Epilepsy 2 Flashcards
What counselling is required when someone presents with seizure or epilepsy ?
Explain the diagnosis & if its first seizure explain that this doesn’t unnecessarily mean epilepsy as not everyone who has a seizure goes on to develop epilepsy
Explain there is a risk of seizure recurrence however and that the DVLA MUST be informed
If someone present with there 1st isolated seizure then what are the guidelines on driving a car and a lorries or other large vehicles (HGV/ PCV) ?
- For car you are allowed to drive again after 6 months if no further seizures occur
- For lorries & other large vehicles (HGV/ PCV) you are allowed to drive them again after 5yrs if no further seizures occur
If someone is diagnosed with epilepsy what are the guidelines on driving ?
- For driving a car - if only ever had asleep seizures (happen as you are falling sleep, while you are asleep or as you are waking up) can drive if not had one in 1yr
- For driving a car - if history of awake seizures then have to wait 3yrs since last awake seizure
- For driving a lorry & other large vehicles e.g. bus - can only drive again after 10yrs without an epileptic attack & haven’t taken anti-epileptic medication for 10yrs
What are the risk factors for developing epilepsy ?
- Brith - SGA, born with abnormal areas of the brain
- Development - conditions with intellectual & developmental disabilities, seizures in past - including febrile
- Head injury - including loss of consciousness
- Fam history - of seizures/ epilepsy
- Drug history - cocaine, opiates, analgesics e.g. tramadol, theophylline, anti-emetics e.g. prochlorperazine, antibiotics e.g. penicillins, cephalosporins, quinolones, Alcohol & benzo withdrawal
What are the indications for a CT scan acutely ?
- Clinical or radiological skull fracture
- Deteriorating GCS
- Focal neurological signs (i.e. certain areas affected)
- Head injury with seizure
- Failue to be GCS 15/15 4hrs after survival
- Suggestion of other pathology e.g. SAH
Who does epilepsy more commonly present in ?
Infants & old age
Who is focal and generlaised epilepsy more in?
- Generalised epilepsy is more common in young people
- Focal epilepsy is more common in adults
What are the 3 main classifications of epilepsy ?
- Focal (partial)
- Generalised
- Unclassified
Describe in general terms what focal (partial) seizures are and why MRI is important in the investigation of them
- Focal seizures have focal onset with features referrable to part of one hemisphere (i.e. can localise the features seen to an area of the brain being affected)
- It is usually due to an underlying structural abnormality (rather than being idiopathic) hence MRI imaging is key in the investigation of these type of seziures
What is the link/ crossover between focal and generalised seizures ?
Focal seizures can develop into generalised seizures but note that they have a focal onset to begin with
Describe in general terms what a generalised seizure is
This is a seizure which causes simultaneous onset of electrical activity throughout the cortex with no localising features referrable to only one hemisphere
How can focal (partial) seizures be further classified ?
Can be classified as simple or complex
In general terms what is the range of symptoms someone may experience with focal seizures ?
Some may experience movements (motor-symptoms) & some may experience unusual feelings or sensations (non-motor & psych symptoms)
Specifically now what are the different motor symptoms someone experience with a focal seizure ?
- Lip-smacking or chewing movements
- Repeatedly picking up objects or putting on clothes
- Suddenly losing muscle tone & limbs going floppy, or limbs suddenly becoming stiff
- Repetitive jerking movements that affect one or both sides of the body
- Making a loud cry or scream
- Making strange postures or repetitive movements such as cycling or kicking
Specifically what are the different non-motor symptoms someone having a focal seizure may experience ?
Sensory:
- Getting an unusual smell or taste
- Strange feeling like a ‘wave’ going through the head
- Stiffness or twitching in part of the body (such as arm or hand)
- Feeling of numbness or tingling
- Sensation that arm or leg feels bigger or smaller than it actually is
- Visual disturbances such as coloured or flashing lights
Psych:
- Hallucinations (visual)
- Deja vu
- Jamais vu - involves a sense of eeriness and the observer’s impression of seeing the situation for the first time, despite rationally knowing that he or she has been in the situation before
- Depersonalisation - ones thoughts or feelings seem unreal or not belonging to them
- Aphasia
Define a simple focal seizure
This is a focal seizure where consciousness is unimpaired, with focal motor, sensory, autonomic or psychiatric symptoms. No post-ictal symptoms
Define a complex focal seizure
- This is a focal seizure where consciousness is impaired. May have a simple focal onset (= aura) or impaired consciousness from the onset. Most commonly arise from the temporal lobe (so ans might be a temporal lobe seizure)
- Post-ictal confusion is common with temporal lobe seizures, whereas recovery is rapid after seizures in the frontal lobe
Define secondary generalised seizures
- This occurs in 2/3rds of focal seizures, it is where electrical disturbance which starts focally spreads widely throughout cortex
- When this happens the person becomes unconscious & will usually have a tonic clonic (convulsive) seizure
What features of a focal seizure would suggest it is occurring in the temporal lobe ?
Think ‘HEAD’
- Hallucinations - auditory, smell or taste
- Epigastric (rising) discomfort/ Emotional (sudden terror, panic, elation)
- Automatisms - lip smacking, grabbing, plucking, signing, kissing, driving etc
- Dysphagia/Deja vu(+ jamais vu)
Automatism = action performed unconsciously & no recollection afterwards
What features of a focal seizure would suggest it is occurring in the frontal lobe ?
Think ‘motor’ features
- Head and leg movements
- Posturing movements
- Motor arrest (unable to move)
- Post-ictal weakness (todds palsy)
- Jacksonian march - spreading of focal motor seizure with retained awareness often starting with face or a thumb
What features of a focal seizure would suggest it is occurring in the parietal lobe ?
- Sensory disturbances - paraesthesia (tingling & numbness), pain (rare)
What features of a focal seizure would suggest it is occurring in the occipital lobe ?
Visual phenomena such as flashes or floaters
