Epilepsy Flashcards
What is the presentation of a generalised tonic-clinic seizure?
Loss of consciousness
Patients might experience aura before the seizure
May be tongue biting, incontinence,groaning and irregular breathing
Tonic = muscle tensing
Clinic = muscle jerking
What is a post ictal period? After what type of seizure is it usually seen?
Person is confused, tired, irritable, low
Tonic clinic
Where do partial seizures most often occur?
Temporal lobe
Partial seizure in temporal lobe. How might it present?
Affects hearing, speech, memory and emotion
Awake
What is the difference between simple and complex partial seizures?
Simple = remain aware
Complex = lose awareness
What is a myoclonic seizure?
Sudden, brief muscle contractions e.g. abrupt jump or jolt
Awake
What type of epilepsy are myoclonic seizures apart of?
Juvenile myoclonic epilepsy in children
What are tonic seizures?
Tonic seizures involve a sudden onset of increased muscle tone, where the entire body stiffens. This results in a fall if the patient is standing, usually backwards. They last only a few seconds, or at most a few minutes.
What are atonic seizures?
Loss of muscle tone resulting in a fall
<3mins
Aware
What may atonic seizures indicate?
Lennox-Gastaut syndrome
What are absence seizures?
Patient becomes blank, stares in to space and then returns to normal
Unaware of surroundings
10-20s
What is west syndrome?
Infantile spasms
Starts at around 6months of age
Clusters of foul body spasms
Associated with developmental regression
What is the characteristic eeg finding in west syndrome?
Hypsarrhythmia
What is treatment of west syndrome with? (2)
ACTH
Vigabatrin
What are febrile convulsions?
Febrile convulsions are tonic-clonic seizures that occur in children during a high fever. They are not caused by epilepsy or other pathology (e.g., meningitis or tumours). Febrile convulsions occur in children aged between 6 months and 5 years. Febrile convulsions do not usually cause any lasting damage. One in three will have another febrile convulsion. They slightly increase the risk of developing epilepsy.
Which types of epilepsy are more common in children? (3)
Absence seizures
Infantile spasms
Febrile convulsion
What safety precautions are put in place with people experiencing seizures? (3)
• The DVLA will remove their driving licence until specific criteria are met (e.g., being seizure-free for one year)
• Taking showers rather than baths (drowning is a major risk in epilepsy)
• Particular caution with swimming, heights, traffic and dangerous equipment
What is the management of generalised tonic clinic seizures in:
Men/women who can’t have children?
Women who can have children?
Men/women who can’t = sodium valproate
Women who can = lamotrigine or levetiracetam
What is the management of partial seizures for:
Men/women who can’t have children?
Women who can have children?
Both = lamotrigine or levetiracetam
What is the management of myoclonic seizures for:
Men/ women who can’t have children?
Women who can have children?
Men/women who can’t = sodium valproate
Women who can = levetiracetam
What is the management of tonic and atonic seizures for:
Men/women who can’t have children?
Women who can have children?
Men/women who can’t = sodium valproate
Women who can = lamotrigine
What is the management of absence seizures?
Ethosuximide
What is a main side effect of lamotrigine?
Steven Johnson syndrome
What are some side effects of ethosuximide? (2)
Night terrors
Rash
What is carbamazepine the first line management for?
Trigeminal neuralgia
What is a side effect of carbamazepine?
Aplastic anaemia
What is a side effect of phenytoin?
Folate and vit d reduction .: osteomalacia
What is the action of sodium valproate?
Increases activity of gaba .: has a calming effect on the brain
What are some side effects of sodium valproate? (5)
• Teratogenic (harmful in pregnancy)
• Liver damage and hepatitis
• Hair loss
• Tremor
• Reduce fertility
What is status epilepticus defined as? (3)
• A seizure lasting more than 5 minutes
• Multiple seizures without regaining consciousness in the interim
more than 3 seizures in 1 hour
What is the first line treatment of status epilepticus?
A benzodiazepine first-line, repeated after 5-10 minutes if the seizure continues
□ Buccal midazolam (10mg)
□ Rectal diazepam (10mg)
□ Intravenous lorazepam (4mg)
Person is in status epilepticus and has already been given 2 doses of first line treatment. What is next option?
§ Second-line options (after two doses of benzodiazepine) are IV levetiracetam, phenytoin or sodium valproate
What is the third line options in status epilepticus?
§ Third-line options are phenobarbital or general anaesthesia
What types of benzodiazepines are used for status epilepticus in the community? (2)
□ Buccal midazolam (10mg)
□ Rectal diazepam (10mg)
What is the option for benzodiazepines for status epilepticus in the hospital?
Intravenous lorazepam (4mg)
