Seizures

Question 1

What is a seizure?

Answer 1

is a sudden synchronous discharge of cerebral neurones causing symptoms or signs that are apparent either to the patient or to an observer

Question 2

What is epilepsy?

Answer 2

is a predisposition to recurrent unprovoked seizures
- It affects 0.4 to 0.6% of the world’s population at any point in time
- 80% live in low- or middle-income countries

Question 3

What is status epilepticus?

Answer 3

a seizure that lasts longer than 5 minutes or having more than 1 seizure within a 5-minute period without returning to a normal level of consciousness between episodes
- is a medical emergency

Question 4

What are pseudo-seizures?

Answer 4

false or fake seizures
- look out for them in status epilepticus

Question 5

Functions of frontal lobe?

Answer 5

1. Planning, organising, sequencing, abstracting, initiation, judgement, self-evaluation and insight
2. Initiation of movement
3. Speech expression involving Broca’s speech area (in the dominant hemisphere)
4. Voluntary control of micturition
5. The more enigmatic aspects of thinking and behaviour such as wisdom, intelligence, ambition, moral sense and judgement, in combination with all parts of the cortex in ways in which science has limited understanding
6. Acquired social behaviour

Question 6

Functions of parietal lobe?

Answer 6

1. It senses
2. Is concerned with appreciating the world around us, creating a three-dimensional representation of the spatial layout of the external world, and also of your body in that three-dimensional representation.

Question 7

Functions of temporal lobe?

Answer 7

The temporal lobe subserves
1. memory (hippocampus and other areas) and emotion,
2. certain aspects of perception, interpretation of numbering
and colour
3. Central representation taste
and of hearing, smell
4. speech interpretation,
5. transmission of visual impulses the temporal visual radiations
Note: Lesions may result in memory
impairment, auditory agnosia (temporo-parietal connections), cortical deafness (if bilateral) and receptive dysphasia

Question 8

Functions of occipital lobe?

Answer 8

The occipital lobe is the common endpoint of the visual nerve pathways.
Note: Lesions
may result in cortical blindness,
visual agnosia (parieto-occipital connections) specific visual processing defects such as impaired perception of colour or movement.

Question 9

How are seizures classified?

Answer 9

Classified according to their clinical presentation and their site of electrical origin in the brain.

1. simple - Consciousness is fully retained during seizure
2. complex - Loss of consciousness during seizure

Question 10

What are partial onset seizures?

Answer 10

Seizures arising from one site within the brain

Question 11

What is a generalized tonic-clonic seizure?

Answer 11

Electrical discharge arises focally and spreads to involve the rest of the entire cerebral cortex causing stiff rhythmic twitching muscles

Question 12

What is a myoclonic seizure?

Answer 12

Sudden rapid motor contractions

Question 13

What is an abscence seizure?

Answer 13

Sudden loss of consciousness for seconds to minutes
- no change in muscle tone
- commonly found on adolescents
- usually misdiagnosed as ADHD

Question 14

Name types of partial onset seizures and their levels of consciousness?

Answer 14

1. simple partial
   - not impaired
2. complex partial
   - impaired
3. secondary generalized tonic-clonic
   - loss of consciousness

Question 15

Name types of generalized onset seizures and their levels of consciousness?

Answer 15

1. absence
   - impaired
2. myocionic
   - not clinically impaired
3. primary generalized tonic-clonic
   - loss of consciousness

Question 16

What are the causes of seizures?

Answer 16

The aetiology is unknown or idiopathic in about two thirds of cases of seizures in Africa

Question 17

Investigations?

Answer 17

1. Diagnosis is clinical.
   - based on taking a history from the patient and any witnesses
2. Electrolytes
3. Electrocardiagraphy
4. Electroencephalography
   - Useful to categorize epilepsy and understand its cause and not confirming a doubtful diagnosis
5. Brain Imaging
   - Esp. in focal-onset seizures and in older patients where the chance of a focal brain lesion is greatest

Question 18

Management?

Answer 18

Using one drug start slow & aim low
- If seizures are stopped, do not increase the dose any further
- If seizures are not controlled, increase dose as long as no or few side-effects
- If seizures still persist add a second AED
- Routine monitoring of AED levels is not needed.
- Adherence counselling and side effects

Question 19

What is the first aid for seizures before arrival in hospital?

Answer 19

1. Avoid injury by removing the patient from any immediate danger e.g. fire, road traffic, water etc.
2. Do not attempt to force anything between the teeth.
3. Wait until the tonic-clonic phase is over
4. Make sure that the airway is clear by extending the neck.
5. Place the patient on his side in the recovery position to avoid aspiration if he vomits.

Question 20

What is an atonic seizure?

Answer 20

Sudden loss of postural muscle tone for 1-2 seconds

Question 21

What is a post ictal phase?

Answer 21

Noted after tonic clonic seizure consciousness is impaired for minutes to hours
- sluggish tired or hard to wake up

Question 22

What can trigger seizures?

Answer 22

1. fatigue
2. sleep deprivation
3. alcohol
4. infections
5. flashing lights if photosensitive.

Question 23

Describe the cessation of medication?

Answer 23

AEDs may be effectively withdrawn in patients who have been seizure free for 2-5 years.
- There is an increased risk of recurrence in adults particularly between 1 and 2 years after stopping.