Seizures

Question 1

Definition of Seizure

Answer 1

A seizure refers to a sudden, abnormal electrical activity in the brain that causes temporary changes in behavior, sensation, or consciousness.

Question 2

Types of Seizure

Answer 2

1) Generalized Seizures: These seizures involve both hemispheres of the brain and typically result in loss of consciousness.
Subtypes include:
a.( Non-motor) Absence Seizures: Brief episodes of staring and temporary loss of awareness.
b. Tonic-Clonic Seizures(Motor): Characterized by stiffening (tonic phase) followed by jerking movements (clonic phase).
c. Myoclonic Seizures(Motor): Sudden, brief muscle jerks.
d. Atonic Seizures(Motor): Loss of muscle tone, causing falls or head drops.

2) Focal (Partial) Seizures: These seizures originate in a specific area of the brain and may or may not involve loss of consciousness.
Subtypes include:
a. Simple Focal Seizures: Involving preserved awareness.
b. Complex Focal Seizures: Associated with altered consciousness or confusion.(post-inctal phase)

*Todd’s Paralysis: Occurs after focal motor seizures:
Temporal Pralysis of affected extremity. Lasts average 15 hrs and subsides adter 2 days

*Different from primary generalized seizure= Focal seizure:
History of aura
Unilateral Shaking
Turning of head to one side
Todd’s Paralysis

Pediatrics

1) Febrile Seizure
Ages btw 6months to 6 years. Peaks at 18 months.
Often follows a resp. tract infection (Roseola)

2_ Other syndromes in children:
i)Lennox- Gastaut syndrome : Developmental delay, multiple seizure types, EEG slow spike waves (1.5-2,5 Hz)
ii) Juvenile myoclonic epilepsy (Myoclonic seizures upon awaking in adolescents
iii) Landau-Kleffner syndrome : Disturbance in language development epilepsy.

3) Infantile Spasms
Bilateral, symmetrical limb and trunk spasms that occur when infant wakes up. Maintains normal level of cosciousness
Treatment : ACTH
Can be the first symptom of tuberous sclerosis.
Diagnosis= Wood’s Lamp= Hypopigmented macules
Treatment= Vigabatrin

4) West syndrome:
Infantile spasms
Developmental delay
Hyppsarrythmia

Question 3

Causes of Seizure ( VITAMINS MNEMONIC)

Answer 3

1) Vascular= Iscemic or hemorrhagic stroke
2) Infection= Meningitis, Encephalitis, brain abscess
3) Trauma/Toxins(cocaine,alcohol withdrawal, isoniazid, Buproprion)
4) Autoimmune= CNS Vasculitis, SLE
5) Metabolic= Electrolyte imbalances
6) Idiopathic
7) Neoplasm
8) Syncope/Psychogenic seizures

Question 4

Symptoms of Seizure

Answer 4

Loss of consciousness or altered awareness.

Muscle convulsions, jerking, or twitching.

Staring spells or temporary unresponsiveness.

Sensations of tingling, numbness, or unusual smells/tastes.

Confusion, disorientation, or memory loss.

Question 5

Diagnosis of Seizure

Answer 5

Medical History: Gathering information about the frequency, duration, and nature of the seizures.

Liver function tests

CBC,Electrolytes, glucose levels

Lumbar puncture : If meningitis is suspected

Toxicology screen.

CT, MRI

If no identifiable cause is found perform EEG :
3Hz spike+ wave pattern= Abscence seizures
Negative EEG does not exclude the diagnosis of epilepsy

Question 6

Treatment of Seizure

Answer 6

Antiepileptic medications: Depending of seizure, convenience, side effects

For generalized seizures:
Levetiracetam
Valproate
Lamotrigine
Topiramate

For focal seizure:
Carbamazepine
Phenytoin
Lamotrigine

For abscence seizures: Ethosuximide
(If +tonic-clonic seizures= Valproate)

Question 7

Complications of Seizure

Answer 7

Injury: Falls, head injuries, or accidents during a seizure.

Status Epilepticus: Prolonged or continuous seizures, which can be a medical emergency.

Emotional and Psychological Impact: Anxiety, depression, or social stigma related to seizures.

Medication Side Effects: Some anti-seizure medications can cause side effects such as drowsiness, dizziness, or cognitive difficulties.