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seizures - Coggle Diagram

- - - - serum bile acid study or resting serum NH4 concentration
  - - - advanced imaging of brain should be performed in all epileptic cats
- - - - facial muscle twitching
      - abnormal behavioural disorders
  - - - prolonged, regularly and repetitive myoclonic contractions
    - - sudden, brief, involuntary contractions of muscles or muscle groups
    - - sudden loss of muscle tone of a few seconds duration
    - - not necessarily associated with focal cerebrocortical disease
    - - sustained increased muscle contraction
- - - - transient hypoglycaemia
      - endocrine diseases
  - - - ataxia
      - Falling
      - rolling
    - - Sudden loss of consciousness with excitement
    - - cavalier king charles spaniel
      - soft coated wheaton terriers
    - - scottish and border terriers
        
        canine epileptoid cramping syndrome 'spikes disease'
        
        type of paraxosymal dyskinesia
        
        appears associated with GIT disease and signs suggestive of atopy
        
        differentiate from syncope and cataplexy/narcolepsy (sudden loss of muscle tone with normal consciousness)
        
        dogs with PD have normal/increased muscle tone during an episode
        
        triggered by exercise and excitement
        
        may respond to a hypoallergenic or gluten-free diet
        
        can do a blood test looking for anti-gliadin antibodies and transflutaminase-2 antibodies
- - - - purebred dogs with first onset 1-5yrs
  - - - younger animals are more prone to developmental and encephalitic diseases
      - older dogs >7 years age are more likely to develop intracranial neoplasia
    - - hydrocephalus
      - cortical dysplasia
      - lissencephaly
    - - extra-axial
        
        meningioma
        
        bone tumours
      - intra-axial
        
        glial tumours
        
        metastasis
      - intra-ventricular
        
        ependymoma
        
        choroid plexus tumours
    - - viral
      - bacterial
      - rickettsial
      - fungal
      - protozoal
      - parasitic
    - - granulomatous meningoencephalitis
      - necrotising meningoencephalitis
      - eosinophilic meningoencephalitis
      - meningoencephalitis of unknown origin
    - - lead
      - organophosphates
      - ethylene glycol
      - Reactive seizures (metabolic or toxic)
        
        occur as a natural response from the normal brain to a transient disturbance in function (metabolic or toxic)
        
        reversible when cause/disturbance is rectified
        
        Typical patient presentation
        
        any age
        
        abnormal neurological examination consistent with diffuse, bilateral and often symmetric forebrain involvement
        
        neurological signs may be preceded or accompanied by gastrointestinal, cardiovascular or respiratory signs
        
        significantly higher risk of developing status epilepticus as the first manifestation of a seizure disorder
        
        most frequent causes are intoxications and hypoglycaemia
    - - ischaemic
        
        thromboembolic
        
        idiopathic
        
        feline ischaemic encephalopathy
      - haemorrhagic
        
        hypertension related
        
        coagulopathy
    - - hepatic
      - renal
    - - hyponatraemia or hypernatraemia
      - hypocalcaemia
    - - hypoglycaemia
      - thiamine deficiency
    - - over 6m and over 6yrs of age
      - abnormal neurological examination in the interictal period (23% still have a normal neurological exam)
      - asymmetric (lateralising) deficits
      - metabolically normal
      - focal or generalised
  - - - prior head trauma in patients with normal imaging studies
      - post encephalitic seizures developing at a later date
  - - - 6 months to 6 years of age
      - normal in the interictal period
      - normal physical and neurological examinations
      - metabolically normal
      - the most common seizure type is generalised tonic-clonic
    - - Tier I
        
        history of 2+ unprovoked epileptic seizures at least 24h apart
        
        age at epileptic seizure onset 6m-6y
        
        unremarkable inter-ictal physical and neurological examination
        
        no significant abnormalities on minimum database blood tests and urinalysis (haematology and biochemistry)
        
        additional discretional laboratory parameters depending on the index of the disease
        
        e.g. fasting and post-prandial bile acids, fasted ammonia, total T4, free T4, thyroid-stimulating hormone when thyroid disorders are suspected and B12 levels
      - Tier II
        
        all factors in tier I
        
        unremarkable fasting and post prandial bile acids
        
        MRI of brain
        
        CSF analysis
      - Tier III
        
        factors listed in tier I and tier II
        
        identification of ictal or inter-ictal EEG abnormalities characteristic for seizure disorders
- - - - shown from molecular genetic studies or familial studies
- - - - prodrome
        
        period prior to onset of seizure activity
        
        owners often predict onset due to behaviour during this period
        
        increased anxiety-related behaviour
        
        attention seeking
        
        whining
        
        reluctance to perform normal activity patterns and increased hiding (esp. cats)
      - aura
        
        initial manifestation of seizure, lasts min-hours
        
        stereotypical sensory or motor behaviour e.g. pacing, licking
        
        autonomic patterns
        
        salivating, urinating, vomiting
        
        unusual psychiatric events
        
        excessive barking, increased/decreased attention seeking
      - Ictal
        
        actual seizure event
        
        involuntary muscle tone or movement
        
        abnormal sensations or behaviour, usually lasting seconds to minutes
      - Post ictal
        
        period after seizure, lasts minutes to days
        
        animal can exhibit...
        
        unusual behaviour
        
        disorientation
        
        inappropriate bowel +/- bladder activity
        
        excessive or depressed thirst and appetite
        
        neurological deficits
        
        weakness
        
        blindness
        
        motor disturbances
      - Status epilepticus
        
        continuous seizure activity lasting for 5 minutes or longer, repeated seizures with failure to return to normality within 30 mins
- - - - cerebral oedema of the temporal lobe
      - altered cerebral metabolism
- - - - CNII
    - - CNVII
    - - CNV