Epilepsy Flashcards
If a patient has at least 2 unprovoked (or reflex) seizures occurring more than 24 hours apart, what could this be?
Epilepsy
If a patient has one unprovoked (or reflex) seizure and a probability of further seizures are similar to the general recurrence risk of after 2 unprovoked seizures (at least 60%), over the next 10 years, what diagnosis is this?
Epilepsy
‘The transient occurrence of signs or symptoms due to abnormal excessive or synchronous neuronal activity in the brain’ - is the definition of what?
A seizure
If a patient has a Seizure that lasts more than give minutes or recurrent one after another with no recovery time in between what is this called?
Status Epilepticus
What can Status Epilepticus be triggered by?
Head injury, metabolic disturbance (hypoglycaemia), cerebrovascular event (stroke) or alcohol withdrawal.
How should Status Epilepticus be managed non-pharmacologically in the community?
1) Note start time of seizure
2) Provide first aid, when stops put in recovery position
If a patient in the community is in ‘status epilepticus’ what and when should drug management be given?
5+ minutes of seizure or 3 seizures in one hour.
First line - Buccal Midazolam or Rectal Diazepam , if continues call 999.
What medications can be given if the patient is still seizing after 5-20 mins?
IV lorazepam (0.1mg/kg MAX 4mg)
NO IV access? - Buccal midazolam
NO response after 10-20 mins *Give second dose = NO MORE THAN TWO DOSES!!
After 20-40 minutes the patient is in established status epilepticus, what medications should be given IV?
AED’s
* Levetiracetam
* Sodium valproate
*Phenytoin or fosphenytoin
If a patient is in refractory Status Epilepticus (40-60 mins), what should be done?
Transfer to ITU.
What is SUDEP?
Sudden unexpected death in epilepsy
What is the cause of Epilepsy?
○ Structural - stroke, trauma, injury
○ Genetic
○ Infectious - TB, Malaria
○ Metabolic
○ Immune - Anti NMDA encephalitis
Idiopathic
What are the risk factors of Epilepsy?
○ Premature birth
○ Febrile seizures (high temp causes!)
○ Brain development malformation
○ Family history of epilepsy or neurological disease
○ Head trauma
○ Infections (meningitis and encephalitis)
○ Tumours ○Cerebrovascular disease/stroke
○ Dementia and neurodegenerative disorders (Alzheimer’s disease)
○Drugs and alcohol withdrawal
What is gold standard for diagnosis of neonates having seizures?
EEG
What testing will be done on a patient who has a new onset of Seizures?
Antibody testing
What are the three seizure types?
1) Focal
2) Generalised
3) Unknown
What are the types of Focal seizures?
Aware/impaired awareness - Motor or Non-motor onset. - Focal or bilateral tonic-clonic
What are the types of Generalised seizures?
Motor (tonic-clonic/other motor)
Nonmotor (absence)
What are the types of unknown seizures?
Motor (tonic-clonic/other motor)
or unclassified
What types of epilepsy are there?
-Focal
-Generalised
-Combined generalised and focal
-Unknown
What is a tonic seizure?
Sustained increased muscle contraction (tense and rigid muscles)
What does ‘motor’ mean during a seizure?
Movement during a seizure
What does ‘non-motor’ mean during a seizure?
No movement during a seizure
What is a myoclonus seizure?
Muscle twitching (can involve single or multiple muscle groups)