Epilepsy Flashcards
Risk factors for epilepsy (7)
Birth Development Seizures in past inc. febrile Head injury Family history Drugs Alcohol
When do we do an ECG and why
Single seizure or first fit ALWAYS
Long QT syndrome can present with seizure
Imaging in seizure
MRIb and CTb
MRIb subtle structural abnormalities in brain could be seizure focus
Who gets a CT scan acutely (6)
- Clinical or radiological skull fracture
• Deteriorating GCS
• Focal signs
• Head injury with seizure
• Failure to be GCS 15/15 4 hours after arrival
• Suggestion of other pathology – eg SAH
When do we use EEG
Classify epilepsy, surgical evaluation, confirmation of non convulsive status, confirmation of non epileptic attack
Do not use to figure out cause of attack. USE HISTORY
Driving and epilepsy - if you have 1 seizure
6months no car
5 years lorry
Driving and epilepsy - Epilepsy diagnosed
1yr no car
3yrs no car if seizure in sleep
10 years off medication for lorry
When do we counsel about SUDEP
At first diagnosis
What is a seizure?
seizure is abnormal synchronisation of neuronal activity - usually excitatory with high frequency action potentials
Interruption of normal brain activity - focal or generalised
Usually brief - secs to mins
If seizure area in brain affects right frontal lobe
Motor cortex
Left motor symptoms - left arm stiff
If seizure in occipital lobe
Visual changes
If seizure in temporal lobe
Abnormal memories, epileptic deja vu
If seizure in limbic system
Fear and emotion
Broad classifications of epilepsy (2)
Generalised
Partial/focal epilepsy
Tx of choice for primary generalised epilepsy
Sodium Valproate
Tx of choice for focal onset epilepsy and why
Carbemazepine
or lamotrigine
sodium valproate works but not 1st choice as side effects
When do we use phenytoin
Anticonvulsant only used acutely - long term effects include gum hypertrophy
When do we NOT use carbemazepine
Primary generalised epilepsies
Can make them worse
What is sodium valproate
Domestos of anticonvulsants however with lots of side effects
Side effects of sodium valproate (4)
Weight gain
Teratogenic
Hair loss
Fatigue
Use of Lamotrigine
Well tolerated in generalized and focal epilepsies
Anti convulsants that induce hepatic enzymes
Carbamazepine, oxcarbazepine, phenobarbitol, phenytoin, primidone, topiramate
Why should we be aware of anti convulsants that induce hepatic enzymes
Can alter efficacy of COCP
Morning after pill dose must be increased
What is status epilepticus?
- Recurrent epileptic seizures without full recovery of
consciousness - Continuous seizure activity lasting more than ?30
minutes
Types of status epilepticus (3)
– Generalized convulsive status epilepticus
– non convulsive status
• conscious but in “altered state”
– Epilepsia partialis continua
• continual focal seizures, consciousness preserved
Precipitants of status (6)
• Severe metabolic disorders – hyponatraemia, pyridoxine deficiency • Infection • Head trauma • Sub-arachnoid haemorrhage • Abrupt withdrawl of anti-convulsants • Treating absence seizures with CBZ
Complications of convulsive status
• Excess cerebral energy demand and poor substrate delivery causes lasting damage • Can cause – respiratory insufficiency and hypoxia – hypotension – hyperthermia – rhabdomyolysis
Managing status
• Stabilize patient – ABC • Must identify cause!! – Emergency blood tests +/- CT • Anti-convulsants – Phenytoin (check levels) – Keppra – valproate – Benzodiazepines • A quick way to admit to ITU
Simple focal seizures
Small part of brain affected, person conscious, doesnt spread. A SFS are sometimes called auras as it can be a warning of another seizure -> secondary generalised
Complex focal seizures
Affects a larger part of one hemisphere, consciousness may be affected
Secondary generalised seizures
Focal start then generalises and moves across network in brain
Unconscious
Tonic colonic
Absences (petit mal)
Unreactive to stimulus, unaware of what doing, may be confused with day dreaming
Tonic seizures
Muscles suddenly become stiff
Atonic seizures
Muscles relax suddenly
Myoclonic seizures
Muscle jerks
Tonic colonic (grand mal)
At the start of the seizure:
the person becomes unconscious their body goes stiff and if they are standing up they usually fall backwards they may cry out they may bite their tongue or cheek. During the seizure:
they jerk and shake (convulse) as their muscles relax and tighten rhythmically
their breathing might be affected and become difficult or sound noisy
their skin may change colour and become very pale or bluish
they may wet themselves.
After the seizure (once the jerking stops):
their breathing and colour return to normal
they may feel tired, confused, have a headache or want to sleep.
