DISEASE- Epilepsy Flashcards
what is an epileptic seizure?
An abnormal synchronisation of neuronal activity
-usually excitatory with high frequency action potentials
-sometimes predominantly inhibitory
Interruption of normal brain activity (either focally or generalised)
Usually brief (seconds to minutes)
epileptic seizures= abnormal synchronisation of neuronal activity
-are these excitatory or inhibitory?
Usually excitatory with high frequency action potentials but sometimes predominently inhibitory
how long are epileptic seizures?
usually brief (seconds to minutes)
what causes epileptic seizures/ the abnormal synchronisation of neuronal activity?
Too much excitation/ too little inhibition
Changes to:
-Cell numbers/ types
-Connectivity
-Synaptic function
-Voltage gates ion channel function
what can cause epilepsy?
-genetic
-acquired brain
-metabolic
-toxic
-environmental factors
at what age do people experience epileptic seziures?
Occur at any age
-most common in infancy and old age
Difference between epilepsy and seizures?
Seizure= abnormal discharge of electrical activity in the brain
Epilepsy= tendency to recurrent epileptic seizures
what are the types of epileptic seizures and where does the electrical discharge occur?
Generalised= electrical discharge happens in many different parts of the brain (both sides) at the same time
Partial (focal site of origin)= electrical discharge is only on one side of the brain and may stay there
What are the types of generalised epileptic seziures?
Absence
Myoclonic
Atonic
Tonic Clonal
What are the types of partial (focal site of origin) epileptic seizures?
Simple: without impaired consciousness
Complex: with impaired consciousness
how are secondary generalised seizures linked to partial/ focal seizures?
Focal seizures can become secondary generalised seizures by spreading to the whole brain
Presentation of primary generalised epilepsy?
-Often presents in childhood/ teens
-Early morning jerks
-Generalised seizures
Risks for primary generalised seizures?
-Sleep deprivation
-Flashing lights
-Birth problems
-Past seizure (e.g. febrile)
-Head injury
-FH
-Drugs/ alcohol
what medication can make primary generalised seizures worse?
Carbamazepine (used to treat focal seizures)
Presentation of absence seizures (type of primary generalised seizures)?
-Often in Children
-Lasts 10-20 seconds
-Patient becomes blank, stares into space and abruptly returns to normal
-During episode will become unaware of surroundings and won’t respond
Treatment for absence seizure?
Ethosuzimide/ Sodium Valproate
90% will grow out of it as they get older
Sodium Valproate= for all primary generalised seizures
Presentation of myclonic seizures (type of primary general epileptic seizure)?
-sudden brief muscle contractions like a SUDDEN JUMP
-Patient usually remains awake
treatment myoclonic seizures?
Sodium Valproate, Leveteracetam, Clonazepam
presentation atonic epileptic seizures?
Typically begins in childhood
</=3 minutes
Brief lapses in muscle tone
‘DROP ATTACKS’
treatment atonic epilepsy?
Sodium valproate
Or
Lamotrigine
(atonic, tonic and generalised tonic clonic is the same treatment)
Presentation of generalised tonic clonic
-What most people think of when they think of epileptic seizures
-Loss of consciousness, 1st tonic (muscle tensing) episode and 2nd clonic (muscle jerking) episode.
-After seizure there is a prolonged post- ictal period where the person is confused, drowsy and feels irritable and depressed
-May be associated with tongue biting, incontinence, groaning, irregular breathing
treatment for generalised tonic clonic seizures?
Sodium Valproate
OR
Lamotrigine
(atonic, tonic and generalised tonic clonic is the same treatment)
investigation for primary generalised epilepsy?
EEG- will show spike wave abnormalities in generalised
who should not receive sodium valproate, why and what is usually given instead?
Women of child bearing age
-it is teratogenic and associated with neuronal tube defects
-Give lamotrigine instead
SE of Sodium valproate?
-weight gain
-teratogenic (neuronal tube defects)
-hair loss
-fatigue
Motor presentation of focal (partial) seizures?
Autonomic movements from temporal lobe: chewing, repetitive body movements (jerking, posturing etc)
Other movements from frontal lobe: head/eye deviation, urinary incontinence, vocalisation, bizarre behaviour
Sensory presentation of focal (partial) seizures?
Altered somatosensation (from parietal lobe)
Olfactory sensation, rising feeling in stomach, auditory (from temporal lobe)
Visual symptoms (from occipital lobe)
Psychic presentation of focal (partial) seizures?
Memories, déjà vu, jamais vue (staring blankly) -from temporal lobe
Treatment of focal (partial) seizures?
Carbamazepine or Lamotrigine
After 1st seizure (not diagnosed with epilepsy)- when can you next drive?
6 months for car
5 years for HGV/PCV
After epilepsy diagnosis- when can you next drive?
1 year or 3 years during sleep for car
10 year off medication for HGV/PCV
A 23-year-old woman presents to her GP, complaining of “falls”. Upon further questioning, she explains that around every week, she falls to the floor, feeling as though her “muscles go all loose and floppy”. These episodes are not associated with loss of consciousness or additional symptoms. Neurological examination shows no physical abnormalities. Her GP suspects epilepsy. What is the most appropriate treatment for this patient’s epileptic syndrome?
Lamotrigine
-she is having an atonic seizure (drop attacks) and is a woman of child bearing age so would not give her sodium Valproate
what are the types of status epilepticus?
Generalized convulsive status epilepticus
Non-convulsive status
Epilepsia partialis continua
Presentation of status epilepticus?
-Recurrent epileptic seizures without full recovery of consciousness
-Continuous seizure lasting >5minutes
how may a partial seizure in the frontal lobe present?
-head/leg movements
-posturing
-post ictal weakness
-Jacksonian march (clonic movements travelling proximally)
how may a partial seizure in occipital lobe present?
floaters/ flashers
how may a partial seziure in parietal lobe present?
paraesthesia
