Epilepsy Flashcards
what is part of the seizure which may be a strange feeling, deja vu, strange smells, flashing lights
aura- implies focal/partial seizure
what symptoms can you get post ictally
headache, confusion, myalgia, sore tongue, temporary weakness (focal seizure in motor cortex), dysphasia (impairment of communication)(if in temporal lobe)
what makes up 2/3 of seizures
idiopathic
structural causes of seizures
cortical scarring, developmental, space occupying lesions, stroke, hippocampal sclerosis, vascular malformation
other causes of seizures
tuberous sclerosis, sarcoidosis, SLE, PAN
non epileptic causes of seizures
trauma, stroke, haemorrhage, incr ICP, alcohol, benzodiazepine withdrawal
metabolic disturbances causes of seizures
hypoxia, changes in Na, calcium decr, glucose incr, uraemia, liver disease, infection, temperature, drugs, pseudoseizures
investigations
24h admission for bloods, drug screen, LP, EEG, CT/MRI
what are focal seizures
focal onset with features referable to a part of one hemisphere. often seen with underlying structural disease
what happens in a simple partial seizure
awareness unimpaired, focal motor sensory autonomic or psychic symptoms. no post ictal symptoms
what happens in a complex partial seizure
awareness impaired. may have simple partial onset - aura or impaired awareness at onset. commonly arise from temporal lobe. recovery rapid after seizures in frontal love, confusion common if temporal lobe
what happens in a partial seizure with secondary generalisation
in 2/3 patients with partial seizures, electrical disturbance spreads widely causing secondary generalised seizure- convulsive
what is a primary generalised seizure
simultaneous onset of electrical discharge throughout the cortex with no localising features referable to only one hemisphere
what types of seizures are primary generalised seizures
absence, tonic-clonic, myoclonic, atonic (akinetic), infantile spasms
what happens in an absence seizure
brief pauses. presents in childhood
what happens in tonic-clonic seizures
loss of consciousness. limbs stiffen (tonic), then jerk (clonic). can have one without the other. post ictal confusion and drowsiness
what happens in myoclonic seizures
sudden jerk of limb, face or trunk. may be thrown suddenly to the ground or violently disobedient limb
what happens in atonic seizures
sudden loss of muscle tone causing a fall no loss of conciousness
what are infantile spasms commonly associated with
tuberous sclerosis
what are localising features of focal seizures in the frontal lobe
motor features, motor arrest, behavioural differences, dysphasia or speech arrest, post ictal Todds palsy
what are localising features of focal seizures in the parietal lobe
sensory disturbances- tingling, numbness, pain. motor symptoms
what are localising features of focal seizures in the occipital lobe
visual phenomena- spots, lines, flashes
what are localising features of focal seizures in the temporal lobe
automatisms (complex motor- impaired awareness and no recollection after); abdominal rising sensation or pain; dysphasia; memory phenomena; emotional disturbance (hippocampal involvement); hallucinations; delusional behaviour
what is the first line of treatment for generalised tonic clonic seizures
sodium valproate or lamotrigine is 1st line. carbamazepine or topiramate.
drugs used in absence seizures
sodium valproate, lamotrigine, ethosuximide
what drugs may worsen seizures in tonic, atonic and myoclonic seizures
carbamazepine, oxcarbazepine
if drugs don’t work what can be done
neurosurgical resection (70% improvement); vagal stimulation (33% improvement)
what is sudden unexpected death in epilepsy associated with
nocturnal seizure associated apnoea or asystole
doses and side effects carbamazepine
100mg/12h incr by 200mg/d every 2 weeks up to max 1000mg/12. SE: leucopenia, diplopia, blurred vision, impaired balance, dwosy, erythematous rash, SIADH
doses and side effects lamotrigine
monotherapy- 25mg/day, incr by 50mg every 2 weeks to max 250mg/12h. SE- maculopapular rash, diplopia, blurred vision, photosensitivity, tremor, agitation, vomiting, aplastic anaemia
doses and side effects phenytoin
no longer first line due to toxicity. SEs- depression, coarse facial features, acne, gum hypertrophy, hypertrophy.
doses and side effects sodium valproate
300mg/12h incr by 100mg every 3 days. nausea very common. SEs- VALPROATE- Valproate, Appetite incr, Liver failure, Pancreatitis, Reversible hair loss, Oedema, Ataxia, Teratogenicity Tremor Thrombocytopenia, Encephalopathy
what feature is important of anti epileptic drugs for pregnant women
teratogenicity. take folic acid 5mg/d. valproate in particular should be avoided
