Thread by @DrSherani432

1) Absence Seizures::
Age 5 years to 10 years, history of febrile seizures in only significant.

Simple TAS:
Sudden onset of impaired Consciousness with blank facial stare without other motor, behavioral phenomenon.
Complex TAS:
Accompanied by motor, behavioral or Autonomic

2) phenomenon.
Clonic... May be subtle, like eye-blinking, Nystagmus, jerk of arms.
Tone... Extension or flexion of trunk in case of contractions(increase tone) , head nodding or dropping objects in case decrease Tone.
Automatism... Rubbing face or hand, licking lip, chewing,

3) grimacing, scratching.
Autonomic...Pallor, Flushing, salivation, sweating.

Atypical Absences::
Less abrupt onset or cessation, more changes in tone, long duration than TAS, associated with other seizures types & mental Retardation, usually begin before age 5 years,

4) heterogeneous ictal and inter-ictal changes.

EEG FEATURES::
TAS::
Sudden onset 3-Hz Generalized Symmetrical spike or multiple spike & slow wave complexes, maximum voltage in fronto-central region, Frequency fast (4 Hz) at onset and slow (2 Hz) at the end.Inter-Ictal EEG

5) background normal in TAS.

AAS::
Variable changes, Irregular, Asymmetrical spikes, frequency from 1.5 Hz to 2.5 Hz. Inter-ictal EEG background is abnormal.

Precipitants::
Hyperventilation(most strongly) , Hypoglycemia, photic stimulation activate TAS.

Etiology::
Genetic

6) factors in TAS, who match IGE.
Acquired factors in retarded, AAS, abnormal neurology exam, or abnormal Inter-ictal EEG.
Recently Thalamo-Cortical circuit, T-type Calcium channels, and GABAergic(GABARB-2 + GABRG2).
Treatment::
1st line... VPA, ESM, LTM
2nd line...

7) Zonisamide, Topiramate.
Clonazepam... Resistant Cases
Combination of VPA + ESM is much effective than alone.

Prognosis::
Average age of cessation is 10 years, TAS 80% remission rate, some continue to have seizures beyond puberty.

Differential Diagnosis::

Absence::

8) Frequency multiple, Duration less than 10 seconds, eye-blinking + automatism common, NO aura, NO post-Ictal impairment, Precipitants are Photic Stimulation and HV.
EEG... Ictal (GSWD) Inter-ictal normal

1:Complex Partial Seizures::
Less frequent, long duration(1 minute, 10

9) seconds) , frequent aura, Importantly Post-Ictal impairment + Pre-Aura strongly suggestive, Rarely precipitated by Photic stimulation and HV, EEG findings localizes to Frontal + Temporal lobes.

2:DayDreaming::
Multiple, situation dependent, No(aura, eye blink, automatism,

10) post-ictal impairment, activation by Photic stimulus or HV), Normal EEG.

3:Tics & Pseudo Seizures::
May need to be considered as well, however Normal EEG and Failure of Seizures by 3 to 5 minutes Hyperventilation.

11) #Neurology #neurologyresident #neurologist #MedTwitter #Exam #epilepsy #EEG #epileptologist

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