Epilepsy Flashcards
Define epilepsy
Neurological disorder -> enduring predisposition to generate epileptic seizures.
Seizures are transient and due to abnormal excessive or synchronous neuronal activity in the brain
Define status epilepticus
A type of seizure - lasting longer than 5mins or multiple seizures without full recovery between them.
What is the key epidemiology of epilepsy?
50 million worldwide
7.6 per 100 people
Higher rates in very young and elderly
What are the different idiopathic Generalised Epilepsies?
Childhood absence epilepsy
Juvenile absence epilepsy
Juvenile myoclonic epilepsy - jerking no loss of consciousness
Generalised tonic (stiffening) clonic (followed by jerking) seizure alone -> loss of consciousness
What are the different aetiologies of epilepsy?
Acquired - stroke, trauma
Genetic - malformation of cortical development
Infectious
Metabolic
Immune
Unknown
What are the key signs and symptoms of a focal seizure in epilepsy?
Impaired consciousness ‘complex’ -> poust aura or onset, post-ictal confusion is common, originate from temporal lobe
Without impaired consciousness ‘simple’ -> focal only, post-ictal absent
Evolving to a bilateral, convulsive seizure - ‘secondary generalised’ -> focal seizure that becomes generalised tonic clonic
What are the key signs and symptoms of a generalised seizure in epilepsy?
Absence seizures - brief pause for less than 10 seconds
Tonic-clonic seizures - loss of consciousness, stiffness, jerking, post-ictal confusion is common.
Myoclonic - sudden jerking
Atonic - loss of muscle tone, fall, consciousness retained
What are the key features of temporal lobe epilepsy?
Complex partial seizures
Sensory auras or autamatism intially
Postictal confusion
What are the key features of a Jacksonian March epilepsy seizure?
Focal motor seizure progressively spreads to neighbouring brain areas
Norm hand/face then to other muscle groups following somatotopic mortex cortex
May become generalised tonic clonic
Often associated with structural brain lesions
What are the key features of Todds Paresis epileptic syndrome?
Temporary postictal weakness or paralysis following a seizure
From mins to hrs -> can last up to 48hrs
Usually unilateral but can be bilateral
Transient so patient recovers
What is requires for a diagnostic workup of epilepsy?
Detailed history and neurological examination
Collateral history
CT or MRI
EEG
Contributatory causes should be ruled out with blood tests, lumbar puncture and more advanced imaging investigations.
What drugs may be used as anti-epileptics?
Normally started after a second seizure.
Lamotrigine or Levetiracetam -> first line for focal
Sodium valproate -> myoclonic seizure in males (risk risk tetrogenicity in females)
Ethosuximide -> absence seizures
What are the key complications of epilepsy?
Status epilepticus
Psychiatric complications -> inc risk of depression and suicide
Sudden unexpected death in epilepsy -> excessive electrical activity induces a cardiac arrhythmia and subsequent death
What is the acute management of status epilepticus?
Premonitory stage (up to 10mins) 10mg buccal midazolam or 20mg diazepam per rectally, repeat in 15 mins
Early status (up to 30mins) - community as above, in hospital IV lorazepam 0.1mg/kg
Established (up to 60mins)
2 doses benzodiazepines _ second line leveitracetam, phenytoin and soidum valproate
What is the key treatement for a refractory stage of status epilepticus?
General anaesthetisa - propoofol 1-4mk/kg bolus
Midazolam - 0.2mg/Kg titrate to effect
Thiopental sodium -> 5mg/kg
Anaesthetic for up to 24 hrs.
What key investigations should be done for status epilepticis?
ABG
Routine bllods - FBC, U&E, LFT, CRP, clotting and bone profile
Toxicology screen (urine)
Anti epileptic drugs (if approprate)
CT?MRI brain imaging Lumbar puncture
What are some potential risk factors for epilepsy?
Genetics
Head trauma
Tumours = common in supratentorial ares
Infections ->meningitis and encephalitisis
Electrolyte - hyper and hyponatremia, hypoglycaemia, hypocalcemia, hyperMg+
What are some potentialal triggers for epiledy?
Sleep deprivation
Playing video games or watching television
What are infantile spasms?
Also called west Syndrome
4-8months age -> myoclonic jerking termed jack-kinfe spasm in clusters
Associated with developmental regerssion and high morbidity.
What is key for the diagnosis fo infantile spasm?
Seizure activity - myoclonus - jack-kinfe spasms
EEG - hypsarrythmia
What is the cause of infantile spasm?
Most have gentic abnormalities or metabolic conditions or brain injuries/malformation
1 in 3 have no known cause for the seizures
What is the typical management for infantile spasms?
Prednisolone
ACTH
Vigabatrin
Optimise child development to reduce decline
What is a potential complication of infantile spasm?
Develop Lennox-Gastaut later in life.
