Seizures Flashcards
What is a seizure
Clinical event where there is sudden disturbance of neurological function caused by abnormal or excessive synchronous discharge of neurons.
Results in abnormal paroxysmal activity which is intermittent and self limiting
Can be epileptic or non-epileptic
What is epilepsy
A disorder of the brain characterised by an enduring predisposition to generate epileptic seizures and by the neurobiologic, cognitive and psychological and social consequences of the condition.
Requires occurrence of at least one epileptic seizure
How should you approach suspected seizures
- was the episode an epileptic seizure
- what type of seizrue - generalised, focal or epilepsy syndrome
- what is the cause of the seizure
- which investigations should be done
- Does the child need treatment
What are some examples of paroxysmal events i.e. funny turns?
Psychological: breath holding, self gratification, tics, daydreaming, night terrors, pseudoseizures
Cardiac: reflex asystolic syncope, long QT syndrome,
syncope
Inner ear: benign paroxsymal vertigo
CNS: Migraine
Gastro: Sandifer syndrome (rare manifestation of GORD
What are the different types of epilepsy?
Generalised = discharge from both hemispheres with loss of consciousness for >3 seconds Focal = seizures originate from one part of one hemisphere
What are absence seizures
Brief episodes of unresponsiveness (no more than 10 seconds)
occasionally associated with repetitive purposeless movements of the fingers, hand or mouth such as lip smacking. May be eye fluttering or flickering
Starts between 4 and 7 years of age
What are the features of a generalised seizure
loss of consciousess for >3 seconds
symmetrical seizures
synchronous discharge on EEG
When do absence seizures usually resolve
by adolescence
How are absence seizures confirmed
Confirmed by typical EEG - 3Hz spike and wave pattern
What are myoclonic seizures
brief repetitive jerking movements of the limbs, neck and trunk
Events range from head nod to being thrown across room
(may need helmets)
What are tonic seizures
Increased in tone
occurs in isolation or as part of a syndrome
difficult to control
What are tonic-clonic seizures
Rhythmic contraction of muscle groups followed by tonic phase
What is the sequence of tonic-clonic seizures
a) rigid tonic phase: fall to ground, apnoea, cyanosis
b) clonic phase: jerking limbs breathing irregular, cyanosis persists, frothing at mouth, may bite tongue, incontinent of urine
What happens after a tonic-clonic seizure
Last seconds to minutes and followed by deep sleep or unconsciousness for up to several hours
what are atonic seizures
Often combined with a myoclonic jerk followed by transient loss of muscle tone
Causes sudden fall to floor or drop of head
Not associated with post ictal dorwsiness
How does a focal seizure from the frontal lobe present
Involves the motor or premotor cortex
May lead to clonic movements which travel proximally (Jacksonian march)
or tonic seizures with both upper limbs raised high for a few seconds
How does seizures present that originate from the temporal lobe
Auditory or sensory (smell or taste) phenomenon
associated automatisms e.g. lip smacking, plucking ones clothing
Deja-vu feelings
last longer than absence seizures
How do occipital seizures present
Stereotypical visual phenomena
How do parietal lobe seizures present
Contralateral dysaethesias (altered sensations) Distorted body image
What are some epilepsy syndromes
West syndrome
Lennox-Gastaut Syndrom
Benign rolandic epilepsy
Juvenile myoclonic epilepsy
What is west syndrome
Known as infantile spasms
onset: 3-12 months
Multiple bursts (20-30) of violent flexor spasms of head, trunk and limbs lasting 1-2 seconds
Episodes distress baby
Most will lose skills and develop LD and continuing epilepsy
Undergoing a neuro-degenerative neuro-encephalopathic process
How is west syndrome diagnosed
EEG features of hypsarrthymia and burst suppression
How is west syndrome treated
Steroids (ACTH) and Vigabatrin
What is lennox-gastaut syndrome
uncommon form of epilepsy but commonest type of intractable epilepsy
- atonic seizures
- absences
- tonic seizures that may only happen at night
Onset: 1-3 years
What does EEG show in Lennox-Gastuat
When child is not obviously fitting shows slow generalised spike and wave
What is benign rolandic epilepsy
Benign because outcome is usually good
Rolandic because seizures begin in the part of the brain called rolandic area
Most common type of epilepsy in children: 15% of all epilepsies
Often start in sleep or just about to wake up
Onset: 4 - 10 years
What are the EEG findings in benign rolandic epilepsy
posterior sharp waves or occiptal discharges
What is the treatment for lennox-gastaut syndrome
sodium valproate
Lamotrigine
Topiramate
What is the treatment for benign rolandic epilepsy
Medications are not always indicated. Consider:
Carbamazepine
Levetiracetam
What is juvenile myoclonic epilepsy
Onset: 10-20 years of age
Common epilepsy syndrome
Most commonly occurs shortly after waking with
- myoclonic seizures
- tonic-clonic seizures
- absence seizures
learning is unimpaired, remission unlikely but response to treatment is good
How is juvenile myoclonic epilepsy treated
Levetiracetam
Sodium Valproate
What are the concerns with sodium valproate
Teratogenic - caution in menstruating girls (lamotrigine is the alternativ)
Associated with liver dysfuntion (including fatal liver failure) in children <3 years old
What is status epilepticus
Prolonged seizure lasting >30 mins or recurrent seizures where the patient does not fully regain consciousness within a 30 min period
What are common causes of Status epilepticus in children
Infection: meningitis Electrolyte disturbances Fever Trauma Drugs: subtherapeutic anticonvulsant levels, poisoning Metabolic: metabolic abnormalities
What is the management of SE
A-E assessment - secure airway - IV access - High flow oxygen - Check BM 5-15 mins - IV lorazepam (50-100 micrograms/kg) - Rectal Diazepam If no response repeat dose after 5-10mins 25 mins - IV phenytoin or phenobarbital 45 mins - Rapid induction of anaesthesia
