232 - Epilepsy Flashcards
What is an epileptic seizure?
A transient event experienced due to synchronous and excessive discharge or cerebral neurones
Why do people get epilepsy?
Idiopathic - ? genetic link
Symptomatic - as a symptom of a cause eg. tumour
Cryptogenic - suggestive of a cause buy can’t find one
What are some differentials for epilepsy?
Syncope Non-epileptic attack disorder Panic attacks Sleep disorders Migrane TIAs Hypoglucaemia
What are the 3 Ps related to syncope?
Prodrome
Posture
Provocation
What are some signs that point to a seizure?
Stereotyped cyanosis unprovoked lateral tongue biting shoulder dislocation post-ictal confusion
What are the 2 main categories of epileptic seizures? What are the subtypes seen in each?
Generalised - starts in both hemispheres, sudden onset
- tonic clonic, absence, myoclonic
Partial/focal - Starts in 1 place then spreads
- simple (aware). complex (unaware)
What are the characteristics of a generalised tonic-clonic seizure? GTCS
Sudden onset, sterotyped
Tonic stiffening - then syncrhonised clonic movements
Cyanosis, stertorous breathing, tongue biting, incontinance, injuries, post-ictal confusion.
What are the characteristics of idiopathic generalised epilepsy?
Mixture of seizures - tonic clonic, absences and myoclonic
Starts in childhood/teens/young adults
EEG abnormal - generalised spike-wive
Triggers - eg. sleep deprivation and alcohol excess
What are the characteristics of JME - Juvenile myoclonic epilepsy?
A form of generalised epilepsy Onset 8-18 FH common Upper limb jerks, GTCS, absences. Seizures on waking, triggers: alcohol, sleep deprivation, photosensitivity MRI ok, EEG abnormal Good treatment response
What are the characteristics of Temporal lobe complex partial epilepsy?
3As
- Aura - olfactory, gustatory, psychic, limbic…
- Arrest - motor and speech
- Automatism - manual or oro-facial movements
Lasts 2-10 minutes, gets post ictial confusion
Descirbe NEAD: Non epileptic attack disorder
Psychologically mediated, altered consciousness + behaviour
Markers:
- awareness maintained
- Gradual onset, prolonged seizure
- Frequant
- No drug response
- Autonomic arousal preceeds it
- Asynchronous movements
- Eyes closed
- Back arching
- Carpet burns
- normal colour
- Tip of tongue bitten
What is catamenial epilepsy?
Seizures around menstruation
What drugs are available for epilepsy?
Sodium valproate (epilim)
Carbamazepine (tegretol)
Lamotrigine (lamictal)
Levetiracetam (keppra)
Sodium valporate
Generalised epilepsy
Na channels / GABA
S/e: weight gain, tremor, teratogenic
Carbamazepine
Partial/focal epilepsy
Na channels
S/e: Rash, ataxia, double vision, interacts with enzyme inducers eg. warfarin and OCP
Lamotrigine
1st line in partial/focal
2nd line for generalised
Na channels
s/e: rash
Levetiracetam
1st line in partial/focal
2nd line for generalised, add in as 2nd line in partical/focal
SV2A protein
s/e: psychiatric issues
What is SUDEP?
Sudden unexpected death in epilepsy
a non-traumatic, unwitnessed death
Normal post mortem
1/1000 a year risk
Why? cardiac arrhythmias?