Epilepsy Flashcards
Epilepsy
Name 4 types of generalised seizures.
- tonic-clonic
- myoclonic
- absence
- tonic, clonic, atonic seizures
Epilepsy
Name 3 types of focal seizures.
- aura
- motor
- loss of awareness or responsiveness
Epilepsy
What is a generalised seizure?
simultaneous involvement of both hemispheres
- consciousness is always lost
Epilepsy
What is a focal seizure?
electrical discharge restricted to a limited part of the cortex of one cerebral hemisphere
- consciousness may be lost of maintained
further characterisable features
- aura
- motor
- change in awareness/consciousness
Epilepsy
Focal seizures with electrical activity confined to one part of the brain may spread after a few seconds, due to failure of inhibitory mechanisms, to involve the whole of both hemispheres, causing a ____
bilateral tonic–clonicseizure
Epilepsy
What is seen in an EEG every time a pt has an absence seizure?
3Hz spike-and-wave EEG activity
Epilepsy
How does an absence seizure appear to an observer?
loss of awareness and a vacant expression for less than 10 seconds before returning abruptly to normal and continuing as though nothing had happened
Epilepsy
What are the 3 phases of a Generalized tonic–clonic seizures.
Describe each stage
prodrome
- aura may or may not be present due to speed of onset of seizure
tonic clonic
- body stiffens
- synchronous jerking of the limbs
- eyes open / tongue bitten / incontinence
post-ictal phase
- flaccid body
- consciousness returns
- confusion/drowsiness and headache often present after
Epilepsy
____ seizures or ‘jerks’ take the form of momentary brief contractions of a muscle or muscle groups: for example, causing a sudden involuntary twitch of a finger or hand. They are common in primary generalized epilepsies.
myoclonic
Epilepsy
____ seizures consist of stiffening of the body, not followed by jerking.
Tonic
Epilepsy
____ seizures involve a sudden collapse with loss of muscle tone and consciousness.
Atonic
Epilepsy
What type of seizure does this describe?
These originate within the motor cortex. Jerking typically begins on one side of the mouth or in one hand, sometimes spreading to involve the entire side. This visible spread of activity is called the Jacksonian march of a seizure. Local temporary paralysis of the limbs affected sometimes follows: Todd’s paralysis.
focal motor seizures
Epilepsy
What type of seizure does this describe?
These usually arise from the temporal lobe (60%) or the frontal lobe. There is often a preceding aura followed by a period of complete or partial loss of awareness of surroundings, lasting for 1–2 minutes on average (as opposed to 10seconds in absence seizures), which the patient generally does not remember subsequently. This stage is accompanied by speech arrest and often by automatisms : semi-purposeful stereotyped motions such as lip smacking or dystonic limb posturing, or more complex motor behaviours such as walking in a circle or undressing. The attacks may be followed by a short period of post-ictal confusion or may develop into a bilateral tonic–clonic seizure.
Focal seizures with altered awareness or responsiveness
Epilepsy
The range of causes of epilepsy is different at different ages and in different countries.
* Children and teenagers : ____
* Younger adults : ____
* Older ages (>60years) : ____
- Children and teenagers : genetic, perinatal and congenital disorders predominate.
- Younger adults : trauma, drugs and alcohol are common.
- Older ages (>60years) : vascular disease and mass lesions such as neoplasms are important.
Epilepsy
Name 3 types of primary generalized epilepsies
- childhood absence epilepsy
- juvenile myoclonic epilepsy
- monogenic disorders
Epilepsy
What examples of infections may cause a seizure?
- encephalitis
- cerebral abscess
- tuberculomas
- chronic meningitis
Epilepsy
What metabolic abnormalities could cause a
seizure?
- hypocalcaemia, hypoglycaemia, hyponatraemia
- acute hypoxia
- uraemia, hepatic encephalopathy
- porphyria
Epilepsy
What kind of drugs may caused a seizure?
- psychiatric drugs
- cocaine
Epilepsy
What investigations are carried out following an episode of loss of consciousness?
Blood tests (serum calcium)
ECG
Epilepsy
How to take a history of a seizure:
Witness account is crucial.
* What happened:
– Before: aura versus pre-syncopal prodrome
– During: convulsion, automatisms versus brief syncopal blackout and pallor
– After: post-ictal confusion and headache versus rapid recovery in syncope
* Circumstances:
– Seizure triggers? Sleep deprivation, alcohol binge or drugs
– Syncope triggers? Pain, heat, prolonged standing
* Epilepsy risk factors?
– Childhood febrile convulsions
– Significant head injury
– Meningitis or encephalitis
– Family history of epilepsy
* Previous unrecognized seizures?
– Myoclonic jerks
– Absences
– Auras (focal seizures)
* Alcohol excess?
* Medication lowering seizure threshold?
* Hold a driving licence?
Epilepsy
What counts as a prolonged seizure?
> 5mins
Epilepsy
How do we terminate a seizure in an emergency?
rectal diazepam, intravenous lorazepam or buccal midazolam
Epilepsy
How do we manage the post-ictal phase (after emergency management)?
Oxygen should be given and the airway monitored
Epilepsy
What do we call this:
a medical emergency where there are continuous seizures for 30 minutes or longer
status epilepticus
Epilepsy
How do we manage status epilepticus in an early status (<30mins)?
- O2
- monitor ECG + bp
- routine bloods
- lorazepam i.v. 4mg bolus
Epilepsy
What are some first-line treatments for generalised tonic-clonic seizures?
3
Sodium valproate
Levetiracetam
Lamotrigine
Epilepsy
What are some first-line treatments for focal seizures withough secondary generalisation?
Carbamazepine
Lamotrigine
Levetiracetam
Epilepsy
What are some first-line treatments for myoclonic seizures?
Sodium valproate
Levetiracetam
Topiramate
Epilepsy
What medication might make a myoclonic seizure worse?
Carbamazepine
Epilepsy
What are some generalise principles to AED prescribing?
- start at low dose and titrate up slowly
- aim for mono-therapy
Epilepsy
What are some common SE of AEDs?
unsteadiness
nystagmus
drowsiness
skin rashes
Epilepsy
Baseline blood investigations include:
- FBC
- U&Es
- LFTs
- Calcium profile
- Glucose level – assessing for any acute infective or biochemical causes of seizures.
Epilepsy
Status epilepticus:
If no IV access has been established, then immediate treatment is ____.
rectal diazepam
Epilepsy
Status epilepticus:
If IV access has been established, then immediate treatment is ____.
IV lorazepam
Epilepsy
Status epilepticus
If seizures remain ongoing despite the administration of two doses of lorazepam, then the algorithm progresses to more specialised drugs such as ____ .
phenytoin, phenobarbital or levetiracetam
Epilepsy
What is SUDEP?
sudden unexplained death in epilepsy
It is rare, but pt need to be councelled about it.
Epilepsy
What medication is considered first-line for women of child-bearing age of all seizure types?
Why?
Lamotrigine
- it is the least teratogenic of the commonly-used anti-epileptic drugs
Epilepsy
What are some common triggers for seizures?
- alcohol
- drugs
- sleep deprivation
- non-compliance with medication
- stress
