Epilepsy Flashcards
T or F , 70 % of patients can be seizure free with treatment
true
Epilepsy definition
Neurological condition with Tendency to recurrent spontaneous seizures
What causes seizures
Brief disturbances in the electrical function of the brain
Possible causes of seizure
Infections
Stroke
Head injuries
Genetic
Brian tumor
Brain damage
Unknown
Mortality rate of epileptic compared to normal population
Twice more
Main causes leading to more death in epileptic population
Status epilepticus
Burns
Drowning
Injury
SUDEP
Chest infection
Aspiration
Suicide
Morbidities present in epilepsy
Injury
Drugs side effects
Aspiration
Cognitive decline
Depression
Psychosis
Employment discriminions
Driving impaired
Embarrassment
Social prejudice
2 groups of seizures
Local
Generalized
What is the treatment gap in epilepsy
Number of people who have epilepsy and do not receive treatment
Treatment gap in Ghana
50-60%
Reasons for treatment gap
Poverty
Lack of medications
Social stigma
No prioritization for treatment
How should you take history in epilepsy
Need a third person to give history - events, surroundings, details of seizures
Questions to ask in epilepsy history
First time occurrence >
Age of onset - adulthood ? Childhood ?
Warning signs ( aura ? Tastes, odors, visual, auditory , repetitive movement )
Frequency
Time of seizures
Step by step explanation
Progression of seizure
Loss of consciousness
Triggers
Medications
PMH
Birth history
Pregnancy - alcohol , smoking, herbal
Antenatal care
Delivery issue - fall, vacuum, obstructed labour , TBA
Sucking, cry, jaundice., meningitis
Milestones
Cerebral palsy
Pathophysiology of seizures
Imbalance between inhibitory ( GABA ) and excitatory ( glutamate and aspartate)
Classification of seizures
Generalized
Focal
Unknown
Types of generalized seizures
Tonic clonic
Absence
Myoclonic absence
Eyelid myoclonia
Myoclonic
Clonic
Tonic
Atonic
Types of absence generalized seizures
Typical
Atypical
Absence with special features
Types of Myoclonic generalized seizures
Myoclonic
Myoclonic atonic
Myoclonic tonic
Types of focal seizures
No impairment of consciousness or awareness ( simple partial ) - focal motor or sensory
Impairment of consciousness or awareness ( complex partial )
Bilateral , convulsive seizure (secondarily geenralized seizure) - tonic, clonic, tonic clonic
Types of unknown seizures
Epileptic spasms
Some causes of focal epilepsy ( anything hat can disturb cortical architecture and function )
Focal infection
Tumour
Hamartoma
Trauma related scarring
Percentage of generalized epilepsy form. All seizures
30%
Trigger factors for seizures on
Sleep deprivation
Missed doses of anti epileptic drugs
Alcohol
Recreational drug misuse
Physical or mental exhaustion
Flickering lights
Intercurrent infections
Metabolic disturbances
Uncommon - Loud noises, music , reading , hot baths
History taking
Attack type
Age at onset
Frequency
Duration
Typical features
Triggers
What type of seizure do you expect n a patient more than 30 yo
Focal type
Causes of focal seizures
Benign Rolandic epilepsy of childhood (idiopathic )
Benign occipital epilepsy of childhood ( idiopathic )
Genetic
Infantile hémiplégia
Dysembroynic
Cerebrovascular dx
Tumors
Infective
Trauma
Inflammatory
Characteristics of tonic clonic seizures
Preceded by aura
Rigid and unconscious
Falls heavily if standing
Breathing stops and central. Cyanosis
Jerking for 2 mins at most
Flaccid state of deep coma
Regain awareness and is confused
Urinary incontinence and tongue biting possible
Causes of tonic clonic generalized seizures
From focal seizures
Genetic
Cerebral birth injury
Hydrocephalus
Cerebral anoxia
Drugs (ATBs, anti malarials, cyclosporin, amphetamines , antiarrythmics , psychotropic )
Alcohol
Toxins
Metabolic dx (all the hypo..)
Infective
Inflammatory
Diffuse degenerative dx
Characteristics of absence seizures
Start in childhood
Brief
Frequent - 20 to 30times in a day
Can be mistaken for daydreaming or poor concentration in school
Myoclonic seizures characteristics
Brief jerking movements mostly in arms
More prominent in morning or when waking up
Provoked by fatigue alcohol and sleep deprivation
Characteristic atonic seizures
Brief loss of muscle tone
Heavy falls
Occur in epilepsy sydrome
Charcateriics of tonic seizures
Increase in tone and loss of awareness
Seen in epilepsy sudrome
Characteristic sof clonic seizures
Same as tonic clonic seizures but no preceding tonic pahse
Common generalized epilepsy syndrome
Childhood absence epilepsy (4-8yo, frequent brief absence)
Juvenile absence epilepsy (10-15 yo, brief absence)
Juvenile Myoclonic epilepsy (15-20 yo, GTCS,absences, morning Myoclonus )
GTCS on awakening (10-25yo , GTCS, sometimes Myoclonus)
Investigations for seizures
ECG
Cranial imaging - CT or MRO
EEG
Other appropriate when signs of infections or metabolic etc
Investigations for epilepsy
EEG
Imaging
