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Seizures lecture Flashcards

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1
Q

What is our normal neurobiology?

A

Electrical activity: non-synchronous

Neurons: can maintain resting potential, depolarise and repolarise

Ion channels/pumps: maintain gradient and have adequate energy to work

Neurotransmitters: balance between inhibitory (GABA) and excitatory (glutamate)

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2
Q

Neurobiology in seizures?

A

Cortical neurons are hypersynchronous

Develop paroxysmal depolarising shift: leading to increased firing rate and sustained NETWORK of firing

Spreading wave of electrical activity
Refractory period reduced
Loss of surrounding neuronal inhibition
Neurotransmitter imbalance may be found

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3
Q

Summary of neurobiology in seizures

A

Initial trigger = high frequency action potential and hyperpolarisation

Often seen in astrocytes with calcium signalling

Leading to a NETWORK ISSUE (‘epileptic aggregate’)

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4
Q

Clinical definition of seizure

A

Transient occurrence of signs/symptoms associated with abnormal excessive/synchronous neuronal activity in the brain

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5
Q

ILAE 2014 epilepsy definition

A
  1. at least 2 unprovoked seizures more than 24 hours apart
  2. 1 unprovoked seizure with probability of further seizure is more than 60% occurring in the next 10 years
  3. diagnosis of epilepsy syndrome
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6
Q

Day to day epilepsy definition

A

At least one unprovoked seizure with high risk of another

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7
Q

Resolved epilepsy

A
  1. age-dependent epilepsy syndrome - now past applicable age

2. seizure free for 10 years and off anti-seizure meds for 5 years

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8
Q

How are seizures classified?

A

1/ generalised
2/ focal
3/ unknown

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9
Q

What is a generalised seizure?

A

rapid onset
bilateral
loss of consciousness
convulsive/non convulsive (brainz monitoring if LOC and non-convulsive)

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10
Q

Examples of generalised seizure

A 
Tonic/clonic
Absence (typical/atypical/with myoclonic changes)
Clonic
Tonic
Atonic
Myoclonic
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11
Q

What is a focal seizure?

A 
onset in 1 hemisphere
often involves: aura/MOTOR/autonomic sx
awareness: retained/altered
often progresses to both hemispheres:
BILATERAL CONVULSIVE SEIZURE
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12
Q

What is an irritative lesion? Where would they look?

A

Epilepsy/minor stroke

look AWAY from focus

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13
Q

What is a destructive lesion? Where would they look?

A

Massive MCA infarct

look TOWARDS the focus

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14
Q

How are absence seizures caused? (most of time)

A

hyperventilating (decreased calcium ions)

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15
Q

What are the causes of a seizure?

A 
PROVOKED:
fever
toxin/drug/withdrawal
metabolic
catamenial
reflex epilepsys

ACQUIRED:
trauma
stroke
tumour
infection
autoimmune
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16
Q

What are the causes of epilepsy?

A

GENETIC
abnormal syndromes
channelopathies
GLUT1 deficiency

STRUCTURAL/METABOLIC
tuberous sclerosis (neurocutaneous disorder)
epilepsy syndrome
structural development disorders

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17
Q

What is a febrile convulsion?

A

Short generalised seizure with increase in temperature in children (6months - 6 years)
Rapid recovery

Treat:
gently cool
refer if first
refer if no source of infection found

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18
Q

What is reflex anoxic seizure?

A

Noxious stimuli -> reflex cardiac standstill and seizure in children (under 2)

cyanosis
pallor
tonic clonic
downbent nystagmus

BENIGN
short latency from stimuli (differentiate between vasovagal)

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19
Q

What is eclampsia?

A

life threatening condition in pregnancy
confusion, headache, tremour -> gen tonic clonic

primips
young women

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20
Q

What conditions predispose to eclampsia?

Study These Flashcards
A

pre-eclampsia (proteinuria, hypertension)

HELLP

21
Q

How do you treat eclampsia?

Study These Flashcards
A 
oxygen
magnesium sulphate (4g IV)
manage BP with labetalol or hydralazine
deliver baba
treat complications
22
Q

Management of post traumatic seizure?

Study These Flashcards
A

CT within 1 hour

hypoxic - ischaemia: myoclonic or focal and altered GCS

23
Q

Definition of post traumatic epilepsy

Study These Flashcards
A

One or more unprovoked seizure 7 days after TBI with no other cause

24
Q

Predictions of PTE

Study These Flashcards
A

skull fracture
severity of injury
haemorrhage
contusion FL>PL>TL

25
Emergency management of seizure in trauma
Help ABC (adjuncts?) COMA C-spine Oxygen Monitoring Access (IV)
26
Med ladder in emergency management of seizure
``` Oxygen Benzos (max 2x dose) Phenytoin Phenobarbitone/thiopentone GA (propofol/thiopentinol) ITU for neuromonitoring ```
27
What is the dose of lorazepam?
2-4 mg IV bolus | 0.1mg/kg
28
What is the dose of diazepam?
5-10mg PR | 0.25mg/kg IV or 0.5mg/kg PR
29
What is the dose of midazolam?
1-2mg bolus iv | 0.5mg/kg buccal
30
What is the dose of phenytoin?
1g IV slow over 30 mins ECG monitoring (cause arrhythmias) 18mg/kg IV
31
What is the dose of phenobarbitone/thiopentone?
4mg/kg
32
What else do you need to think about giving in seizure?
glucose (0.5mg/kg IV) thiamine recatal paraldehyde (children) DVLA post seizure
33
Prophylaxis of seizure post head trauma?
phenytoin levetiracetam (topiramate)
34
What should you avoid giving in absence seizures?
carbamazapine
35
What can you do whilst wait for CT head in TBI?
1. optimal neuroprotection 2. bleeding status (meds/clotting) 3. prepare for theatre
36
How can you optimise neuroprotection?
``` loosen c-spine immobilisation hyperosmotic fluids (mannitol/HTS) head up tilt 30 degs sedation? control CO2 (normal to low) control O2 (avoid hypoxia and hyperoxia) glucose and temp control ensure have BP ```
37
What is an ICP bolt?
intracranial device screwed into brain with small port into part of brain with limited function directly measures ICP -> continual assessment (CPP=MAP-ICP)
38
What are the indications for ICP bolt?
1. GCS <8 and abnorm CT 2. GCS <8, norm CT but 2 of: - age >40 - BP <90 - abnorm posturing
39
What is an external ventricular drain?
temporary diversion of CSF due to: - obstruction of csf flow - failure of csf absorption (sah) - overproduction of csf (rare) intraventricular meds often seen in diffuse injuries to avoid surgery and decrease icp
40
pros of EVD?
monitor ICP | decrease ICP
41
cons of EVD?
operative risk risk of infection difficult if ventricles displaced or small if decompress ventricles could lead to expansion of haematoma not difinitive
42
When can you do burr holes?
frontal suboccipital parietal temporal bones
43
What are the pros of burr holes?
buys time - temporarily relieves pressure
44
what are the cons of burr holes?
unlikely benefit to acute bleed (sticky wont come out) operative risk delay definitive treatment
45
indications for surgery in EDH
>30cm3 (regardless of GCS) | GCS <9 and anisocoria (unequal pupils)
46
indications for conservative management of EDH
``` vol <30cm3 thickness <15mm midline shift <5mm GCS >8 No focal neuro deficit ```
47
indications for surgery in acute SDH
``` thickness >10mm and MLS >5mm regardless of GCS if thickness if <10mm and MLS <5mm but: - GCS drops by 2 - pupils fixed and dilated or anisocoria - ICP more than 20 ```
48
What is status epilepticus?
Seizure lasting 30 mins or more or cluster of shorter seizures without intervening and recovery continues for 30 mins or more
49
what can prolonged seizures cause?
mesial temporal sclerosis (temporal lobe seizures) - CA1 and subiculum seizures beget seizures (kindling) - seizures induce more seizures? risk of death

Seizures (1 decks)

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