Epilepsy Flashcards
What is a seizure?
Transient neurological condition caused by abnormal electrical activity (excitatory > inhibitory neurones)
3 features used to diagnose epilepsy?
- 2 unprovoked seizures >24 hours apart
- 1 unprovoked seizure with a high risk of recurrence
- epilepsy syndrome features
4 main stages of a seizure? What are the characteristic features of each stage?
- prodromal - irritable, mood changes
- early ictal (aura) - sensory, cognitive, behavioural changes, emotions
- ictal - typically refers to Generalised tonic-clonic seizure
- post-ictal - reduced consciousness, malaise, memory loss, confusion
Typical features of the ictal period?
Refers to Generalised Tonic-Clonic seizures in lay-mans terms:
- urinary incontinence
- tongue biting
- stiffness (tonic) and rhythmic jerking (clonic)
How long does the ictal period generally last for?
1-2 minutes
3 main types of seizures?
- focal
- generalised
- unclassified
2 main types of focal/partial seizures?
- aware (simple partial seizures)
2. unaware (complex partial seizures)
Motor symptoms you can get with seizures?
tonic - increased tone/stiffness clonic - rhythmic jerking atonic - floppy myoclonic - "shock like" jerks spasms - sudden flexion and extension movements
Types of generalised seizures?
- absence
- generalised tonic-clonic
- atonic seizures
- myoclonic seizures
- tonic seizures
Absence seizures classically appear in which type of patients?
Young children
Investigations for epilepsy?
- bedside - ECG
- bloods - FBC, U&Es, LFTs, CRP, glucose, bone profile
- imaging - MRI head (rule out causes)
- EEG - confirm diagnosis (cannot be use to rule out)
Management of epilepsy? (3)
- 1st fit clinic (for investigations and AEDs if necessary)
- education and lifestyle advice
1st line AEDs used in focal epilepsy?
Lamotrigene (women of childbearing age) or Cabamezipine
1st line AEDs used in generalised tonic-clonic epilepsy?
Sodium valproate (or Lamotrigine in women of childbearing age)
AED typically used as 1st line in absence, atonic and myoclonic epilepsy?
Sodium valproate
Why is sodium valproate not used in women of child bearing age?
Highly teratogenic
Education and Lifestyle advice given in epilepsy?
- Driving - inform DVLA and stop for 6 months for cars after 1st seizure and 1 year after epileptic seizure
- water - take showers not baths, caution when swimming
- fire and electrical hazards
2 main complications of epilepsy?
- Sudden Unexplained Death in Epilepsy (SUDEP)
2. Status Epilepticus
What is status epilepticus?
When a seizure persists for more then 5 mins or 2 seizures occur without a period of recovery inbetween
Initial management of Status?
- A-E assessment
2. IV Lorazepam (rectal diazepam or buccal midazolam in the community)
How long should you wait before giving another dose of IV Lorazepam to a patient with Status?
10 mins
What should you give after giving 2 doses of benzodiazepine in a patient with Status? (3 options)
- IV Phenytoin
- IV Phenobarbital
- IV Fosphenytoin
Main risk factors for Sudden Unexplained Death in Epilepsy (SUDEP)?
- nocturnal seizures
2. poorly controlled epilepsy
