-
medications that may induce epileptiform discharges
- buproprion
- cefepime
- clozapine
- lithium
- tramadol
-
febrile seizures in infant
- complex if:
- focal
- last >15 minutes
- recurrent within 24 hours
- febrile seizures occur 6 months - 5 years old
- rectal diazepam as needed for seizures lasting longer than 5 minutes
- does increase risk of subsequent epilepsy
- history of developmental delay increases the risk of future epilepsy
- >=4 febrile seizures is consistent with increased risk of development of epilepsy
-
carbamazepine
autoinduction of its own metabolism
-
status epilepticus
midazolam im superior to lorazepam im
-
contraception for women with epilepsy
- IUD is preferred
- enzyme inducing antiseizure medications induce the metabolism of estrogen and progestin; thus more likely failure of contraception
-
West syndrome
- infant
- epileptic spasms
- hypsarrhthmia on EEG
- developmental regression
- do a comparative genomic hybridization array
-
pyridoxine dependent epilepsy
serum alpha-aminoadipic semialdehyde level
-
syncope
- sudden loss of posture with jerking
- routine EEG normal
- loss of postural tone, fall, several seconds of multifocal proximal and distal arrhythmic jerks
- rapid return to full consciousness
- EEG - initial theta slowing, then generalized delta, then suppression before return to normal
-
primary generalized tonic-clonic seizures
- lamotrigine has efficacy
- gabapentin, carbamazepine, pregabalin, and oxcarbazepine lack efficacy
-
highest frequency of anxiety and/or psychosis disorder with epilepsy
left mesial temporal lobe focus
-
autoimmune encephalitides
- first line treatment
- corticosteroids
- IVIG
- plasma exchange
- second line treatment
- cyclophosphamide & rituximab for patients with NMDA receptor encephalitis
-
Rasmussen encephalitis
surgical hemispherotomy
-
definition of epilepsy
- recurrent unprovoked seizures at least 24 hours apart
- a single unprovoked seizure with an estimated >60% risk of recurrence
-
levetiracetam
binding of synaptic vesicle protein SV2A
-
sodium channel blockade is anti-seizure mechanism
- lamotrigine
- carbamazepine
- lacosamide
- oxcarbazepine
- phyentoin
-
depression in epilepsy
- 10-20% in patients with controlled seizures; higher in others
- SSRI (i.e. sertraline) are first line treatments; few interactions
- MAO inhibitors and serotonin-norepinephrine reuptake inhibitors are generally safe
- tricyclics not recommended due to side effects and interactions
- avoid buproprion
- ECT can be performed in patients with epilepsy
-
limbic encephalitis
- antibodies against the voltage gated potassium channel complex (LGI1 - leucine rich, glioma inactivated antibodies)
- faciobrachial dystonic seizures - brief tonic contractions of the face and arm and may alternate body sides
- occur early in limbic encephalitis
- seizures may be partial, complex, or generalized
- may occur with autonomic signs or hyponatremia (SIADH)
-
syncope induced by cough
EEG shows generalized slowing or suppression
-
corpus callosotomy
atonic seizure treatment
-
most frequent epilepsy related cause of death
- SUDEP - >20 times sudden death in general population
- MVA - elevated risk of 2 times population
-
delta brush EEG pattern
N-methyl-D-aspartate (NMDA) receptor antibody autoimmune encephalitis
-
risk of seizure recurrence with development, neurologic exam, MRI, EEG
- all factors normal - risk is 30-40%
- all factors abnormal - risk is 90%
-
infantile spasms in tuberous sclerosis
vigabatrin is used
-
seizure with sensation of laryngeal constriction, choking, clouded consciousness, 1-2 minutes, 1-3 times a week
most likely arise from insula
-
typical aura, dyscognitive features, orofacial and manual automatisms
mesial temporal seizure
-
visual phenomena
occipital seizure
-
somatosensory aura and wide variety of ictal manifestations
parietal seizure
-
asymmetric tonic posturing
supplementary sensory motor seizures
-
centrotemporal spike-and-slow-wave discharges on EEG; frontal dipole
- benign Rolandic epilepsy
- hemifacial and motor manifestations
- occur around sleep onset
- childhood
-
anterior dominant generalized 3 Hz spike and slow wave bursts
absence epilepsy
-
generalized 1.5 Hz - 2.5 Hz spike and polyspike & slow wave paroxysmal fast activity
Lennox-Gastaut syndrome
-
generalized paroxysmal 4 Hz to 6 Hz polyspike and slow wave bursts
juvenile myoclonic epilepsy
-
intermittent centroparietal theta rhythm
- Panayiotopoulus syndrome - a benign focal epilepsy of childhood
- seizures with prominent autonomic features
- prolonged seizures
-
Lennox-Gastaut syndrome continues to have frequent generalized seizures despite adequate trials of several appropriate medications & vagus nerve stimulator installed
ketogenic diet is next step
-
corpus callosotomy
atonic drop attack treatment
-
highest rate of major congenital malformations
- valproate
- 5-14%
- neural tube defects are the most common
- also - cardiac defects, clefts, hypospadias
- exposure to valproate during pregnancy also associated with decrease in IQ and autism
-
dexamethasone & phenytoin interaction
reduces serum phenytoin level
-
pediatric seizure at night
increases risk of recurrence
-
febrile seizure - risk of recurrence
- increased risk of recurrence
- young age
- low grade fever
- family history of febrile seizure
- focal seizure more than generalized
- seizure duration DOES NOT increase risk of recurrence
-
Dravet syndrome
- early infant seizures
- usually febrile
- hemiconvulsive at first
- development is normal until seizures start
-
progressive myoclonic epilepsy
- progressive decline
- myoclonic epilepsy
- ataxia often
-
a complications of long-term use of phenobarbital
- decreased bone density
- Dupuytren contractures
- plantar fibromatosis
- joint pain
- frozen shoulder
- also, sedation, mood changes, decreased concentration
-
carbamazepine or oxcarbazepine side effect
hyponatremia
-
gabapentin, pregabalin, valproate side effect
peripheral edema
-
valproate side effect
thrombocytopenia
-
valproate or topiramate
hyperammonemia
|
|
