Epilepsy Flashcards
How can syncope and epilepsy be differentiated?
In syncope, recovery is rapid.
In seizure, recovery takes minutes-hours.
Is examination useful in seizure?
No, only useful in ruling out syncope.
History is crucial.
What test should be performed in any individual reporting a collapse?
ECG - regardless of clinical suspicion.
Which arrhythmia commonly presents with collapse?
Prolonged QT syndrome
How long must a patient avoid driving for after a seizure?
6 months
If HGV driver, this is 5 years.
If a patient is diagnosed with epilepsy, how long are they unable to drive for?
Must be seizure-free for a year.
If HGV driver, 10 years seizure-free plus on no treatment during this.
What factors can precipitate a seizure?
Head injury
Hypoglycaemia
If seizure occurs in the context of a causative factor is it epilepsy?
No, epilepsy is diagnosed in seizures occurring in the absence of any other causative factor.
What occurs in the brain during an epileptic seizure?
Spontaneous discharge of electrical activity disturbing normal brain activity.
What is SUDEP?
A term used to describe sudden death in those with epilepsy.
An umbrella term.
In focal epilepsy, the specific area of the brain affected (and which displays symptoms) is called what?
The seizure focus.
What are the networks called that connect the different brain regions?
Cortical networks.
What type of seizure can arise from focal epilepsy?
Focal seizures
Generalised seizures (if affecting the cortical networks)
What type of seizure can arise from generalised epilepsy?
Generalised seizures
What is epilepsy?
The tendency to have recurring seizures.
What is a seizure where there is LOC called?
Disconscious epilepsy
A focal seizure, producing motor symptoms, suggests which lobe is affected?
Frontal lobe
A focal seizure, producing sensory symptoms, suggests which lobe is affected?
Parietal lobe
A focal seizure, producing psychic symptoms, suggests which lobe is affected?
Temporal lobe
Can focal seizures generalise?
Yes, if they spread to the cortical network.
If a focal seizure generalises, which forms result?
Tonic
Tonic clonic
What are the forms of generalised seiziure?
Absence Myoclonic Atonic Tonic Tonic clonic
Which age group are affected by generalised seizures?
Young people
Thought to carry a genetic risk.
Which age group are affected by focal seizures?
The elderly
Due to a structural abnormality.
How is a primary generalised epilepsy treated?
Sodium valproate
If female and of child-bearing age, give lamotrigine (as sodium valproate is teratogenic).
How is focal epilepsy treated?
Lamotrigine (or carbamazepine).
Gabapentin is 2nd line.
In which situation is phenytoin used?
Acute management only as high dose can be given rapidly.
Causes hirsutism and gingival hyperplasia when used long-term.
What are side-effects of sodium valproate?
Weight gain
Hair loss
Teratogenicity
What is the main issue with carbamazepine therapy?
Causes severe dizziness.
Is carbamazepine suitable in generalised epilepsy?
No, it worsens epilepsy in these patients.
Only suitable in focal epilepsy.
Do anti-convulsants work alongside contraception?
No, they reduce effectiveness.
Avoid anti-convulsants where possible as they have many drug interactions.
What is status epilepticus?
A state of recurrent epileptic seizures where there is no full recovery of consciousness.
A neurological emergency.
After how long should a seizure be treated as status epilepticus?
If no spontaneous resolution following 10 minutes of fitting.
What are potential causes of status epilepticus?
Hyponatraemia Pyridoxine deficiency Infection Head trauma Subarachnoid haemorrhage Abrupt withdrawal of anti-convulsants
What can kill patients in status epilepticus?
Aspiration
Hypotension
Hyperthermia
Rhabdomyolysis
How is status epilepticus treated?
Give 10mg benzodiazepines.
Check for response.
If no recovery, give again 5 mins later.
If still doesn’t resolve, give phenytoin 5 mins after that.
What is a potential issue with giving benzodiazepines?
They can cause respiratory depression.
After 1 hour of status epilepticus, what should be done?
Patient should be moved to ITU.
What are non-epileptic attacks?
Behavioural episodes that look like seizures, caused by stress.
How are non-epileptic attacks best treated?
Deal with trauma rather than treat symptoms.
What is the most common trigger of a non-epileptic attack?
Sexual assault
What occurs in a tonic clonic seizure?
A burst of electricity affecting the motor cortex of the frontal lobe resulting in all the muscles of the body contracting.
Proceeds to relax-jerk in a pattern.
Do functional attacks last longer than epileptic seizures?
Yes, usually 10-20 mins.
What form of activity is seen in a functional attack?
Prominent motor activity, or
Episodic collapse with no movement, or
Abreactive attacks
How is a functional attack treated?
Remove any epilepsy medication
Reassure patient
CBT
