epilepsy Flashcards
what are the types of seizures?
myoclonic seizures
tonic clonic
atonic
generlaised tonic -clonic
partial or focal seizures
what seizures are most common in children?
febrile
absence
infantile spasms
what are tonic clonic seizures?
tonic - muslce tensing
clonic - muscle jerking
associated with complete loss of consciousness
what is involved within tonic clonic seizures?
aura - warning pre seizure
during; tongue bititng, incontinence, groaning and irregular breathing
post ictal: confused, tired, irritable and low
where do partial seizures occur?
one area in the brain - usual temporal
what does partial seizures affect?
hearing, speech, memory, emotions
what occurs during partial seizures?
remain awake
can remain aware in simple but lose awareness in complex partial seizures
what symptoms occur during partial seizures?
deja vu
strange smells, taste, sights or sound sensation
unusual emotions
abnormal behaviours
what are myoclonic seizures?
sudden, brief msucle contractions like abrupt, jump or jolt
remain awake
what are tonic seizure’s?
sudden onset of increased muscle - often results in fall
last briefly
begin in childhood
what are atonic seizures?
drop attacks - sudden loss in muscle tone - results in a fall
what are absence seizures?
usually in children
Patient becomes blank, stares in space
then abruptly returns to normal
do not respond and unaware of surroundings
what are infantile spasms?
also known as west syndrome
presents at 6mths
clusters of full body symptoms
how do you detect infantile spasms?
hypsarrhthymias - on EEG
how is infantile spasms managed?
associated with developmental regression and has poor prognosis
treat with ACTH and vigabatrin
what are febrile convulsions?
tonic clonic seizures occurring in children with high fevers
are febrile convulsions linked to epilepsy?
do not cause lasting damage
have a slight risk of developing epilepsy
how do you investigate epilepsy and why?
EEG: typical patterns show different forms of epilepsy
MRI brain: diagnose structural pathology
ECG
serum electrolytes- sodium, potassium , calcium and magnesium
blood glucose: hypoglycaemia and diabetes
blood cultures, urine cultures and LP
what general management need to be taken with seizures?
DVLA remove their driving licence - until seizure free for one year
taking showers rather than baths
caution with swimming, heights, traffic and dangerous equipment
for men, what is 1st line management for generalised tonic -clonic?
sodium valproate
for women of childbearing age, what management should they have for generalised tonic clonic seizures?
lamotrigine
levetiracetam
what management is given for partial or focal seizures?
lamotrigine
levetiracam
what medication is given in myoclonic seizures?
sodium valproate - men
levetiracim - women of childbearing age
what medication is given to tonic atonic seizures?
men- sodium valproate
women of childbearing age - lamotrigine
what medication should be given to absence seizures?
ethosuximide
how does sodium valproate work?
increasing activity of GABA - calming effect on the brain
what are the side effects are sodium valproate?
teratogenic - harmful in pregnancy
liver damage and hepatitis
hair loss
tremor
reduce fertility
why is sodium valproate tetrogenic?
neural tube defects and developmental delay
what is valproate pregnancy prevention?
ensure effective contraception
fill out annual acknowledgement form
how do you define status epilepticus?
seizure lasting more than 5mmins
mulitple seizures without regaining consciousness between
how do you manage status epilepticus?
ABCDE
secure airway
high flow oxygen
check BMs
gaining IV cannula
what are medical management for status epilepticus?
benzopdiazepines - repeat after 5-10 mins after seizures
second line - after benzo = IV levetiracetam, phenytoin, sodium valproate
third line - phenobarbita or GA
