Epilepsy Flashcards
What is epilepsy?
Condition characterised by seizures
What are seizures?
Transient episodes of abnormal electrical activity in the brain
What types of seizures are seen in adults?
Generalised tonic-clonic seizures
Partial seizures (or focal seizures)
Myoclonic seizures
Tonic seizures
Atonic seizures
What types of seizures are seen in adults?
Absence seizures
Infantile spasms
Febrile convulsions
What is a partial seizure?
Occur in an isolated brain area, often the temporal lobe
What do partial seizures affect?
Hearing, speech, memory and emotions
Are patients awake in a partial seizure>
Yes
What are symptoms associated with partial seizures?
Déjà vu
Strange smells, tastes, sight or sound sensations
Unusual emotions
Abnormal behaviours
How do myoclonus seizures present?
With sudden, brief muscle contractions
What can myoclonic seizures occur as part of>
Juvenile myoclonic epilepsy
What do tonic seizures involve/
Increased muscle tone, where the entire body stiffens
What do tonic seizures result in?
A fall if the patient is standing
What do a tonic seizures involve?
A sudden loss of muscle tone, often resulting in a fall
When do atomic seizures begin?
In childhood
What may atonic seizures indicate?
Lennox-Gastaut syndrome.
Who are absent seizures typically seen in?
Children
Do absent seizures stop?
They stop as the get older
What is the differential diagnosis in epilepsy?
Vasovagal syncope
Pseudoseizures
Cardiac syncope
Hypoglycaemia
Hemiplegic migraine
TIA
What investigations should be done?
electroencephalogram (EEG)
MRI brain
What additional investigations can be considered?
ECG
Serum electrolytes
Blood glucose
Blood cultures, urine cultures and lumbar puncture
What is the treatemnt of generalised tonic clonic seizures?
Men, Women who cannot have children = sodium valproate
Women able to have children= lamotrigine or levetiracetam
Partial or focal seizure management?
Lamotrigine or Levetiracetam
Myoclonic seizures management?
Men and women who cannot have children = sodium valproate
Women able to have children = Levetiracetam
Tonic and atonic seizure management?
Men, women who cannot have children = sodium valproate
Women who can have children = lamotrigene
Absent seizure treatment?
Ethosuximide
How does sodium valproate work?
Increase the activity of gamma-amino uteric acid (GABA) => calming effect of the brain
What are side effects of sodium valproate?
Teratogenic (harmful in pregnancy)
Liver damage and hepatitis
Hair loss
Tremor
Reduce fertility
What can sodium valproate cause in pregnancy?
Neural tube defect and developmental delay
What is status epilecticus?
Medical emergency
Seizure lasting more than 5 minutes
Multiple seizures without regaining consciousness in the interim
What does management of of status epilecticus involve?
ABCDE approach:
Securing the airway
Giving high-concentration oxygen
Checking blood glucose levels
Gaining intravenous access (inserting a cannula)
What is the medical treatment for status epilecticus?
First line = benzodiazepine, repeated after 5-10 mins if the seizure continues
Second line= IV levetiracetam, phenytoin or sodium valproate
Third line = phenobarbital or general anaesthesia
