Epilepsy Flashcards
What are the causes of blackouts?
Vasovagal
Reflex syncope
Cardiogenic syncope
Epilepsy
Metabolic
Unkown
What are the 3 categories of syncope?
Reflex (neurocardiogenic)- vagal tone increases
Orthostatic- BP related
Cardiogenic- CO falls
What assessment is done for syncope?
Heart sounds
Pulse
Postural BPs
ECG- heart block, QT ratio
What is a pseudo seizure?
Non epileptic attack
What are provoked seizures?
Non epileptic:
- Alcohol/drug withdrawal
- Head injury
- Stroke
- Neurosugery
What is epilepsy?
Tendency to recurrent seizures without provoking factors
Disruption of electrical activity in neurons causes seizures
What are convulsions?
Motor signs of electrical discharges
What is the classification of seizures?
Primary generalised
Focal/partial seizures
What are generalised seizures?
Widespread electrical discharge with no localizing features referable to a single hemisphere
What are the subtypes of generalised seizures?
Absences seizures
Tonic-clonic seizures
Myoclonic seizures
Atonic seizures
Infantile spasms
What are the features of absence seizures?
Brief pauses (<10secs)
Presents in childhood
What are the features of tonic-clonic seizures?
Loss of consciousness
Limbs stiffen (tonic) then jerk (clonic)
Post- ictal confusion and drowsiness
What are the features of myoclonic seizures?
Sudden jerk of limb, face or trunk
May be thrown suddenly to ground or have a violently disobedient limb
What are the features of atonic seizures?
Sudden loss of muscle tone causing fall
No loss of consciousness
What are the elements of a seizure?
Prodrome
Aura (implies focal seizure)
Deja vu
Strange smells
Headache
Confusion
Myalgia
What assessment is done for seizures?
Refer:
- MRI for focal lesion
- EEG
- Anti-epileptic drugs
- Refer to epilepsy nurse
- Inform DVLA
What assessment is done for epilepsy?
EEG for primary generalised epilepsies
MRI if <50 with possible focal onset seizures
Video telemetry if uncertainty about diagnosis
What is the treatment of generalised absence seizures?
First line: Sodium Valproate
Second line: Lamotrigine
What is the treatment of generalised tonic clonic seizures?
First line: Sodium Valproate
Second line: Topiramate
What is the treatment of generalised myoclonic seizures?
First line: Sodium Valproate
Second line: Topiramate
What is the treatment of generalised atonic seizures?
Sodium Valproate or Lamotrigene
What is the treatment of focal seizures?
First line: Lamotrigine
Second line: Sodium Valproate
What are other interventions for epilepsy other than AEDs?
Psychological therapies- CBT
Surgical intervention- neurological resection, vagal nerve stimulation, deep brain stimulation (DBS)
What is Status Epilepticus?
Generalised convulsive/non-convulsive seizures for 5 minutes or more
What is the treatment of status epilepticus?
First line: Midazolam
Second line: Valproate
Third line: Anaesthesia
