrome (serious disorder that affects the skin, mucous membrane, genitals and eyes)
