Epilepsy Flashcards
Describe an epileptic seizure
-Discrete episode of symptoms
-Reflecting brain disturbance
-Due to paroxysmal abnormal electrical activity (often presumed)
Describe epilepsy as a condition
-A continuing tendency to unprovoked (can have a event as trigger) epileptic seizures
Classification of epileptic seizures
-Focal onset
=Features reflect site of origin, look for underlying focal cause
=Awareness: affected or not?
=Motor onset or other?
-Generalised onset
=Reflect generalised disorder e.g. genetics
=Motor: GTCS, GTS, GCS, other (myoclonic)
=Absences
Classification of epilepsy
-Primary
= Not a symptoms of underlying disease
=Generally genetic
-Secondary
= Due to some other disease (trauma, infection, tumour, stroke)
Describe auras
-Precede a seizure
-Due to focal epileptic disturbance which then spreads to become generalised
=Aura itself a seizure so a focal cause
Examples of epilepsy classification
Primary:
=Primary absence seizure disorder of childhood
=Juvenile Myoclonic Epilepsy
Secondary:
=Focal motor epilepsy with secondary generalisation due to glioma
=Temporal lobe seizures due to mesial temporal lobe sclerosis
Questions for diagnostic steps
-Episode(s) epileptic seizure(s) or not?
-If so, what types of seizures ?
-Is there a continuing tendency to unprovoked seizures ?
-Primary or Secondary ?
-If Primary: what is the Epilepsy Classification ?
-If Secondary: what is the Epilepsy classification & cause ?
Investigations for epilepsy
-Brain imaging (cause)
-Routine EEG (classification- where seizure began, level of awareness during seizure, other features), after second simple tonic-clonic, abnormal electrical activity
-Ambulatory EEG
-Video-Telemetry EEG recording
-MRI brain (first seizure under child 2yrs, focal, no response to first line antiepileptic)
-ECG to exclude heart problems, electrolytes, glucose, cultures, urine culture, LP.
Common triggers of epilepsy
Sleep deprivation
Excessive Alcohol
Intercurrent illness / pyrexia
Hormonal factors
[Flashing Lights]
Examples of anti-epilepsy drugs
Lamotrigine (female)
Sodium Valproate (males)
Carbamazepine
Levetiracetam
Phenytoin
Phenobarbitone
What is included in an assessment of drug therapy?
Seizure frequency
Seizure severity
Side effects
Quality of Life
General advice for patients with epilepsy
Occupation
Hobbies
Driving- cannot drive for 6 months following seizure with no relevant structural abnormalities, established epilepsy= fit free for 12 months until able to drive
Insurance matters
Contraception & Pregnancy
Telling others/Stigma
SUDEP
Describe epilepsy surgery
-For focal onset epilepsy
-Affecting a person’s life
-where drug treatment has failed
=Removing a focal part of the brain where seizures are arising
=Stopping spread of seizures from a focus
What is SUDEP?
Sudden, Unexpected, Death
=In patients with epilepsy
=No other cause of death identified
=[No trauma, not overdose, no other disease etc]
-Seems to occur during or after a seizure
=But may be no seizure witnessed
=Often happens in sleep
[Not due to status epilepticus]
-600 SUDEP instances per year- 1:1000 risk on average
What is status epilepticus and what is the management?
CONVULSIVE STATUS
A Generalised Convulsive Seizure that lasts >5 minutes
Or
A second seizure occurring without person regaining consciousness after the first (within 5 minutes)
NON-CONVULSIVE STATUS
-Medical emergency- benzodiazepine buccal or rectal, secure airway with adjunct, high-conc oxygen, glucose levels, IV lorazepam (buccal midazolam or PR diazepam pre-hospital). Repeat after 10 mins, if persists use IV phenobarbital or phenytoin (consider intubation and ventilation in ITU under GA if no response within 45 minutes from onset)
