Seizure Disorders Flashcards
(36 cards)
Seizures: (Gradual or Sudden?) , ______________ of cerebral neurons, which produces an involuntary and _____________ alteration or behaviour or function. (The term refers to the whole range of paroxysmal events that follow the abnormal discharge).
Synonyms: ______________, ______________, Fits.
Sudden; abnormal discharge
time limited
Convulsion ; Epilepsy
Convulsion: __________ that include __________ phenomena (__________, __________, __________).
Epilepsy: __________ __________.
Seizures ; motor
Recurrent seizures.
Status epilepticus: repeated ____________ __________ without a __________ interval OR __________ that last longer than __________.
tonic-clonic seizures
lucid
tonic- clonic seizures
30 minutes.
Pathophysiology
Excitatory neuro- transmitters
List 3
Inhibitory neuro- transmitters
List 1
Glutamate
Acetyl-choline
5-hydroxytryptamine (5HT)
Gamma-amino butyric acid (GABA)
AETIOLOGY 1
________
CNS ________
________ diseases
Head ________
Brain ________
High ________
Idiopathic
CNS Infections
Cerebro-vascular diseases Head injury
Brain Tumours
High fever
AETIOLOGY of seizures
Neuro-cutaneous syndromes
_____________
Neurofibromatosis
_____________ syndrome
Cerebral _____________
Nutritional disorders
_____________ deficiency
Poisonings
_____________
Drugs (phenothiazines, _____________)
Tuberous sclerosis ; Sturge-Webber’s
malformations ; Pyridoxine deficiency
Lead; amphetamines
AETIOLOGY 3
Metabolic
___________, ___________ , hypomagnesaemia,
inborn errors of metabolism (e.g. ________)
Atrophic brain lesions
Post-anoxic, -traumatic, -infectious
Degenerative brain diseases
___________, ___________, gangliosidoses etc
Hypoglycaemia, hypocalcaemia,
PKU
Tay-Sachs, Neiman-Pick
CLASSIFICATION (ILAE) 1
PARTIAL
Simple partial with
_________ signs (_________)
_________ signs (_________ seizures)
_________ signs (_________ epilepsy)
Complex partial (_________ epilepsy)
Partial with _________ _________
motor signs ; Jacksonian
sensory ; sensory
autonomic ; abdominal
Temporal lobe ; secondary generalisation
CLASSIFICATION (ILAE) 2
GENERALISED
__________
Typical (__________ epilepsy)
Atypical (Lennox-Gastaut syndrome)
__________ (__________)
__________ (__________ attacks)
__________
__________
__________ (__________ epilepsy)
UNCLASSIFIED
__________ seizures, __________ __________.
Absence
Typical (Petit Mal epilepsy)
Myoclonic (myoclonic jerks)
Atonic (drop attacks)
Tonic
Clonic
Toni-Clonic (Grand Mal epilepsy)
Neonatal seizures, Infantile spasms.
PRESENTATION
________ (commoner with ________ seizures)
Seizure type
________ (faecal or urinary)
________ ________
Paralysis (Todd’s)
________ between seizures
Aura ; partial
Incontinence ; Post-ictal sleep
Loss of consciousness
NEONATAL SEIZURES
Seizures occurring in the ___________________
Aetiology: A cause can be found in up 70% of cases and include:
_______________ (60%)
_______________ (20%)
_______________, _______________, _______________ (20%)
Intracranial _______________ (15%)
Drug withdrawal
first 28 days of life.
Hypoxic-ischaemic encephalopathy (60%) Infection (20%)
Hypoglycaemia, hypocalcaemia, hypomagnesaemia (20%)
Intracranial haemorrhage (15%)
Clinical features of neonatal seizures (mainly _______)
__________ repeatedly
__________ movements of the mouth
__________ attacks
Jitteriness and tremulousness
Blinking
Chewing
Apnoeic
Investigations of neonatal seizures
Sepsis screen (______ , ______ + Triple tap [ ______,_____ ,______] culture)
E/U + Glucose, Ca and PO4
Neuro-imaging (________ and ________)
FBC ; ESR ; blood, CSF, Urinary bladder
EEG ; transfontanelle USS)
Treatment of neonatal seizures
______ ______ (3-5 mg/kg/D)
______ ______ if seizures are refractory.
Prognosis of neonatal seizures
50% will ______
20% will ______
30% will have ____________________ (mental retardation, cerebral palsy, epilepsy)
Oral phenobarbitone
IM pyridoxine
resolve ; die
residual neurological deficit
FEBRILE CONVULSION
Definition
____________ seizures following a (gradual or rapid?) _______________
Generalised tonic-clonic
rise in body temperature.
Febrile convulsions
Clinical and Diagnostic criteria
_________ up to _________
Fever at time of seizure > ____oC
Seizures < _________
No _________
No _________ in between seizures
There is a positive family history in 60 – 70% of children.
3 months ; 6 years
38oC ; 15 minutes
CNS infection ; neurological abnormality in between seizures
Aetiology of febrile convulsions
Aetiology
__________
__________
Tonsillitis
__________
UTI
__________ etc
Investigations
FBC, ESR, MP Lumbar Puncture
Malaria
Otitis media
Pneumonia
Septicaemia etc
Treatment of febrile convulsions
Principles involve the:
________ of seizures and appropriate management of childhood ________
treatment of the underlying cause
prevention of febrile convulsions. Drug of choice is ___________ 0.2 – 0.5 mg/kg/D 12 hourly from the onset of fever until it subsides.
control ; fevers
diazepam
Risk factors for recurrence of febrile convulsions
Age < __________
_________ in first degree relatives
_________ in first degree relatives
One or more _________ in the first convulsion
Many subsequent febrile episodes
_______ factors 80-100% recurrence
_____ factor 25%
_____ factor 12%
Prognosis
2 –7% will progress to __________
15 months; Epilepsy
Febrile convulsion ; complex features
3 – 5 ; factor; No factor
epilepsy
INFANTILE SPASMS
Definition
____________________ spasms characteristically occurring in _________. Syn. West’s syndrome, Salaam attacks etc.
Classified into ___________ and __________ (18% associated with neonatal ______________).
Mixed flexor-extensor
series
Idiopathic; symptomatic
Clinical features of infantile spasms
Age __________ – __________
Typically there is sudden __________ of the __________ and __________ with __________ and __________ of the __________ + __________ and __________. This is followed by relaxation. It occurs repeatedly.
_____________________ is common as there is underlying structural or metabolic abnormalities.
8 months – 2 years
flexion; head ; trunk
flexion ; adduction ; arms
cry ; loss of awareness.
Regression of milestones
Investigations of infantile spasms
_______ which shows _________ pattern.
Treatment
Control of seizures with _________ or _________ (for _________) or nitrazepam.
Prevention aims at preventing _________, encouraging _________ and the prompt treatment of _________.
EEG ; hypsarrythmia
ACTH ; prednisolone ;4 weeks
intrauterine malnutrition
early feeding ; neonatal hypoglycaemia.
Prognosis of infantile spasms
Normal mentality in 12–25% of those with symptomatic IS and up to 44% in those with idiopathic IS.
Other seizures present in up to ______% even after the IS type seizures have resolved.
60%
ABSENCE seizures
Definition
________ seizures characterised by ___________.
Clinical features
Age 5 – 15 years
(Boys or Girls?) more affected than (boys or girls ?) 2:1
Repeated episodes of _________ or _________
Generalised
poor school performance.
Girls ; boys
staring blankly ; day dreaming.
