Epilepsy Flashcards
what questions should you ask a patient who has presented with a seizure?
what happened before/during/after
how did they feel
what were they doing
what is a vital part of a history of a seizure?
eye witness account
what investigation is mandatory following a seizure?
ECG
what imaging can be done to look for a possible cause of a seizure?
MRI or CT
what are the indications for EEG following a seizure?
classification of epilepsy
confirming non-epileptic attacks
surgical evaluation
how long must you be seizure free after your first seizure before you can drive a car?
six months
how long must you be seizure free after your first seizure before you can drive a HGV/PCV?
five years
how long must you be seizure free if you have epilepsy before you can drive a car?
1 year
3 years if during sleep
how long must you be seizure free if you have epilepsy before you can drive a HGC/PCV?
10 years off of medication
what is epilepsy?
a tendency to recurrent, usually spontaneous, epileptic seizures
what are epileptic seizures?
abnormal synchronisations of neuronal activity
what does focal interruption of brain activity result in?
a focal seizure
what does generalised interruption of normal brain activity result in?
a generalised seizure
how long do seizures tend to last?
seconds to minutes
when is epilepsy most common?
infancy to old age
what are the two main types of epilepsy?
focal
general
what is the seizure focus?
the part of the brain that is structurally abnormal in epilepsy
how does structural abnormality result in an epileptic seizure?
the seizure focus irritates the surrounding brain, resulting in a seizure
what part of the brain is irritated in focal epilepsy?
just the area around the seizure focus
what is another name for focal epilepsy?
partial epilepsy
what are the possible types of seizures seen in focal epilepsy?
tonic
tonic clonic
what are the two types of focal epilepsy?
simple
complex/dyscognitive
what is simple focal epilepsy?
without impaired consciousness
what is complex focal epilepsy?
with impaired consciousness
what motor symptoms can be seen in focal epilepsy?
rhythmic jerking
posturing
head and eye deviation
vocalisation
what psychiatric symptoms can be seen in focal epilepsy?
deja vu
depersonalisation
aphasia
complex visual hallucinations
what is it called when focal epilepsy becomes generalised?
second degree generalisation
when can focal epilepsy come on?
any age
what is the management for focal epilepsy?
carbamazepine or lamotrigine
what is the pathophysiology behind general epilepsy?
irritation from the seizure focus spreads throughout the brain, irritating other areas
what seizure types can be seen in general epilepsy?
absence myoclonic atonic tonic tonic clonic
what is primary generalised epilepsy?
general epilepsy with tonic clonic seizures
when does general epilepsy often present?
childhood or teenage years
what is the treatment of choice for general epilepsy?
sodium valproate
what is the alternative management of general epilepsy and when is this given?
lamotrigine
pregnancy - sodium valproate is teratogenic
how is general epilepsy with absence seizures managed?
sodium valproate
ethosuximide
how is general epilepsy with myoclonic seizures managed?
sodium valproate
levetiracetam
clonazepam
name four anticonvulsant drugs
phenytoin
sodium valproate
carbamazepine
lamotrigine
what drug can be given for acute management of a seizure?
phenytoin
name some possible side effects of sodium valproate
weight gain
teratogenic
hair loss
fatigue
what is a possible serious side effect of lamotrigine?
stevens johnson syndrome
what is status epilepticus?
recurrent epileptic seizures without full recovery of consciousness
continuous seizure activity for >30 minutes
what are the three types of status epilepticus?
generalised convulsive status
non convulsive status
epilepsia partíalis continua
what happens in generalised convulsive status?
generalised convulsions without cessation
what can generalised convulsive status cause?
respiratory insufficiency
hypotension
hyperthermia
rhabdomyolysis
how does non-convulsive status present?
conscious, but in an altered state
how does epilepsy partialis continua present?
continual focal seizures
preserved consciousness
what are some possible precipitants of status epilepticus?
metabolic disorders infection head trauma abrupt withdrawal of anti-convulsants subarachnoid haemorrhage
how is status epilepticus managed?
anti-convulsants = phenytoin, valproate
benzodiazepines
what should be give if a patient in status epilepticus is hypoglycaemic?
50ml 50% glucose
what should be given if there is indications that a patient with status epilepticus is an alcoholic or has impaired nutritional status?
thiamine
what should be done if status epilepticus persists?
transfer to ITU
general anaesthesia
monitor with full EEGs
