Seizures

Question 1

What types of seizures are there?

Answer 1

Focal onset
Generalized onset
Unknown onset

Question 2

What kinds of motor onset focal onset seizures are there?

Answer 2

Automatisms
Atonic
Clonic
Epileptic spasms
Hyperkinetic
Myoclonic
Tonic

Question 3

What kinds of non-motor onset focal onset seizures are there?

Answer 3

Autonomic
Behavioural arrest
Cognitive
Emotional
Sensory

Question 4

What kinds of motor onset generalized onset seizures are there?

Answer 4

Tonic clonic
Tonic
Clonic
Myoclonic
Myoclonic tonic
Myoclonic atonic
Atonic
Epileptic spasms

Question 5

What kinds of non-motor onset generalized onset seizures are there?

Answer 5

Typical
Atypical
Myoclonic
Eyelid myoclonia

Question 6

What kinds of motor onset unknown onset seizures are there?

Answer 6

Tonic clonic

Epileptic spasms

Question 7

What kinds of non-motor onset unknown onset seizures are there?

Answer 7

Behaviour arrest

Question 8

Define epilepsy

Answer 8

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

Question 9

What is an epilepsy syndrome?

Answer 9

A cluster of features w/ recognizable pattern (seizure type, eeg, brain imaging, genetic profile)

Question 10

Give examples of epilepsy syndromes in neonates

Answer 10

Benign familial neonatal epilepsy

Ohtahara syndrome

Question 11

Give examples of epilepsy syndromes in infants

Answer 11

West syndrome
Myoclonic epilepsy in infancy
Dravet syndrome

Question 12

Give examples of epilepsy syndromes in childhood

Answer 12

Benign epilepsy with centrotemporal spikes
Lennox-Gastaut syndrome
Landau-Kleffner syndrome
Childhood absence epilepsy

Question 13

Give examples of epilepsy syndromes in adolescents

Answer 13

Juvenile absence epilepsy
Juvenile myoclonic epilepsy
Generalized tonic-clonic seizures
Familial temporal lobe epilepsies

Question 14

Give examples of epilepsy syndromes in with no specific age

Answer 14

Familial focal epilepsy

Reflex epilepsy

Question 15

Name structural-metabolic causes of epilepsy

Answer 15

Cortical development malformation
Neurocutaneous disorder
Tumour
Trauma
Infection
Angioma
Perinatal insult
Stroke

Question 16

Name distinctive epilepsy constellations

Answer 16

Mesial temporal sclerosis
Rasmussen
Gelastic seizures w/ hypothalamic hamartoma
Hemiconvulsive hemiplegic epilepsy

Question 17

Name epilepsies of unknown cause

Answer 17

Benign neonatal seizures

Febrile seizures

Question 18

Define a febrile seizure

Answer 18

Seizure in children between 6mo - 5y assoc w/ fever w/o evidence of intracranial infection

Question 19

When do the majority of febrile seizures occur?

Answer 19

Before 3yo

Avg age 18-22mo

Question 20

Which gender is more affected by febrile seizures?

Answer 20

Boys > girls

Question 21

What is the recurrence risk of a febrile seizure?

Answer 21

1/3 have at least 1 recurrence

Younger the age, greater the risk

Question 22

What is the risk of developing epilepsy after a febrile seizure?

Answer 22

2%

Incr if complex or abnormal neurological state

Question 23

Differentiate simple from complex febrile seizures

Answer 23

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

Question 24

Discuss management of a febrile seizure

Answer 24

Identify underlying disease

Question 25

When is long term use of AED indicated in febrile seizures?

Answer 25

Complex febrile seizure

Question 26

What treatment can be offered for febrile seizures

Answer 26

Phenobarbitone
Epilim
Rectal diazepam
Antipyretic

Question 27

Name paroxysmal non-epileptic events

Answer 27

CVS

• syncope
• breath holding spell

Movement d/o

• myoclonus
• motor tic
• Sandifer syndrome
• stereotypies
• self-stimulating behaviour
• dystonic drug reactions

Other
- conversion migraine

Question 28

Differentiate an epileptic seizure from a PNE

Answer 28

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

Question 29

Discuss approach to epilepsy

Answer 29

Event
Seizure type
Epilepsy syndrome 
Aetiology
Impairment

Question 30

What impairments can result due to epilepsy?

Answer 30

Cognitive
Psychosis
Learning disability
Autism
Depression

Question 31

What are the principles of treating epilepsy?

Answer 31

1. Changes made gradually
2. High initial doses = incr side effect
3. Rapid withdrawal = incr risk of status
4. Dose according to weight

Question 32

What is the first line treatment for absence epilepsy?

Answer 32

Epilim

Question 33

What is the first line treatment for focal or generalised epilepsy?

Answer 33

Carbamazepine

Question 34

What seizures can carbamazepine exacerbate?

Answer 34

Absence seizures

Myoclonus

Question 35

What seizures can phenobarbitone precipitate?

Answer 35

Infantile spasms

Myoclonus

Question 36

What is the mechanism of action of carbamazepine?

Answer 36

Blocks voltage sensitive Na+ channels

Question 37

What is the mechanism of action of sodium valproate?

Answer 37

Incr synthesis and release of GABA
Reduces GHB
Inhibits NMDA receptors

Question 38

Which 2 medications have only positive/no side effects?

Answer 38

Lamotrigine

Gabapentin