Seizures and Epilepsy Flashcards
Paroxysmal, time-limited changes in motor activity and/or behavior that result from abnormal electrical activity in the brain
Transient occurrence of signs/symptoms resulting from ABNORMAL EXCESSIVE or SYNCHRONOUS neuronal activity in the brain
Seizures/convulsions
General term to include any one of the ff: epilepsy, febrile seizures secondary to metabolic, infectious or other etiologies
Seizure Disorder
Disorder of the brain characterized by an enduring PREDISPOSITION TO GENERATE SEIZURES and by the neurobiological, cognitive, psychological and social consequences of this condition
2 or more unprovoked seizures occurring in a time frame of >24 hrs
EPILEPSY
Disorder that manifests one or more specific seizure types and has a specific age of onset and prognosis
Epileptic syndrome
The primary determinant of the type of MEDICATIONS the patient is likely to respond to
Seizure type
Determines the TYPE OF PROGNOSIS one could expect
Epilepsy syndrome
ILAE 2017 Classification of Seizure Types
FOCAL (aware or impaired consciousness)
- Motor onset (automatisms, myoclonic etc)
- Non-motor onset (autonomic, emotional etc)
GENERALIZED
- Motor (tonic-clonic, tonic, clonic etc)
- Non-motor (absence)
UNKNOWN
- Motor
- Non-motor
- Unclassified
Partial seizure
Initial activation of a system of neurons LIMITED TO A PART OF ONE CEREBRAL HEMISPHERE
FOCAL SEIZURE
Focal seizure w/o impairment of consciousness
Focal seizure w/ impairment of consciousness (focal dyscognitive seizures)
Clinical and EEG changes indicate synchronous involvement of ALL OR BOTH HEMISPHERES
GENERALIZED SEIZURES
MC type of Benign Epilepsy Syndrome with Focal Seizures
- outgrown during adolescence
- focal seizure with buccal and throat tingling and tonic or clonic contractions of 1 side of the face, with drooling and inability to speak but with preserved consciousness and comprehension
Benign Epilepsy with Occipital Spikes
- Panayiotopoulos type
- Lennox-Gastaut type
TRIAD of West Syndrome
2-12 months (infancy stage)
Infantile epileptic spasms
Developmental regression
EEG - HYPSARRHYTHMIA
EEG in Benign Childhood Epilepsy with Centrotemporal Spike
broad based centrotemporal spikes
8 mo old boy
(+) truncal flexion (as if doing sit ups) multiple times throughout the day
lost of ability to sit w/o support which he was able to do a month ago
EEG - high voltage, slow, chaotic background w/ multifocal spike
West Syndrome
Later childhood (2-10 y/o)
complex partial seizure, visual auras, migraine headache
Lennox-Gastaut type
Triad of Lennox-Gastaut type
developmental delay
multiple seizure type
polyspike bursts in sleep and slow background in wakefulness
Early childhood
complex partial seizure with ictal vomiting
Panayiotopoulos type
AED for Focal seizures and Epilepsies
Oxcarbazepine
Carbamazepine
AED for Absence seizure
Ethosuximide
Lamotrigine
Valproic acid
AED for Juvenile Myoclonic Epilepsy
Valproate
Lamotrigine
AED for Lennox-Gastaut
Clobazam
Valproate
Topiramate
Lamotrigine
AED for Infantile Spasms
ACTH
AED for Dravet syndrome
Valproate + Benzodiazepine (Clobazam or Clonazepam)
AED for Benign Myoclonic Epilepsy
Valproate
Benzodiazepines
Clonazepam
Lamotrigine
Topiramate
AED for Severe Myoclonic Epilepsy
Topiramate
Clobazam
Valproate
Zonisamide
AED for Partial and Secondary Generalized Tonic and Clonic Seizures
Oxcarbazepine
Levetiracetam
Carbamazepine
Valproic acid
Phenobarbital Topiramate Lamotrigine Clobazam Clonazepam
generalized
< 15 minutes
no recurrence in the 1st 24
hours
absent focal signs in the
post-ictal period
Simple Febrile Seizure (70-75%)
MC seizure disorder during childhood
focal
> 15 minutes
recurrence in the 1st 24
hours
(+) focal signs in the
post-ictal period
Complex Febrile Seizure
Lumbar puncture should be performed in all patients below _______ for a first febrile seizure
18 mos (1 year and 6 mos)
When to do lumbar tap?
ALL infants <6 mo of age who present with fever and seizure or if the child is ill-appearing or at any age if there are clinical signs or symptoms of concer
Option in a child 6-12 mo of age who is deficient in Hib and Strep pneumoniae immunizations
Risk factors for recurrence of febrile seizures
MAJOR
<1 y/o
duration of fever < 24 hrs
fever 38 - 39 C
MINOR family hx of febrile seizures family hx of epilepsy complex febrile seizure daycare male gender lower serum sodium at time of presentation
In patients developing febrile status epilepticus, what viral infection is most commonly associated in 1/3 of the cases?
HHV 6 and HHV 7
Continuous seizure activity or recurrent seizure activity w/o regaining of consciousness > 5 minutes
STATUS EPILEPTICUS
Status epilepticus that has FAILED to RESPOND to therapy usually with at least 2 medications (benzodiazepine and another medication)
REFRACTORY STATUS EPILEPTICUS
Initial and Emergent therapy for Status Epilepticus
Diazepam or Lorazepam – in 3-5 mins anticipate for response
Phenytoin/Fosphenytoin and Phenobarbital - if after 5 minutes may recurrence pa din
Valproate and Levetiracetam - if wala pa din
Only drug that may be used for benign infantile seizures
Phenobarbital
Lumbar puncture indications for first febrile seizure
all patients <18 mos
(+) clinical signs of meningitis
Greatest risk factor for occurrence of subsequent
Neurodevelopmental abnormalities
1st step in management of status epilepticus
securing airway
breathing
circulation
Most commonly associated viral infections with febrile status epilepticus
HHV 6
HHV 7
ABSOLUTE contraindications to a lumbar puncture
signs of increased ICP
local infection at desired punctured site
radiological signs of obstructive hydrocephalus, cerebral edema or herniation, (+) intracranial lesion or midline shift
RELATIVE contraindications to a lumbar puncture
signs of shock, sepsis, hypotension
coagulation defects
focal neurologic defect
GCS <8
epileptic seizure
Recommended treatment for Neisseria meningitidis invasive infections in neonate
Cefotaxime
Most frequently identified symptom in meningococcemia
Fever
