Epilepsy Flashcards
How is epilepsy diagnosed
If any of following criteria is met
- at least 2 unprovoked seizures occurring greater than 24 hrs
- One unprovoked seizure and a probability of further seizures of at least 60% after 2 unprovoked seizures, occurring over next 10 years
- diagnosis of an epilepsy syndrome
What is the new basic seizure classification
Based on 3 things
- where seizures begin in the brain
- level of awareness during a seizure
3, other features of seizures
How does generalised tonic-clonic seizure present
loss of consciousness, stiffening and jerking of the body
- may bite their tongue
-experience incontinence of urine
typically have POSTICTAL phase where they feel drowsy and tired for around 15 minutes
How do focal seizures present
can either be aware or impaired awareness
frontal lobe - motor abnormalities and Jacksonian movements
parietal lobe - sensory abnormalities
temporal lobe - automatisms - smacking of lips etc
aura - hallucinations, rising epigastric sensation
Occipital lobe - floaters/flashes
How do myoclonic seizures present
bilateral upper and lower limb contracting and relaxing
No loss of consciousness, incontinence or postictal periods
How do absence seizures present
episodes of staring blankly into space and being unresponsive
typically seen in children aged 3-10 years, most patients become seizure free in adolescence
no automatism
How do atonic seizures present
sudden weakness in all body muscles, short duration and retained awareness
What investigations are required
EEG-
Absence seizures - 3Hz spike and wave
MRI
What is status epilepticus
defined as a single seizure lasting >5 minutes OR
> =2 seizures within a 5 minute period without person returning to normal between them
How do you manage Status epilepticus
ABC-
airway adjunct , oxygen , check blood glucose
First line drugs IV BENZODIAZEPINES - diazepam or lorazepam
What should be given in pre hospital setting for status epilepticus
PR diazepam
Buccal Midazolam
What should be given in hospital setting for status epilepticus
IV lorazepam - can be repeated once after 10-20 minutes
What is the next line of management for status epilepticus
if ongoing - start PHENYTOIN or PHENOBARBITAL infusion
If no response within 45 minutes - induce general anesthesia using
THIOPENTAL SODIUM
When do you start antiepileptics following a second epileptic seizure
Start after first seizure if
- patient has a neurological deficit
-brain imaging shows a structural abnormality
-the EEG shows unequivocal epileptic activity
How do you treat generalised tonic-clonic seizures
males- sodium valproate
females - lamotrigine or levetiracetam
