Epilepsy Flashcards
Presentation
Blackout, collapse => recurrent seizure
- tongue biting
- urine incontinence
Post ictal phase - 15min fatigue
-Todd’s paresis - 48hr unilateral limb, facial weakness
How would you rule out a non epileptic seizure
-management
Psychological or other medical cause which you can treat
Febrile - 6months-5years
- due to rapid dev of fever in viral infection
- brief T or TC
- self limiting
Alcohol withdrawal - 36hrs after last drink
-chlordiazepoxide/diazepam
-lorazepam in liver failure
Short term BZ to reduce seizure risk acute alcohol withdrawal and DT
Psychogenic non epileptic seizure
- Hx of MH, personality disorder
- no electrical brain changes
- psychology, psychotherapy interventions
Provoked seizures - occurs within 1wk of acute brain insult
- stroke, hemorrhage, TBI, encephalitis, metabolic disturbance, drugs
- address underlying cause
- short term AED
Types of epileptic seizure
- focal
- generalised
- unknown origin
- focal => bilateral
Focal - start in specific brain region
- varying awareness
- motor/non motor/aura
Generalised - start in both sides
- LOC
- motor (TC, T, C, MC, A)
- non motor (absence)
Unknown origin
-start of seizure unknown
Focal to bilateral
-starts in 1 side => to other
Investigations
Gold standard - EEG and MRI
-routine EEG is abnormal in most epileptics
Management of epilepsy
- acute
- prevention
- when to start preventative management
Acute if episode lasts longer than 10min
-PR/SL diazepam
IF NO CHANGE => STATUS EPILEPTICUS => EMERGENCY
Prevention
Generally started after a 2nd epileptic seizure
After 1st if
- neuro deficit
- structural abnormality
- unequivocal EEG activity
- risk of seizure is unacceptable to patient/family
1st line for generalised => Sodium valproate
1st line for focal => carbamazepine
2nd line for either => lamotrigine
When to diagnose as drug resistant epilepsy
-examples of surgical management
No change with 2 AEDs
Lesion/lobar resection
Disconnection of the hemispheres
Definition of epilepsy
When is it considered resolved
Min of 2 unprovoked seizures occurring more than 1 day apart
Age dependent epilepsy - now past that age OR
Seizure free for 10 years with no AEDs in last 5 years
Differentiating between a tonic clonic movement and a myotonic jerk
Myotonic jerk - intermittent mv
Tonic clonic - continuous mv
DVLA considerations
Stop driving and inform DVLA
- seizure affecting consciousness=> stop for 6 months
- established epilepsy => seizure free for 1 year
Contraception, pregnancy and breastfeeding considerations
AEDs are teratogenic
- may need to change medication
- breastfeeding is ok
Contraception + AED effectiveness can be altered
Status epilepticus
-pathophysiology
Failure of normal mechanisms that terminate seizures => start treatment
Initiation of mechanisms that prolong seizures => long term consequences
- neuronal loss
- toxic metabolite accumulation causes further damage
Management of status epilepticus
ABC
- 2 large bore venous cannulae
- basic bloods - FBC, U&E, LFTs, toxicology
- BG
- alcohol related => pabrinex before IV glucose
Step 1 - IV BZ
- if resolves within 10mins => give prophylactic Step 2 AEDs
- if no resolution within 10mins => Step 2
Step 2 - IV phenytoin and inform anaesthetist and neurointensivist
Step 3 - Anaesthesia and ventilation in ICU
Localising features of focal seizures
- temporal
- frontal
- parietal
- occipital
Temporal - Hallucinations, Epigastric rising/Emotional, Automatisms, Dejavu, Dysphasia (post ictal)
Frontal - Head/leg mv, posturing, post-ictal weakness,
Parietal - paraesthesia
Occipital - floaters/flashes
