Seizures

Question 1

What is needed for neurons to maintain resting potential, depolarise, and depolarise

Answer 1

Ionic gradient

Question 2

What maintains ionic gradient in neurones

Answer 2

Ionic channels and pumps

Question 3

Inhib and excitatory NT

Answer 3

Glutamate excite
GABA inhib

Question 4

Seizure cellular level

Answer 4

cortical neurons begin to fire in a hypersynchronous manner. This increased rate and sustained network of firing has a characteristic pattern and is called a paroxysmal depolarizing shift. It results in a spreading wave of electrical activity

Question 5

How does refractory period of neurones change during a seizure

Answer 5

May reduce

Question 6

Neuronal changes during seizure

Answer 6

Hypersynchronous firing
Sustained incr firing rate
Paroxysmal depolarising shift
Decr refractory period
Loss of surrounding neuronal inhibition
NT imbalance

Question 7

Initial trigger of seizures

Answer 7

High frequency action potential generation with concurrent hyper polarisation
(Likely mediated by astrocytedps through calcium signalling)

Question 8

Which cell type is involved in the initial trigger of a seizure via hyper polarisation

Answer 8

Astrocyte

Question 9

Seizure definition

Answer 9

Transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.

Question 10

Epilepsy

Answer 10

Conceptually, epilepsy exists after at least one unprovoked seizure, when there is high risk for another.

Epilepsy is considered to be a disease of the brain defined by any of the following conditions:
1. At least two unprovoked seizures occurring >24 h apart
2. One unprovoked seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years
3. Diagnosis of an epilepsy syndrome

Question 11

Resolved epilepsy

Answer 11

– had an age-dependent epilepsy syndrome but are now past the applicable age
– or who have remained seizure-free for the last 10 years and off antiseizure medicines for at least the last 5 years

Question 12

How long does a person have to be seizure free and off meds for resolved epilepsy

Answer 12

10 yrs
Off meds 5 yrs

Question 13

Generalised seizure

Answer 13

Rapid bilateral onset
Always LOC
Convulsive or non convulsive

Question 14

Generalised seizure subtypes

Answer 14

Tonic clonic
Atonic
Absence
Myoclonic

Question 15

What parts of the brain are involved in generalised seizure

Answer 15

Originate within brain and quickly engage bilateral networks
Can include cortical and subcortical structures

Question 16

Focal seizure

Answer 16

Onset within 1 hemisphere
Aura, motor, or autonomic sx
Retained or altered consciousness (stare blankly, grunting, automatisms)
Often progresses to bilateral convulsive in adults

Question 17

What does a focal seizure often progress to in adults

Answer 17

Bilateral convulsive seizure

Question 18

Focal seizure parts of brain involved

Answer 18

Originate in networks limited to 1 hemisphere
May be discretely localised or more widely distributed

Question 19

What is an unknown seizure

Answer 19

Insufficient evidence to characterise as focal, generalised, or both

Question 20

What type of seizure is a generalised onset non motor presentation

Answer 20

Absence

Question 21

Which type of seizure may have retained awareness

Answer 21

Focal

Question 22

Sx of cognitive seizure

Answer 22

Impaired language
Other cognitive impairment
Positive features - deja vu, hallucination, perception distortion

Question 23

Sx of emotional seizure

Answer 23

Anxiety
Fear
Joy

Question 24

Simple partial and complex partial seizure

Answer 24

Simple - focal that doesn’t effect consciousness
Complex - focal that affects consciousness

Question 25

Secondary generalised seizure

Answer 25

Focal that progresses to generalised

Question 26

What can bring on an absence seizure in kids

Answer 26

Hyperventilation

Question 27

What type of seizure may have aura

Answer 27

Focal

Question 28

Causes of epilepsy

Answer 28

Genetics - channelipathy, GLUT1 deficiency Structural-metabolic issues - neurocutaneous disorder, childhood epilepsy, cortical dysplasia

Question 29

Acquired Causes of seizures

Answer 29

Trauma Stroke Tumour Infection Autoimmune

Question 30

Causes of provoked seizures

Answer 30

Fever Drugs/toxins Metabolic Catamenial Reflex epilepsies

Question 31

Cryptogenic seizure

Answer 31

Probably has underlying cause but normal imaging

Question 32

Symptomatic seizure

Answer 32

Secondary to known or presumed brain disorder

Question 33

Are epilepsy syndromes more common in kids or adults

Answer 33

Kids

Question 34

Epilepsy syndromes

Answer 34

Benign Rolandic epilepsy Infantile spasms / west syndrome Juvenile Myoclonic Progressive Myoclonic Rasmussen Lennox gastaut Dravets Landau klefgner

Question 35

Epilepsy imitators

Answer 35

Vasovagal syncope Reflex anoxic seizure Breath holding attack Hyperventilation syncope Neurological syncope Orthostatic intolerance Long QT Cardiac syncope Innattention Tantrums Panic attack Dissociative state Hallucinations Non epileptic seizure Hypnogogic jerks Sleep related rhythmic movement disorder

Question 36

Status epilepticus

Answer 36

Seizure lasting 30+ mins, or cluster or seizures without intervening recover for 30+ mins

Question 37

Consequences of prolonged seizures

Answer 37

Mesial temporal sclerosis Death

Question 38

Febrile convulsions

Answer 38

Seizures associated with raised temperature in a child (usually 6months to 6 years) Typically short generalised seizures with rapid recovery

Question 39

Febrile convulsions usual age

Answer 39

6mo-6yrs

Question 40

Febrile convulsion tx

Answer 40

Gently cool Rarely - benzo is not terminating NOT AED

Question 41

Can antipyretics prevent febrile convulsions

Answer 41

No

Question 42

Eclampsia

Answer 42

Acute life threatening condition associated with pregnancy

Question 43

Eclampsia presentation

Answer 43

Confusion, headaches, tremor, twitching Progresses to generalised tonic clonic and comz

Question 44

Eclampsia risk factors

Answer 44

Often already has pre eclampsia May have HELLP syndrome Primitravida Young

Question 45

Eclampsia tx

Answer 45

Oxygen Magnesium sulphate BP max - hydralazine, labetalol Deliver baby

Question 46

Impact seizure recommendation

Answer 46

Generally benign CT within 1 hr

Question 47

5 types of post traumatic seizure

Answer 47

Immediate - within 24hrs Early - within 7 days Late - after 7 days Recurrent - post traumatic epilepsy, focal or fpgeneralised Hypoxic-ischaemic - usually myoclonic or focal w alt consciousness, if status usually fatal

Question 48

Post traumatic epilepsy

Answer 48

One or more unprovoked seizures occurring 7 days after TBI with no other cause

Question 49

Contusion to which lobes if most linked to post traumatic epilepsy

Answer 49

Frontal > parietal > temporal

Question 50

Post traumatic epilepsy prophylaxis

Answer 50

Steroids

Question 51

Seizure tx ladder

Answer 51

Oxygen Benzos Phenytoin Levetiracetam Phanobarbitone/thiopentone General anaesthesia- propofol, fentanyl Neuro monitoring in ICU Consider - glusoces, thiamine, rectal paraldehyde

Question 52

Seizure prophylaxis

Answer 52

AED Post head injury - phenytoin, levetiracetam (keppra)

Question 53

What AED type should be avoided in absence seizures

Answer 53

Carbamazepine