Epilepsy Flashcards
What is the most important thing when assessing patients with loss of consciousness?
History
What would you ask in a history in a patient with loss of consciousness?
What were you doing at the time?
What had you been doing in the previous 24hrs?
Has this happened before?
Any warning symptoms?
Any awareness during event?
How they felt on recovery
What could be some warning symptoms that someone is going to lose consciousness?
Light-headed
Sweating
Nauseated
Hot
Loss of hearing
Tinnitus
Loss of vision
In terms of how a patient felt on recovery, what may be asked?
Bitten tongue?
Incontinence?
Spell of amnesia?
Muscle pain, shoulder dislocation, etc?
Syncope?
Loss of consciousness for a short period of time
in which scenario is there more likely to be a period of amnesia; syncope or seizure?
Seizure
As well as the patient’s account of the loss of consciousness, what else can be helpful when trying to work put cause?
Eye-witness description
What are the three categories of syncope?
Reflex
Orthostatic
Cardiogenic
Which type of syncope is due to a fall in BP?
Orthostatic
Which type of syncope may occur in response to taking blood?
Reflex
Which type of syncope may occur as a result of aortic stenosis?
Cardiogenic
What would be examined in assessment of syncope?
Heart sounds
Pulse
Postural BP
Which investigation are carried out in those with syncope?
ECG
Possibly 24hr ECG
What cause of syncope could be a cardiogenic cause?
Syncope occurs upon exertion
What may a witness say about observing someone with cardiogenic syncope?
Seemed to stop breathing
Unable to feel a pulse
Patient goes grey/ashen white
If someone has cardiogenic syncope, where should they be referred to?
Cardiology urgently
Admission for telemetry
What is epilepsy?
Tendency to recurrent unprovoked seizures
What causes a seizure?
Disruption to neuronal electrical activity
List some factors that increase the risk of seizures in those with epilespy.
Missed medications
Sleep disturbances, fatigue
Hormonal changes
Drugs/alcohol
Stress, anxiety
Photosensitivity
Usually epilepsy is diagnosed when a patient has had more than one unprovoked seizure. When may a patient be diagnosed with epilepsy after one seizure?
If investigations suggest a tendency to reoccur e.g. abnormality on imaging or ECG
What are the two classifications of seizure?
Generalised seizures
Focal seizures
When do most generalised epilepsies present?
Childhood
When do focal epilepsies present?
Any age
Which investigations are important to do if a patient has seizures?
Brain imaging to ensure no structural abnormality
EEGs
Describe the presentation of generalised seizures.
Unpredictable, tend to occur in clusters
May have vague warning
Afterwards have tongue bites and incontinence
Muscle pain
Period of amnesia
What would an eye witness describe seeing in someone having a generalised seizure?
Groaning sound
Rigid phase
Eyes open- staring or roll upwards
Foaming at mouth
Jerking for few mins then groggy for 15-30mins
What is the most common type of focal seizure?
Temporal lobe seizure
Describe what the patient may say happened in a focal seizure.
Rising feeling in stomach
Funny taste or smell
Deja vu
No recollection of event
Disorientated for a spell afterwards
What would an eye witness describe seeing in someone having a focal seizure of the temporal lobe?
Sudden arrest in activity
Staring blankly into space
Automatisms e.g. lip smacking, repetitive picking at clothes
Disorientated afterwards
What would an eye witness describe seeing in someone having a focal seizure in the frontal lobe??
Starts with twitching
Often purely nocturnal
Patients recover quickly
What should be the initial assessments after a seizure?
ECG, routine bloods
A&E often arrange CT
What may be carried out for further assessment of a seizure in a neurology clinic?
MRI for focal lesion
EEG
Discuss Anti-epileptic drugs
Refer to epilepsy nurse
Which organisation needs to be informed if a patient has epilepsy?
DVLA
What is given for the first line treatment of epilepsy?.
Lorazepam, midazolam
What is given for the second line treatment of epilepsy?.
Valproate, levetiracetam or phenytoin- IV
Which drugs are mot effective in generalised epilepsy?
Sodium Valproate
Levetiracetam
Lamotrigine
Which drugs are mot effective in focal epilepsy?
Lamotrigine
Carbamazeprine
Levetiracetam
What are some side effects of sodium valproate?
Tremor, weight gain, ataxia, nausea, drowsiness, hepatitis, bone marrow suppression, drug induced parkinsonism
Which group of people should not be prescribed sodium valproate?
Women of childbearing age
What are some side effects of carbamazepine?
Ataxia, drowsiness, nystagmus, blurred vision, low serum sodium levels, skin rash
What are some side effects of lamotrgine?
Skin rash, difficulty sleeping
What are some side effects of levetiracetam?
Irritability, depression
What is status epilepticus?
Prolonged or recurrent tonic-clonic seizures persisting for more than ten minutes with no recovery period between seizures
Do patients with status epilepticus have history of epilespy?
Usually no
What is the first line treatment for ongoing seizures?
Lorazepam, given IV
If there is no IV access in patients with ongoing seizures, what is the first line treatment?
Buccal midozolam
What is meant by non-epileptic episodes/pseudoseizures?
Episodes that look like seizures but aren’t because there’s no electrical disturbance in the brain.
When are non-epileptic attacks/pseudoseizures more likely to happen?
Times of stress of at rest
What is the gold standard investigation for the diagnosis of pseudoseizure?
Video EEG
