Epilepsy 1 Flashcards
best way to take a seizure history
find out what happened before, during and after the event
take a collateral history
feel woozy and slump to the ground and get back up suggests…
syncope
stiff, rigid, spasming on the ground suggests a….
seizure
what should you ask in the O section of SOCRATES in a seizure history?
what were they doing?
what did they look like when it happened
what movements should you ask about in a seizure history
stiff/rigid movements
head turning right to the left
rigors
a tonic clonic seizure looks like…
rigid, stiff body with rigors and jerking
eyes open
risk factors for epilepsy
birth problems development seizures in the past eg febrile fits head injury FH drugs alcohol
what should be covered in the social history
driving
occupation
what would you examine in a suspected epileptic patient
neurological exam
what drugs can precipitate epileptic seizures?
penicillins, cephalosporins, quinolones anti-emetics opioids tramadol theophylline the pill
main Ix of someone with a seizure
ECG
what cardiac syndrome can cause seizures
long QT syndrome
when would you image someone with a seizure acutely?
skull fracture
GCS going down
head injury
suggested pathology intracerebrally
an EEG is an essential investigation for someone with a seizure T or F
F, very ineffective
when would you do an EEG on a patient?
classify epilepsy (NOT TO DIAGNOSE IT)
confirm non-epileptic attack
confirm non-convulsive status
differentials for epilepsy
syncope
non-epileptic attack
panic attack
sleep phenomena
define epilepsy
a condition in which you have recurrent epileptic seizures
what are the driving regulations for someone with a seizure (not epilepsy)
dont drive for 6 months
what are the driving regulations for someone with epilepsy who has seizures while awake
cant drive for 6 months
what are the driving regulations for someone with eplepsy while asleep
can maybe still drive if its been more than a year since the last attack
pathophysiology of epileptic seizures
abnormal discharge of electricity in the brain from excitatory neurons with high freq APs
what is a focal seizure
abnormal electrical discharge only affecting 1 part of the brain
what is a generalised seizure
abnormal electrical discharge affecting more than 1 part of the brain
a fit lasting more than _ mins is pathological
10
how long do epileptic seizures last
secs-mins
main incidence of epilepsy
infancy and 50-80yrs old
name the only jobs you cant do if youve got stable epilepsy
pilot a plane
carry a firearm for the military
causes of death for epileptics
aspiration
cardiac event
slowed brain function which eventually stops
there are _ types of epilepsy, what are they?
2
focal
generalised
what is the problem in focal epilepsy
one part of the brain is structurally abnormal which causes focal seizures and if the seizure hits a pathway/cortical network you can also get generalised seizures
what is the problem in generalised epilepsy
abnormality in the brain pathways, NOT structural problem so you get generalised seizures
those with a genetic disposition of epilepsy are more likely to get ___ epilepsy
generalised
name the types of generalised seizures
absence myoclonic atonic tonic tonic clonic
if both arms are tonic, what is happening to the brain?
must be an abnormal electric discharge in the motor cortices of the brain on both sides
what is clonus?
uncoordinated, shaking movement that becomes worse; happens because the abnormal electrical activity becomes less active after a while so it a form of abnormal relaxation
in a tonic clonic fit, does tonicity or clonus happen first
tonicity
sensory focal seizures described as..
a sensory problem that cannot be described well by the patient because it is abnormal i.e not stabbing, not warm sensation
what epilepsy is more common over the age of 50? why?
focal
the older you get the more likely you are to have a structural abnormality
what are the 3 types of focal epilepsy?
motor
sensory
psychic eg memories
generalised epilepsies tend to manifest under the age of __
30
Tx for primary generalised epilepsy
sodium valproate
main contraindication to sodium valproate?
teratogenicity
what drug can be given as a substitute for sodium valproate?
lamotrigine
contraindications to carbamazepine?
on the pill
presentation of juvenile myoclonic epilepsy
early morning jerks
generalised seizures
triggered by sleep deprivation, flashing lights
Tx of focal onset epilepsy
carbamazepine
__ of patients will have drug resistant epilepsy
1/3
Tx for absence seizures
sodium valproate
Tx for myoclonic seizures
sodium valproate
levetiracetam
clonazepam
Tx for atonic, tonic, generalised tonic clonic seizures
sodium valproate
what drug should never be given for a generalised seizures
carbamazepine
side effects of sodium valproate
weight gain
teratogenic
hair loss
fatigue
what epileptic drug can cause mood swings?
levetiracetam
when should you treat an epileptic seizure
only if theyve had recurrent seizures ie epilepsy
increased risk if theres only been 1
what epileptic drugs can affect womens contraception? what should be done
carbamazepine
topiramate
AVOID PROG-PILL, give higher dose of contraception
the morning after pill doesnt work for epileptics T or F
T
what should be given to epileptic women preconceptually ?
high dose folic acid
hippocampal sclerosis is a type of __ epilepsy
focal
