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Flashcards in Neurology Deck (23)
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1
Q

What are the features of generalised seizures?

A
Onset in both hemispheres 
Loss of conciousness
No warning 
Symmetrical seizure 
Bilaterally synchronous seizure discharge on EEG or varying asymmetry
2
Q

What are the features of absence seizures?

A

Transient loss of conciousness
Abrupt onset and termination
Unaccompanied by motor phenomena- except for flickering of the eyelids and minor alteration in muscle tone
Can by typical (petit mal) or precipitated by hyperventilation

3
Q

What are the features of myoclonic seizures?

A

Brief, often repetitive jerking movements of the limbs, neck or trunk
Myoclonic movements are seen in hiccoughs (myoclonus of the diaphragm) or passing through stage II sleep

4
Q

What are tonic seizures?

A

Generalised increase in tone

5
Q

What are the features of tonic-clonic seizures?

A

Rhythmical contraction of muscle groups following the tonic phase
In rigid tonic phase, children may fall
They don’t breathe and become cyanosed
Followed by the clonic phase, jerking of the limbs
Breathing is irregular and cyanosis persists
Saliva may accumulate in mouth
May be biting of the tongue and incontinence of urine
Seizure lasts a few seconds to minutes- followed by unconsciousness or deep sleep for up to several hours

6
Q

What are the features of atonic seizures?

A

Often combined with a myoclonic jerk, followed by a transient loss of muscle tone causing a sudden fall to the floor or drop of the head

7
Q

What are the features of focal seizures?

A

May have aura which reflects site of origin

May be associated with change in consciousness or more generalised tonic-clonic seizure

8
Q

What are the features of different focal seizures in different parts of the brain?

A

Frontal- motor phenomena
Temporal- auditory or sensory (smell or taste)
Occipital- positive or negative visual phenomena
Parietal lobe seizures- contralateral altered sensation (dysaethesia)

9
Q

What is status epilepticus?

A

Can be convulsive with tonic/clonic movements or it can be non-convulsive with impairment of consciousness and often subtle twitching
Seizure lasting >30 mins or repeated seizures lasting >30 mins without recovery of consciousness

10
Q

Which syndromes are associated with epilepsy?

A

o West syndrome (4-6 months)
o Lennox-Gastaut syndrome (1-3 years)
o Childhood absence epilepsy (4-12 years)
o Benign epilepsy
o Early onset benign childhood occipital epilepsy
o Juvenile myoclonic epilepsy

11
Q

What are the features of West syndrome?

A

4-6 months
EEG shows hypsarrhythmia (chaotic background of slow wave activity with sharp multi-focal components). Pattern of seizure is violent flexor spasms of the head, trunk and limbs followed by extension of the arms. Spasms occur for 1-2 seconds and repeat 20-30 times

12
Q

What are the features of Lennox-gastaut?

A

1-3 years

Most drop attacks, tonic seizures and atypical absences

13
Q

What are the features of childhood absence?

A

4-12 years

EEG shows 3/second spike and wave discharge which is bilaterally synchronous

14
Q

What are the features of benign epilepsy?

A

Tonic-clonic seizures in sleep or simple focal seizures with awareness of abnormal feelings. EEG shows focal sharp waves from the Rolandic area

15
Q

What are the features of early onset benign childhood occipital epilepsy?

A

Periods of unresponsiveness in young children and hallucinations/visual disturbance in older children. EEG shows occipital discharges

16
Q

What are the features of juvenile myoclonic epilepsy?

A

Myoclonic seizures but generalised tonic-clonic or absences may also occur, mostly shortly after waking. There is a characteristic EEG.

17
Q

When is an EEG indicated?

A

Whenever epilepsy is suspected- it can identify a background level of activity that is
abnormal for the child’s age
o Asymmetry or slowing that might suggest underlying structural abnormalities
o Evidence of neuronal hyperexcitability eg. sharp waves or spike-wave complexes
• Many children with epilepsy have a normal initial EEG and many children without epilepsy have abnormal EEGs
• Unless a seizure is actually captured- an EEG does no more than add supportive evidence to the diagnosis
• NB – if the standard EEG is normal, a sleep or sleep-deprived record can be helpful

18
Q

What is the structural imaging for seizures?

A

o MRI & CT scans are not required routinely for childhood generalised epilepsies
o They are indicated if there are neurological signs between seizures, or if seizures are focal
o They are used to identify a tumour, vascular lesion or area of sclerosis which could be treatable
o MRI FLAIR sequences better detect mesial temporal sclerosis in temporal lobe epilepsy

19
Q

What are the functional scans for epilepsy?

A

o Detects area of abnormal metabolism suggestive of seizure foci
o These include PET and SPECT scanning- which use isotopes & ligands taken upy my metabolically active cells
o Both can be used between seizures to detect areas of hypometabolism in epileptogenic lesions

20
Q

What are the investigations for seizures?

A

EEG- first line
Imaging- MRI and CT if structural abnormality or symptoms between seizures
Metabolic inv- warranted when there is developmental regression or seizures related to feeding or fasting
Genetic studies- Genetic deletions causing abnormalities of sodium and other ion channel- SCN1A mutation in severe myoclonic epilepsy

21
Q

What is important to consider with management of seizures?

A

Monotherapy at the minimum dose is desired
Drug levels aren’t measured routinely
AED can be discontinued after 2 seizure free years
Children with prolonged seizures are given rescue therapy (usually rectal or buccal diazepam)

22
Q

What are the medications used for the different types of seizures?

A

Tonic-clonic: valproate, carbamazepine (2nd lamotrigine, topiramate)
Absence: valproate, ethosuximide (2nd lamotrigine)
Myoclonic: valproate (2nd lamotrigine)
Focal: Carbamazepine, valproate, lamotrigine (most effective).
(2nd topiramate, levetiracetam, oxcarbazepine, gabapentin, tiagabine, vigabatrin)

23
Q

What are other treatment options in seizures?

A

o Ketogenic- diets may be helpful in some children
o Vagal nerve stimulation- delivered using an external programmable wire or magnet
o Surgery- if well localised with useful EEG and MRI findings, but involves removal of sections of brain