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neurology > seizures > Flashcards

seizures Flashcards

1
Q

prevalence of seizures vs febrile convulsion vs epilepsy in childhood

A

seizures = 2-5%
febrile convulsion = 1 in 30 = 3%
epilepsy = 0.5%

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2
Q

examples of generalised onset seizures

A
  • GTC
  • tonic
  • myoclonic
  • typical absence
  • atonic
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3
Q

aetiology of epilepsy

A
  1. genetic epilepsy
  2. structural - malformation/focal epileptogenic lesion
  3. infection e.g. neurocystercercosis
  4. inflammation / immune e.g. ADEM
  5. metabolic
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4
Q

describe key features of seizures arising from the frontal vs temporal vs occipital cortces

A

frontal = MOTOR, nocturnal
temporal = most common focal epilepsy = oromotor automatisms (lipsmacking), weird psych stuff e.g. fear / deja vu, olfactory/auditory
occipital = visual

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5
Q

what can and shouldn’t be used to distinguish syncope vs GTC

A

don’t use convulsions / incontinence
post-confusion is good (<30s for syncope, 2-20mins GTC)
trigger is also RARE in seizure

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6
Q

what determines what kinds of investigations you need to do if you suspect epilepsy?

A

how likely it is that there is a sinister cause:

idiopathic focal (BOE, BRE): nothing
idiopathic generalised (CAE, JAE, JME): mostly nothing
symptomatic focal - imaging
symptomatic generalised (infantile spasms / lennox gastaut): consider all

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7
Q

most common cause of focal epilepsy worldwide

A

neurocystercercosis

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8
Q

what kind of epilepsies are the following provocation procedures for EEG used for?
1. hyperventilation
2. photic stimulation

A
  1. Hyperventilation – stimulates absence seizures
  2. Photic stimulation – idiopathic generalised epilepsy
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9
Q

following correspond to what EEG pattern?
1. absence seizures
2. BRE
3. BOE
4. juvenile myoclonic
5. Infantile spasms
6. lennox-gastaut

A
  1. absence seizures = 3Hz spikes
  2. BRE = centro-temporal sharp waves
  3. BOE = right occipital spikes
  4. juvenile myoclonic = 4-6Hz
  5. Infantile spasms = hypsarrhythmia
  6. lennox-gastaut = < 2.5 Hz sharp/slow
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10
Q

which types of epilepsy classically have normal inter-ictal EEGs

A

FLE, TLE, IGE

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11
Q

% of autistic children with epilepsy

A

30%

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12
Q

what are the four seizure syndromes to know about in the neonatal period

A

• Benign neonatal seizures
• Benign familial neonatal seizures
• Early myoclonic encephalopathy (EME)
• Ohtahara syndrome (early infantile epileptic encephalopathy - EIEE)

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13
Q

key features of benign neonatal seizures

A
  • ‘fifth day fits’
  • resolve by 2 weeks
  • everything is fine - no fhx, neuro exam ok, eeg fine
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14
Q

key features of benign familial neonatal seizures

A
  • within 1st week onset; self-resolve in early infancy
  • AD inheritance, usually KCh channelopathy
  • everything else fine
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15
Q

differentiate EME vs EIEE

A

EME
present as neonate
metabolic/genetic
abnormal at birth/at seizure onset
starts as myoclonic > infantile spasms
progressive into vegetative state; death in infancy

EIEE
present in first 3 months
anoxia / genetic
always abnormal at birth
tonic > west/ lennox-gastaut
static: causes mental retardation + quadriplegia, last slightly longer

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16
Q

EEG pattern of EME and EIEE

A

suppression burst

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17
Q

clinical triad of west syndrome

A

i. Epileptic spasms (seizures type)
ii. Hypsarrythmia (EEG)
iii. Arrest of psychomotor development/regression (clinical)

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18
Q

peak age of onset for infantile spasms

A

3-7mo

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19
Q

classic spasms of infantile spasms

A
  • most commonly after waking
  • sudden, brief, bilateral and symmetric contraction of the muscles of the neck, trunk and extremities, occurring in clusters
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20
Q

first line treatment for infantile spasms

A

1st line = high dose pred
if tuberous sclerosis, 1st line = vigabatrin
if treatable metabolic condition, treat

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21
Q

common causes of infantile spasms (and most common)

A

malformations
1. cortical dysplasia = most common > can treat
2. Cerebral dysgenesis = Aicardi syndrome
3. Lissencephaly = Miller-Dieker syndrome

tuberous sclerosis
T21
infections
metabolic
genetics

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22
Q

dravet syndrome also known as…?

A

severe myoclonic epilepsy of childhood

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23
Q

3 key features of dravet

A
  1. pleomorphic triggered by fever/ warm temps/ lights
  2. seizures in first year, but dev delay + abnormal EEG at 2-3y
    - hypotonia, ataxia
    - multifocal spikes on EEG
  3. 90% from SCNA1 mutation
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24
Q

major causes of mortality in dravet

A

SUDEP
status
accidents e.g. drowning
infections

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25
Q

Mx options in dravet? what Rx to avoid?

A
  1. avoid triggers
  2. initially - valproate +/- clobazam
    ** 90% from SCNA1 mutation, so avoid Na blockers e.g. carbamazepine!
26
Q

name the three benign focal epilepsies of childhood

A
  1. childhood epilepsy with centrotemporal spikes (CECTS) = BRE = BECTS
  2. BOE of childhood early onset = panayiotopoulos
  3. BOE of childhood late onset = gastaut
27
Q

key features of BRE

A
  1. asleep/about to wake
  2. up to 2mins with rolandic complex i.e. oropharyngeal sensorimotor seizures: numbness/tingling, hypersalivation, guttural vocalisation
  3. fully conscious
  4. start ~6-8yo, remit by puberty
28
Q

incidence of BRE

A

most common childhood epilepsy- 15%

29
Q

Rx for BRE

A

1st line valproate
Carbamazepine, phenobarbital and lamotrigine CONTRA-INDICATED

30
Q

early BOE key features for exam and 1st line Rx

A
  • peak onset 3-5yo, spontaneous remission 2-3y after onset
  • focal autonomic (vomiting**, pallor, sweating, apnoea, HR) > generalised
  • infrequent seizures, but status typical
  • 1st line if having more seizures- carbamazepine
31
Q

late BOE features that distinguish it from early BOE

A
  • 8-9yo onset, and remission less likely
  • vomiting uncommon; eye features more common
  • daytime not night (cf early)
  • more frequent and shorter seizures (cf early)
  • EEG markedly activated by eye closure
32
Q

key features of childhood absence epilepsy

A
  • peak onset 5-6y; remission in 80% after Rx
  • impaired consciousness e.g. staring WITHOUT loss of body tone
  • induced by hyperventilation
  • 3Hz EEG
33
Q

Rx to give and avoid in CAE

A
  1. ethosuxamide, 2nd lamotrgine
    AVOID carbamazepine, vigabatrin, gaba - they aggravate the seizures!!
34
Q

lennox-gastaut key features

A
  • peak onset 3-5y
  • seizures severe AF - pleomorphic and everyday (WEAR HELMET)
  • developmentally normal BEFORE first seizure
  • slow spike+wave <2.5Hz EEG
  • no drug is great
35
Q

ketogenic diet esp effective in which epilepsy?

A

epilepsy with myoclonic-atonic seizures (EMAS) = doose syndrome

36
Q

key features of EMAS / Doose syndrome

A
  • peak 2-4y
  • WEAR HELMETS (as well as lennox-gastaut)
  • myoclonic / drop seizures
  • ketogenic diet v effective (many GLUT1 defect)
  • 50% do well
37
Q

landau-kleffner syndrome (LKS) - key features

A
  • a/w sleep
  • EEG: CT spikes+waves > continuous when asleep i.e. ESES
  • normal until 3-6y, when they lose language (later than autism)
  • no tx effective
38
Q

gelastic seizures - what are they, and what causes them

A

= sudden laughing/crying
hypothalamic hamartoma - can have surgery

39
Q

juvenile myoclonic epilepsy- key features, Rx and which to avoid

A
  • 12-15y peak onset; low remission - lifelong tx
  • triggers: sleep dep, alcohol, lights
  • morning myoclonic jerks, and absence/GTC on waking
  • 1st valproate, AVOID carbamazepine/phenytoin
40
Q

which is the key chromosomopathy associated with epilepsy

A

T21

41
Q

which Rx need levels and monitoring

A

phenytoin
phenobarb
very rarely carbamazepine/valproate

42
Q

biggest risk factors for SUDEP

A
  1. poorly controlled tonic-clonic seizures ***
  2. male
  3. longstanding epilepsy
  4. younger age at onset
43
Q

risk factors for febrile convulsion

A

Major
i. Age <1 year
ii. Duration of fever <24 hours
iii. Fever 38-39 degrees

Minor
i. Family history of febrile seizures / epilepsy
iii. Complex febrile seizures
iv. Daycare
v. Male gender
vi. Low sodium at the time of presentation

44
Q

definition of complex febrile convulsion

A

i. Focal features at onset or during seizure
ii. Duration of >15 minutes
iii. Recurrence within the same febrile illness
iv. Incomplete recovery in an hour

45
Q

risk factors for development of epilepsy with febrile convulsion

A

one risk factor = 2%, >1 factor = 10% risk:
family history of epilepsy
any neurodevelopmental problem
prolonged or focal febrile seizures
febrile status epilepticus

46
Q

1st line treatment:
- for most seizures
- neonatal seizures
- focal seizures

A
  • most childhood epilepsies = valproate
  • neonatal = phenobarb
  • focal epilepsy = carbamazepine
47
Q

first line Rx for:
- most seizures
- neonatal
- partial

A
  • most = valproate
  • neonatal = phenobarb
  • partial = carbamazepine
48
Q

MOA classes of the anti-epileptics and their broad side effects

A

NaCl blockers - CBZ, PHT, VPA, LTG
- esp CNS (drowsy, ataxia, tremor, vom etc)
GABAergic - PB, BZP, VGA, VPA
- esp behavioural (aggression, irritability etc)

49
Q

specific side effects they want you to know for exams:
- CBZ
- valproate
- phenytoin
- lamotrigine
- vigabatrin
- topiramate
- oxcarbazepine

A
  • CBZ: hypoNa, saliva, SJS/DRESS in azeans
  • valproate: pancreatitis/liver failure
  • phenytoin: serum sickness, gums, hirsutism, OP, megaloblastic anaemia
  • lamotrigine: SJS
  • vigabatrin: retinopathy, psychosis
  • topiramate: nephrolithiasis, glaucoma
  • oxcarbazepine: hypoNa
50
Q

lamotrigine - what reduces and increases its half-life?

A

CBZ/phenytoin reduces
valproate increases

51
Q

which triple combo of AED works well

A

LTG + VPA + CLB

52
Q

which AED will exacerbate BRE/BOE and IGE

A

CBZ and OXC

53
Q

asians - beware of which AEDs and why

A

CBZ, OXC, PHT, LTG, HLA-B*15:02 allele

54
Q

which AEDs are weight gain, weight neutral and weight loss

A

Weight gain = carbamazepine, oxcarbazepine, valproate, and the gabas
Weight neutral = lamotrigine, keppra, phenytoin
Weight loss = topiramate

55
Q

when to withdraw AED generally

A

after 2 years seizure free therapy in unspecified epilepsy syndrome

56
Q

teratogenic effects of AEDs - which 3 do we not like, and which is the worst?

A

valproate worst; NTD
CBZ = spina bifida
phenytoin = clefts

57
Q

first sign of CBZ toxicity

A

diplopia

58
Q

which drug to avoid in mitochondrial disorders

A

valproate

59
Q

which drug to avoid in dravet

A

lamotrigine

60
Q

vagal nerve stimulation in epilepsy - success rates

A

50% have >=50% seizure reduction
<10% chance of seizure freedom

61
Q

what is the thought process behind ketogenic diet

A

4 fat: 1 protein/carb > body burns fat more than CHO/protein > ketones produced > brain uses these for glucose&raquo_space; (dunno how) raises the seizure threshold

62
Q

when is the ketogenic diet CI?

A

metabolic diseases with fat oxidation deficits and/or lactic acidosis

neurology (6 decks)

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