Epilepsy Flashcards
Define epilepsy
Tendency to have recurrent, unprovoked seizures
Define seizure
Transient excessive electrical activity with motor, sensory, cognitive manifestations discernible to patient or observer
What are the two groups of seizures?
Generalised
Partial
Depends on if the abnormal electrical activity is whole brain or focal
What are the different types of generalised seizures?
Tonic-clonic Absence Atonic Tonic Clonic Myclonic
What are the features of tonic-clonic seizures?
‘Grand Mal’
Patients are initially rigid - tonic
Convulse with rhythmical muscular contractions - clonic
What are the features of absence seizures?
Children
Loss consciousness
Appears vacant
Up to 30 seconds
What are the features of an atonic seizure?
Brief loss of muscle tone
Patient falls to the ground
What are the features of a tonic seizure?
Rigidity
What are the features of a clonic seizures?
Convulsions
Rhythmical muscular contractions
What are the features myoclonic seizures?
An extremely briefly contraction
<0.1 seconds
Jerky movement
What are the two types of partial seizures?
Impaired consciousness
Unimpaired consciousness
Also classified re area of brain affected
Using what investigations is epilepsy diagnosed?
Electroencephalogram
MRI
What are some RFs for generalised seizures?
FH
Prev CNS infection
Head trauma
Prior seizure events
What other investigations should be done for suspected epilepsy?
Blood glucose (extreme hyper/hypo can provoke GTCS) FBC (signs of infection) Electrolyte panel Toxicology panel Head CT (structural lesion)
What anti-convulsant drugs are used to treat GTCS?
First line: Valproate - 10-15mg/kg/day
Lamotrigine - specialist needed for dosing
Levetiracetam - 500mg orally 2x a day increase gradually
Phenytoin - 15-20mg/kg orally
Gabapentin - 300mg 3x a day increase gradually
What anti-convulsants are used in absence seizures in children?
Valproate
Lamotrigine
What are some diagnostic features of focal seizures?
Movement on one side of the body or specific part
Premonitory sensation e.g. fear, epigastric sensation, jamais vu, deja vu
(temporal lobe)
Temporary aphasia
Staring and becoming unaware of surroundings
What are the features of non-epileptic seizures?
Present with epileptic-like seizures
No characteristic electrical discharges
Mental Health history
What anti-convulsant is first line for focal seizures?
Carbamazepine
For how long can you not drive following a seizure?
6 months
If epilepsy has been established they must be 12 months fit free
What need to be considered with valproate?
Teratogenic
What is the mechanism of action of sodium valproate?
Increases GABA activity
What is the mechanism of action of carbamazepine?
Binds to sodium channels increasing refractory period
What is the mechanism of action of lamotrigine?
Sodium channel blocker
What is the mechanism of cation of phenytoin?
Binds to sodium channels increasing their refractory period
What medication can be used as ‘rescue’ for acute management of seizures?
Benzodiazepine
Intranasal or sublingual
What factors favour true epileptic seizures over psychogenic?
Tongue biting
Raised serum prolactin
What favours psychogenic seizures?
pelvic thrusting family member with epilepsy much more common in females crying after seizure don't occur when alone gradual onset
