232 - Epilepsy Flashcards
what is a seizure and what is epilepsy?
- A transient abnormal electrical discharge of cerebral neurones
- recurrent unprovoked seizures
what do seizures of different parts of the brain affect?
- frontal - movement, speech, emotion
- parietal - sensations
- occipital - vision
- temporal - hearing, memory, speech
what is status epilepticus?
continuous seizure activity for >30mins
what is the difference between partial and generalised seizures?
- partial - focal seizures involving only one part of the brain and always begin in the same place - simple and complex
- generalised - involve whole of the brain and always produce impaired or loss or consciousness - absence, myoclonic, tonic, tonic-clonic, atonic seizurees
what are the differences between simple and complex partial seizures?
- simple - no impaired/loss of consciousness (remembers experience), presents as a sterotypic aura, brief and may progress to complex/2ry generalised seizures
- complex - impaired/loss of consiouness. begins with behavioural arrest, staring, automatisms (lip smacking, chewing). Lasts 60-90 seconds and resolves with brief post ictal confusion
what are absence seizures (petit mal)?
episodes of impaired consciousness not preceded by aura and not followed by post ictal confusion. Not remembered. short
what are myoclonic/ tonic seizures?
- myoclonic - brief arrythmic, high amplitude jerking movements. EEG fast high amplitude spikes
- tonic - sudden onset rigidity - occur during sleep or drowsy
what are tonic-clonic seizures (grand mal)?
- preceded by prodrome and/or aura.
- tonic phase - rigid and collapse. no breathing > cyanosis
- clonic phase - arrythmic jerking of limbs, irregular breathing (cyanosis), tongue biting and incontinence
- post ictal phase
what are differentials for suspected epilepsy?
- syncope (vasovagal or cardiogenic)
- psychogenic non epileptic attacks
- panic attacks
- sleep disorders
- migraine
- TIA
- hypoglycaemia
what are the differences between seizures and Non-epileptic attack disorder (NEAD)?
- seizure - sudden, prodrome, 1-5m, rhythmic and synchronous,blue colour, tongue biting, prolonged recovery
- NEAD - gradual, prolonged duration, irregular and asynchronous, tongue biting rare, quick recovery
what are the causes for epilepsy in infants, children/adolescents, young adults, 30-50 and over 50s?
- infants - developmental malformations, perinatal injuries, infections
- child/adolescents - idiopathic generalised epilepsy (normal imaging and EEG, alcohol and sleep deprivation triggers)
- Young adult - IGEs, head injury, alcohol, vascular malformations, hippocampal sclerosis
- 30-50 - brain tumours
- over 50s - cerebrovascular disease
what is neurocystercosis?
most common cause of epilepsy worldwide - pork tape worm eggs migrate to brain and form cysts
what investigations should be carried out in suspected epilepsy?
- ECG all blackouts
- EEG - seizure localisation and classification. distinguish between epilepsy and NEAD in prolonged monitoring
- Imaging CT or MRI to see cause and response to treatment
what is the acute management for a tonic-clonic seizure?
- recovery position
* if >5m give IV lorazepam or buccal midazolam or rectal diazepam if IV access not possible
what are the 1st line treatments for generalised seizures and partial seizures?
- generalised - sodium valproate (Na channels/GABA) - incr appetite and weight, hairloss, liver failure
- partial - carbamazepine (Na channels) - lupus, dizzy, visual disturbance
