Seizures Flashcards
What types of seizures are there?
Focal onset
Generalized onset
Unknown onset
What kinds of motor onset focal onset seizures are there?
Automatisms Atonic Clonic Epileptic spasms Hyperkinetic Myoclonic Tonic
What kinds of non-motor onset focal onset seizures are there?
Autonomic Behavioural arrest Cognitive Emotional Sensory
What kinds of motor onset generalized onset seizures are there?
Tonic clonic Tonic Clonic Myoclonic Myoclonic tonic Myoclonic atonic Atonic Epileptic spasms
What kinds of non-motor onset generalized onset seizures are there?
Typical
Atypical
Myoclonic
Eyelid myoclonia
What kinds of motor onset unknown onset seizures are there?
Tonic clonic
Epileptic spasms
What kinds of non-motor onset unknown onset seizures are there?
Behaviour arrest
Define epilepsy
At least 2 unprovoked/reflex seizures >24hrs apart
1 unprovoked/reflex seizure and probability >60% of another seizure over next 10 years
Diagnosis of epilepsy syndrome
What is an epilepsy syndrome?
A cluster of features w/ recognizable pattern (seizure type, eeg, brain imaging, genetic profile)
Give examples of epilepsy syndromes in neonates
Benign familial neonatal epilepsy
Ohtahara syndrome
Give examples of epilepsy syndromes in infants
West syndrome
Myoclonic epilepsy in infancy
Dravet syndrome
Give examples of epilepsy syndromes in childhood
Benign epilepsy with centrotemporal spikes
Lennox-Gastaut syndrome
Landau-Kleffner syndrome
Childhood absence epilepsy
Give examples of epilepsy syndromes in adolescents
Juvenile absence epilepsy
Juvenile myoclonic epilepsy
Generalized tonic-clonic seizures
Familial temporal lobe epilepsies
Give examples of epilepsy syndromes in with no specific age
Familial focal epilepsy
Reflex epilepsy
Name structural-metabolic causes of epilepsy
Cortical development malformation Neurocutaneous disorder Tumour Trauma Infection Angioma Perinatal insult Stroke
Name distinctive epilepsy constellations
Mesial temporal sclerosis
Rasmussen
Gelastic seizures w/ hypothalamic hamartoma
Hemiconvulsive hemiplegic epilepsy
Name epilepsies of unknown cause
Benign neonatal seizures
Febrile seizures
Define a febrile seizure
Seizure in children between 6mo - 5y assoc w/ fever w/o evidence of intracranial infection
When do the majority of febrile seizures occur?
Before 3yo
Avg age 18-22mo
Which gender is more affected by febrile seizures?
Boys > girls
What is the recurrence risk of a febrile seizure?
1/3 have at least 1 recurrence
Younger the age, greater the risk
What is the risk of developing epilepsy after a febrile seizure?
2%
Incr if complex or abnormal neurological state
Differentiate simple from complex febrile seizures
Simple
- GTC
- <15min
- no recurrence within 24hrs
- no postictal deficit
- no family hx
- normal neurodevelopment
Complex
- focal
- > 15min
- 2 or more within 24 hours
- postictal deficit
- often family hx
- developmental delay
Discuss management of a febrile seizure
Identify underlying disease
When is long term use of AED indicated in febrile seizures?
Complex febrile seizure
What treatment can be offered for febrile seizures
Phenobarbitone
Epilim
Rectal diazepam
Antipyretic
Name paroxysmal non-epileptic events
CVS
- syncope
- breath holding spell
Movement d/o
- myoclonus
- motor tic
- Sandifer syndrome
- stereotypies
- self-stimulating behaviour
- dystonic drug reactions
Other
- conversion migraine
Differentiate an epileptic seizure from a PNE
Epileptic
- <3min
- brief cry, no emotional content
- synchronous movement
- never pelvic thrusting
- eyes usually open
- acute onset/offset
- improves w/ medication
- frequent injury
- frequent incontinence
- rare
- awake or asleep
- lethargy/confusion
PNE
- > 3 min
- complex weeping, yelling
- flailing, thrashing movement
- pelvic thrusting (adults > children)
- eyes often closed
- slow onset/offset
- no change with medication
- injury uncommon
- occasional incontinence
- common
- daytime
- no postictal behaviour
Discuss approach to epilepsy
Event Seizure type Epilepsy syndrome Aetiology Impairment
What impairments can result due to epilepsy?
Cognitive Psychosis Learning disability Autism Depression
What are the principles of treating epilepsy?
- Changes made gradually
- High initial doses = incr side effect
- Rapid withdrawal = incr risk of status
- Dose according to weight
What is the first line treatment for absence epilepsy?
Epilim
What is the first line treatment for focal or generalised epilepsy?
Carbamazepine
What seizures can carbamazepine exacerbate?
Absence seizures
Myoclonus
What seizures can phenobarbitone precipitate?
Infantile spasms
Myoclonus
What is the mechanism of action of carbamazepine?
Blocks voltage sensitive Na+ channels
What is the mechanism of action of sodium valproate?
Incr synthesis and release of GABA
Reduces GHB
Inhibits NMDA receptors
Which 2 medications have only positive/no side effects?
Lamotrigine
Gabapentin
