Seizures Flashcards by Rachel Glass

What types of seizures are there?

Focal onset
Generalized onset
Unknown onset

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What kinds of motor onset focal onset seizures are there?

Automatisms
Atonic
Clonic
Epileptic spasms
Hyperkinetic
Myoclonic
Tonic

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

Autonomic
Behavioural arrest
Cognitive
Emotional
Sensory

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What kinds of motor onset generalized onset seizures are there?

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

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

Typical
Atypical
Myoclonic
Eyelid myoclonia

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What kinds of motor onset unknown onset seizures are there?

Tonic clonic

Epileptic spasms

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

Behaviour arrest

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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

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What is an epilepsy syndrome?

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

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Give examples of epilepsy syndromes in neonates

Benign familial neonatal epilepsy

Ohtahara syndrome

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Give examples of epilepsy syndromes in infants

West syndrome
Myoclonic epilepsy in infancy
Dravet syndrome

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Give examples of epilepsy syndromes in childhood

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

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Give examples of epilepsy syndromes in adolescents

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

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Give examples of epilepsy syndromes in with no specific age

Familial focal epilepsy

Reflex epilepsy

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Name structural-metabolic causes of epilepsy

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

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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?

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?

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