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Flashcards in Seizuring patient - SA/LA Deck (43):
1

Define seizure

electrical imbalance between excitation and inhibition, they have a certain rhythmicity

2

How can seizures be classified by CS?

FOCAL: when people appear absent
GENERALISED: tonic, clonic,
* don't use the petit-mal and grand-mal seizure

3

Describe focal seizures

SIMPLE FOCAL: no loss of consciousness
COMPLEX FOCAL: impairment of consciousness
FOCAL SEIZURE WITH SECONDARY GENERALISATION

4

2 types of generalised seizures

Convulsive or non-convulsive

5

Define status epilepticus

- prolonged seizure activity
- >/ 5 mins (clinical)
- >/ 30 mins (basic science) --> brain damage
- life-threatening emergency always

6

Describe cluster seizures

>/ 2 seizures in a 24 hour period, very serious!

7

Name 4 classifications of seizures

- prodrome
- aura
- ictus
- post-ictal

8

Define prodrome

behaviour changes that occur hours or days before the seizure

9

Define aura

sensory/ focal onset seizures may start with a sensory experience such as a perceived smell or a feeling of deja vu. The existence of aura in animals is difficult to prove but owners often report a behavior change of their dog minutes before the ictus.

10

What is ictus?

the seizure event itsel

11

What is post-ictus?

neurological status alternations hours or days after the seizure

12

How can seizures be classified over time?

- self-limiting
- clustered or continuous (status epilepticus)
- reflexive

13

Describe a self-limiting seizure

= focal or generalised types

14

Describe a clustered or continuous (status epilepticus) seizure

= focal or generalised types

15

What causes a reflexive seizure?

a precipitating stimuli

16

Classic - CS - feline seizure

- lip smacking
- hypersalivation
- yowling (consider feline dementia as alternative ddx in older cats with this CS).

17

Name 5 events that can mimic seizures.

- syncope
- narcolepsy
- pain
- vestibular syndrome
- movement disorders (e.g. Scotty Cramp)

18

Outline syncope

- partial or complete loss of consciousnesss
- lack of motor activity
- no post-ictal signs
- shorter in duration
* can mimic seizures

19

What is narcolepsy?

= sleeping disorder, very rare
- stimulated often by excited, food, drugs
* can mimic seizures

20

Outline different breeds and movement disorders

- scotty cramp
- CKCS - episodes of tetany, hypertonicity, deer-stalking
- Norwich terriers
- Boxers - paroxysmal dystonic choreathetosis
- Bichon frises - similar to boxers

21

Classic signs of seizures

- typically last 1 minute
- exhibit several stages
- often, but not always, occur at rest or out of sleep
- clonic movemetns (rhythmic mm contractions are common in both partial and generalised seizures)
- most recurrent seizures respond at least in part to AEDs

22

What is an EEG?

= electroencephalogram, easures the electrical activity of the brain

23

T/F: a seizure can happen without pathology

True

24

How can seizures be classified by aetiology?

- SYMPTOMATIC or SECONDARY: structural brain lesion
- REACTIVE SEIZURE: metabolic or toxic cause
- IDIOPATHIC or PRIMARY EPILEPSY: suspected genetic cause
- POSSIBLE SYMPTOMATIC or CRYPTOGENIC SEIZURE: rule out only via PME

25

What is a cryptogenic seizure?

one of obscure or uncertain origin

26

How can seizures be classified by location?

INTRA-CRANIAL: functional (idiopathic epilepsy) or structural (symptomatic epilepsy, possible symptomatic epilepsy)
EXTRA-CRANIAL: Intrinsic (metabolic - reactive seizure) or extrinsic (toxic - reactive seizures)

27

3 categories of extracranial epilepsy

- electrolyte imbalances
- energy deprivation
- organ dysfunction

28

Give examples of electrolyte imbalances causing extracranial epilepsy

hypernatraemia, hyponatraemia, hypocalcaemia

29

2 examples of energy deprivation extra-cranial seizures

thiamine deficiency and hypoglycaemia

30

2 examples of organ dysfunction extracranial epilepsy

- uraemic encephalopathy
- HE

31

Outline species and idiopathic epilepsy

DOG: 6 months to 6 years
CAT
GENERALISED SEIZURES: various breeds, e.g GSD
PARTIAL SEIZURES with/without 2nd generalisation: springer spaniels

32

Outline epilepsy in horses (signalment)

- Arab foals - congenital, grow out of it
- Foal with PAS (neonatal maladjustment syndrome)
- Adults (due to structural or metabolic brain disease, migrating parasite, previous trauma etc, intracarotid injection!)

33

Ddx (ordered) - seizures in animals

- Metabolic (PSS, hypoglycaemia)
- Infectious diseases
- Congenital
- (toxic, trauma)

34

Ddx (ordered) - seizures in animals 6 months - 6 years

- Idiopathic epilepsy
- Inflammatory/ infectious
- Metabolic
- (neoplasia, toxic, trauma)

35

Ddx (ordered) - seizures in animals > 6 years

- Neoplasia
- Idiopathic epilepsy (late-onset)
- Inflammatory/ infectious
- (metabolic)
- (toxic, trauma)

36

Describe disease progression of metabolic seizures

waxing and waning

37

Ddx - inter-ictal exam findings, normal

- Idiopathic epilepsy
- metabolic (wax and wane phenomenon)
- Neoplasia (silent area of brain, early in disease)
- (toxic)

38

Ddx - inter-ictal exam findings, abnormal, symmetrical

- Metabolic
- Toxic
- Hydrocephalus
- Degenerative
- (midline structural disease)

39

Ddx - inter-ictal exam findings, abnormal, Asymmetrical

- Neoplasia
- Inflammatory/ infectious
- anomalies

40

Ddx = lateralising seizures, symmetrical, generalised onset

- idiopathic epilepsy
- metabolic
- toxic
- degenerative
- hydrocephalus
- trauma
- midline structural problems (pituitary tumour)

41

Ddx = lateralising seizures, Asymmetrical, FOCAL onset

- inflammatory/ infectious
- neoplasia
- anomalies
- trauma
- cryptogenic and idiopathic

42

What is the minimum database for extracranial causes of seizures?

- CBC and cytology
- Biochem
- Ammonia (if indicated)
- resting bile acids (in small animals, dynamic bile acid test)
- UA (uncommon in horses)
- BP in mature small animals (especially cats - cardiac work up)
- Further diagnostics depending on signalment/ hx and PE

43

Diagnostics - intracranial causes of seizures

- Imaging - brain - MRI and CT
- CLINICAL PATHOLOGY:
- CSF (wbc, differential cell count, protein content)
- POSITIVE brain imaging or inflammatory CSF for infectious agents