Flashcards in NEURO - Epilepsy Deck (32)
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1
Define:
- ictus
- seizure
- epilepsy
•Ictus: Sudden neurological event
•Seizure: Abnormal, hypersynchronous neural activity
•Epilepsy: Tendency to repeated, spontaneous seizures
2
Common seizure types
- (3) generalised
- (2) focal
Generalised
•Generalised Tonic-Clonic (GTCS)
•Absence
•Myoclonus
Focal
•Dyscognitive
•Evolving to a bilateral, convulsive seizure (Secondarily generalised)
3
Discuss generalised tonic clonic seizure
- 2 phases
- duration
- injury
- post event
•Tonic phase: Arms down, Eyes open, Cry
•Clonic phase
•Apnoea: Cyanosis or plethora
•Last 1-5 minutes
•Minor injury common: Tongue biting
•Aftergoing confusion: Wake up in the ambulance or ED
4
Describe absence (generalised) seizure
- Px
- duration
- epidemiology
•Alteration of consciousness: Stay upright, No warning, Difficult to detect
•Facial twitch: 3Hz Blink, Oral myoclonias, Eyes often drift open
•Last 2-10 seconds
•Present in children or teenagers
5
Describe myoclonus (generalised) seizure
- Px
•Sudden, involuntary muscle twitch
•Not specific to seizure: Sleep myoclonus, Common in metabolic encephalopathy
•Myoclonic seizures: Action related, Appear as prodrome to GTCS
6
Describe focal seizures
- area of brain
- consciousness involvement
- Px depending on location
- duration
•Single area of brain
•Without alteration of consciousness
•Features depend on location
- Temporal – Smell, deja-vu
- Motor strip – Localised clonus
- Occipital – Visual hallucinations etc...
•Usually brief
7
Describe focal dyscognitive seizures
- area of brain
- consciousness involvement
- comparison to absence seizure
•Localised region
•Affects consciousness: Bilateral temporal lobes involved
•Similar to absence but…
- Longer
- Less distinct offset
- Automatisms
- Less frequent
- Preceding simple seizure
8
Describe childhood absence epilepsy (Petit Mal)
- onset
- seizure types
•Onset 4-8 years, up to 12
Seizure types
–Absence seizures: Frequent - many / day
–Generalized Tonic-Clonic Seizures: 40%, Adolescence
9
Describe juvenile absence epilepsy
- onset
- seizure types
•Onset: adolescence
•Seizure types
–Generalized Tonic-Clonic Seizures
–Absence seizures: infrequent, Absence Status
10
Describe juvenile myoclonic epilepsy (Janz)
- onset
- seizure types
- other associated features
- prognosis
•Onset 12 - 18 years
•Seizure types
–Myoclonus
–GTCS (general tonic clonic seizure)
–Absences in 30%
•Photosensitive
•Sleep-wake cycle
•May evolve from CAE
•Prognosis
–Not often refractory
–Spontaneous remission rare
11
Difference between seizure type & epilepsy syndrome
Seizure type:
- clinical characteristics (Seizure, pts)
- EEG features
Epilepsy syndrome:
- seizure types
- age
- clinical course
- interictal EEG
- MRI
12
(3) DDx of a seizure
•Syncope
•TIA
•Psychogenic pseudoseizure
13
Discuss syncope
- causes
- Px
•Cause: Insufficient cerebral blood flow
-Neurocardiogenic
-Orthostatic
-Cardiac
•Collapse and LOC
-Convulsion
-Urinary incontinence
14
Hx of a syncope
- before
- during
- after
Before:
- predisposition
- trigger
- pre-syncope (prodrome)
During:
- Px
- convulsion?
- other associated features to DDx causes of syncope/seizure
After:
- recovery
- confusion?
15
(5) Typical predispositions of syncope
•Dehydration
•Anti-hypertensives
•Prolonged standing
•Stressful situation
•Recent awakening
16
(4) Triggers of syncope
•Emotional
•Valsalva
•Pain
•Postural change
17
(3) pre-syncope Px (prodromes)
•“Dizziness”
•Feeling of distance
•Visual disturbance
–Silver flickers
–Greying of vision
18
(3) Predisposition & triggers of seizure
–Sleep deprivation
–Hang-over or abrupt abstinence
–Flicker
19
What (2) medications can induce seizures?
–Clozapine
–Tramadol
20
What should you ask in a syncope pt?
•Previous syncope and presyncope
•Recent medication changes
•Drugs
–Amphetamines
21
Features of psychogenic pseudoseizure
•Fluctuating intensity
•Very long
•Eyes closed: Pseudo-sleep
•Non-anatomical tremor
•Reactive
•Consciousness retained: Usually denied
22
Difference between epilepsy & seizure
Epilepsy is a disorder characterized by recurring seizures (also known as “seizure disorder”)
A seizure is a brief, temporary
disturbance in the electrical activity of the brain
23
Comment on ictal & interictal EEG
Ictal EEG:
•Almost always abnormal in seizure
•Perfect for pseudoseizure
Interictal EEG:
•Diagnostic test for epilepsy, not seizure
–Prognosis
–Epilepsy syndrome diagnosis
•Most abnormal patterns also seen in normals
–Normal patterns often interpreted as abnormal
24
Prognosis of single seizure presentation
- % recurrence at one year
- % recurrence long term
•Most recurrence early
•40% recur at one year
•Just over 50% long term
25
Can early treatment change prognosis in seizures?
–Better early seizure freedom if treated early
–BUT By five years outcome identical
26
Is not treating the first seizure dangerous?
No.
Only elevated due to underlying condition
Recurrent seizures not a big mortality risk
27
How do you diagnose epilepsy?
•History of minor seizures: Focal, Myoclonus
•Await recurrence
•Epileptiform EEG
•Epileptogenic MRI lesion
28
What should you educate the pt on with diagnosis of epilepsy?
Safety
•Swimming
•Heights
•Work
•Triggers: Alcohol, Sleep
Conditions on driving (Allowed after 6-12 months of seizure free)
29
Discuss the basics of treating epilepsy
Do not treat unless prolonged & recurrent.
Acute seizures
•Almost always self limiting
•Only need to treat acutely if;
–Prolonged
–Recurrent
•Seizure termination
–Benzodiazepines
•Acute prophylaxis
–Benzodiazepines
–Phenytoin (Levetiracetam, Valproate)
30
