Epilepsy Flashcards
What are the most common diagnosis in patients referred to first seizure clinics?
- Epilepsy (25%)
- Syncope (23%)
- Single seizure (including provoked, 16%)
- Psychiatric/psychological (6%)
Describe how episodes of collapse are assessed?
- Patients account
- History and preceding events
- Context/timing
- History of event itself
- Warning symptoms
- Level of awareness/recollection
- Afterwards
- First recollection
- Seizure markers (prolonged disorientation, tongue biting, incontinence, muscle pains)
- History and preceding events
- Witness account (always try and get this)
- How they were before
- Context
- Description of episode
- Eyes open or closed
- Description of abnormal movements
- Pallor, alteration in breathing pattern, pulses
- Duration of LOC
- Time to recovery
- How they were before
What are important things to ask witnesses of someone collapsing to assess the episode?
- How they were before
- Context
- Description of episode
- Eyes open or closed
- Description of abnormal movements
- Pallor, alteration in breathing pattern, pulses
- Duration of LOC
- Time to recovery
What are the 3 categories of syncope?
- Reflex (neuro-cardiogenic)
- Taking blood/medical situations
- Cough, micturition
- Orthostatic
- Dehydration, medication related (anti-hypertensive)
- Endocrine, autonomic nervous system
- Cardiogenic
- Arrhythmia, aortic stenosis
What can cause reflex syncope?
- Taking blood/medical situations
- Cough, micturition
What can cause orthostatic syncope?
- Dehydration, medication related (anti-hypertensive)
- Endocrine, autonomic nervous system
What can cause cardiogenic syncope?
- Arrhythmia, aortic stenosis
Generally, what is syncope due to?
It is due to either a low BP or global cerebral hypoperfusion
What is the medical term for temporary loss of consciousness?
Syncope
Describe important parts of a history for syncope?
- Patient account
- History of preceding events
- Stimulus (blood being taken, defecation)
- Context (only in bathroom, only when standing)
- History of event itself
- Warning sign (felt lightheaded, clammy, vision blacking out)
- Afterwards
- Very brief LOC
- Urinary incontinence
- History of preceding events
- Witness account
- Description of episode
- Looked a bit pale
- Suddenly went floppy
- May have been a few brief jerks
- Brief LOC
- Rapid recovery
- If more prolonged was the patient propped up
- Description of episode
When assessming syncope what investigations should be done?
- Examination
- Heart sounds, pulse
- Postural BPs
- Must have ECG
- Look for heart block
- QT ratio
- May need 24 hour ECG
- May need to see cardiology if recurrent (5 day recordings, reveal devices)
Consider tilt table
Describe a typical history for cardiogenic syncope?
- History of preceding events
- On exertion
- History of event itself
- Chest pain, palpitations, SOB
- Afterwards
- Chest pain, palpitations, SOB
- Came around fairly quickly
- Recovery may be longer
- Clammy/sweaty
Witness account:
- Description of episode
- Suddenly went floppy
- Looked grey/ashen white
- Seemed to stop breathing
- Unable to feel a pulse
- There may have been a few brief jerks
- Variable duration of LOC
- Rapid recovery
Do patients who have cardiogenic syncope recover quickly or slowly?
Quick recovery
What assessments are important for cardiogenic syncope?
- Family history important
- Examination
- Heart sounds, pulse
- Must have ECG
- Look for heart block
- QT ratio
- Refer to cardiology urgently/admission for telemetry
- May need 24 hour ECG/ECHO/prolonged monitoring
What is epilepsy?
Tendency to recurrent seizures
Neurons have background electrical activity, what happens if this is disrupted?
Seizures
How many unprovoked seizures are required for the term epilepsy to be used?
If patients have more than 1 unprovoked seizures:
- Also used after single seizure if investigations suggest a tendency to recurrence (over 60% risk of recurrence over 10 years)
- This could be thought due to abnormality on imagining or EEG
When can the term epilepsy be used after a single unprovoked seizure?
- After single seizure if investigations suggest a tendency to recurrence (over 60% risk of recurrence over 10 years)
- This could be thought due to abnormality on imagining or EEG
What are examples of provoked seizures?
- Alcohol withdrawal
- Drug withdrawal
- Within a few days after a head injury
- Within 24 hours of stroke
- Within 24 hours of neurosurgery
- With severe electrolyte disturbance
- Eclampsia
What is used to classify seizures?
The international league against epilepsy (ILAE)
What does ILAE stand for?
International league against epilepsy
What are the different classes of seizures from ILAE?
- Generalised seizures
- Absence seizures
- Generalised tonic-clonic seizures
- Myoclonic seizures
- Juvenile myoclonic epilepsy
- Atonic seizures
- Focal seizures
- Simple partial seizures
- Complex partial seizures
- Secondary generalised
- Or by localisation of onset (temporal lobe, frontal etc)
What are examples of generalised seizures?
- Absence seizures
- Generalised tonic-clonic seizures
- Myoclonic seizures
- Juvenile myoclonic epilepsy
- Atonic seizures
What are examples of focal seizures?
- Simple partial seizures
- Complex partial seizures
- Secondary generalised
- Or by localisation of onset (temporal lobe, frontal etc)
Compare and contrast primary and focal seizures?
What are focal seizures also known as?
Partial seizures
What is the difference in typical age between primary and focal seizures?
Primary - < 25 years
Focal - any age
What is a generalised tonic clonic seizure?
Disturbance in the functioning of both sides of your brain. This disturbance is caused by electrical signals spreading through the brain inappropriately