Diagnosis and Management of Epilepsy Flashcards
Define seizures
abnormal synchronous discharge of neurons in the cortex that produces stereotyped behaviours; usually self limited, lasting seconds to minutes
Define Epilepsy
2 or more unprovoked seizures
Define Postictal
Time after a seizure- seconds to hours
Characterized by disorientation and confusion
Define Interictal
Time between seizures
Define an Aura
A warning sign of an impeding seizure
Define an EEG
Eelectroencephalograph: recording of gross electrical activity of the cortex via the scalp
What are the types and subtypes of seizures?
Generalized
Partial: Simple or complex
Seizures can start partial and become generalized
Does a generalized seizure have an aura?
No
Does a partial seizure have an aura?
Yes both complex and simple
Does a generalized seizure have an altered LOC?
Yes
Does a partial seizure have an altered LOC?
Yes for complex, no for simple
Does a generalized seizure show postictal confusion?
Yes (except absence)
Does a partial seizure show postictal confusion?
No for simple, yes for complex
What are the subtypes of a generalized seizure?
Tonic-clonic
Atonic
Myotonic (like twitching while falling asleep)
Absence (though to originate from thalamus)
How does a complex partial seizure present?
Starts focally and becomes generalized
What would a partial (focal) seizure that includes loss of awareness classify as?
Complex
What are the features of an absence seizure in terms of age, aura, frequency, duration, change to tonic-clonic, post ictal confusion, EEG findings, CT/MRI findings, and treatment?
Pediatric No aura up to 100s/day 10-15 seconds no change to tonic-clonic no postictal confusion generalized 3 Hz spies and waves -ve CT/MRI Ethosuximide
What are the features of a complex partial seizure in terms of age, aura, frequency, duration, change to tonic-clonic, post ictal confusion, EEG findings, CT/MRI findings, and treatment?
Older patients presents with aura not very frequent 1-2 minutes changes to tonic-clonic sometimes presents with postictal confusion focal epileptiform discharges positive findings on CT/MRI Various treatments
Define the prevalence of epilepsy in terms of lifetime risk and male/female`
1% of population has epilepsy
5% life time risk
M=F
Risk starts high in life, decreases, then increases again at later age
What are the primary and secondary causes of seizures?
Primary: idiopathic epilepsy
Secondary: Metabolic: nonadherence, Diabetic, EtOH withdrawal, Drugs,
Structural: Tumour, puss, bleeding, stroke
Do subcortical strokes cause seizures?
No
What do we look for in bloodwork to confirm seizures?
Na, Mg, Ca
Is EEG helpful in diagnosing seizures?
Yes but
First EEG is 50% sensitive
Three EEG’s are 80% sensitive, one of which is done sleep deprived
What are the ontario regulations in terms of driving for patients who present with a seizure?
Must be reported and instructed not to drive
Not able to drive for minimum 6 months
Ex. insulin induced seizure
How do antiepileptic drugs work?
increase GABA; ex. benzodiazepines
Decrease glutamate
Alter ion channels (Na, Ca)
Or combination of the above
What is the process of managing AED? what is the success rate?
start with monotherapy, titrate up
If sz or complications, switch to another monotherapy drug
if sz try dual therapy using drugs with different mechanism of action
75% of patients will become seizure free
With each failed medication, the chance of becoming seizure free becomes lower
1 unprovoked seizure+ abnormal MRI, EEG, or physical. Treat?
Yes
1 provoked seizure + reversible cause. Treat?
No
1 provoked seizure +irreversible cause. Treat?
Yes
2 unprovoked seizures. Treat?
Yes
what are the first aid steps for a person seizing?
1- cushion head, remove glasses 2- loosen tight clothing 3- turn to the side to keep airway open 4- time seizure 5- don't put anything in the mouth 6- don't restrain 7- offer help postictally 8- ask about diabetes
Define status epilepticus
Ongoing seizure lasting >5 min
repeated seizures without return to baseline in the inter-ictal period
High morbidity and mortality
How do you treat a patient with seizure lasting more than 2 min? (status epilepticus)
As for capillary glucose (most important) ask for monitors +IV access Attach O2 roll pt on the side if glc 2 give ativan+phenytion IV
