Epilepsy Flashcards
What is the classification of seizures?
Clonically: partial, generalised.
Partial: only involve 1 portion of the brain at their onset. Altho may become generalised (2o generalised tonic-clonic seizures)
What are generalised seizures?
Tonic clonic (grad mal) Absence seizures (petit mal) Myoclonic seizures (rare, involuntary muscle jerks)
What are partial seizures?
.
Simple partial seizures - no impairmwnt of consciousness eg Jacksonian seizures
Complex partial seizure- w/ Impairment of C, eg temporal lobe epilepsy
What are tonic clonic seizures??
Sudden onset of rigit tonic phase followed by a convulsion (clonic phase) in which the miscles jerk rheythmically.
Sec-mins , +/- assc w/ tongue biting + urine incontinence and followed by period of drowsiness + coma for several hours.
Grad mal
What are petit mal seizures?
Typical absences- usually a disorder in childhood, kid ceases activity, stares and pales for a few seconds only.
3Hz spike on EEG.
What are Jacksonian seizures?
Whats Todds paralysis?
Motor seizures- simple partial seizures originate in motor cortex- jerking movements, usually starting at lips and mouth corners, fingers, thumb, then limbs of opposite site of epileptic focus.
Paralysis of the involved limb for several hours.
What are temporal lobe seizures?
Complex partial seizures assc w/ olfactory and visual hallucinations, feelings of unreality (jamais -vu) or undue familiarity (deejavu) with surroundings.
What are some precipitating fx and the aeriology?
Flashing lights or a flickinh television screen may provoke attack to susceptible pts.
Aeriology: no cause is found in 2/3 Known causes: CVD- 15%, Cerebral tumours- 6% Alcohol related seizures-6% Post traumatic epilepsy 2%
Rarer- hipoocampal sclerosis- poss resection, malformations of cortical developmen, vascular malformations. Encephalotis.
Occasionally: matabolic: ‼️ hypoglycaemia, hypoxia, hypocalcaemia,mhyponatraemia, -> convolusions.
30%-1st FHx
1o epilepsies- complex developmental abnormalities or neuronal control- abn synaptic connections amd distribution + release of neurotransmitters.
How would you evaluate and investigate?
3 steps
- Confirm its epilepsy- dx- clinically- detailed witness invaluable. Differentiate from disorders that might be causing conculsions.
- Determine seizure type
- Identify underlying cause.
E EG- single most useful- during- cortical spike focus in temporal lobe eg or by genetalized spike and wave activity.
CT or MRI in all for the cause except kids.
Pick up rate for treatable causes low.
How would u manage epilepsy?
Emergency- no harm, ABC.
DRUGS- when definite dx of recurrent seizures or substantial risk of recurrence
1st line AEDs - dose increased until dose is achieved or tolerance exceeded.
Idiosyncratic side effects( non dose related) are more common.
Intoxification of all AEDs causes- nystagmus, ataxia, dysarrthria.
What are some side effects of chronic administration of phenytoin?
Gum hypertrophy, hypertrichosis, osteomalacia, folate deficiency.
These are reduced if the serum levels are kept under therautic range.
Phenytoin- potent helatic enzyme inducer and will reduce the efficacy of the concentrative pill.
What are some recomend anti epileptics ?+ what are their side effects?
Generalised tomic clonic- phenytoin-> SE-> rashes, blood dyscrasias, lymphadenopathy
Carbamazepine, -> rashes, leucopenia
Na Valproate-> anorexia, hair loss, liver damage
Newer drugs: Gabapectin, topiramade, : also for partial
Generalised absence- Na valproate,
Ethosuximide: rashes, blood dyscrasias, night terrors
Partial seizures - carbamazepine, phenytoin, Na valproate.
When do u withdraw from drugs?
Gradual! When pt seizure free for 2Y. Only achieved in
Whats status epilepticus?
Medical emergency, when 2 or more seizures follow each other w/o recovery of consciousness.
When Grand mal seizure follow one another- risk of death due to CardioResp F, .
Precipitating fx: abbruptly stopping aeds, alcohol abused, concurrent illness, and poor compliance.
60% w/o hx of epilepsy.,
Initial tx:
IV lorazepam or Rectal Diazepam
Lorazepam- resp depression + hypotension, so rescisitation ready.
If lorazepam fails to control seizure-> phenytoin infusion.
Rapid infusion can cause arrythmias so EEG monitoring during infusion.
What is the emergency investigation and mx of status epilepticus?
General: ABC- secure airway, remove false teeth, add oropharyngeal tube.
Administer O2 by nasal cannula or face mask
Secure venous access: - many cause phlebitis, so use large vein
Glucose- 50mL of 50% IV if hypoglycaemia if
Thiamine 250mg iv over 10mins if nutrition poor or alcohol abuse suspected
Cardioresp monitor and pulse oximetry. eEG in refractory status or pseudostatus.
Control of seizures: 1st line: Lorazepam 4mg iv at 2 mg/min , repeated after 20mins - rectal diazepam (10-20mg) if IV access diff.
2nd line: if seizure cont, phenytoin, 15mh/kg iv diluted to 10mg/mL in 0.9% Nacl
Refractory status: if seizures continue despite these, use tiopental or propofol.
Inv: ugrent: blood, glucose, serum U+Es, Ca, Mg,
Consider: brain CT,LP, blood cultures.
Serum anticolvulsant levels.
Whats epilepsy?
Seizure=convolusion or transient abnormal event- resulting in paroxysmal discharge of cerebral neurones.
Epilepsy- continuing tendency to have such seizures.
Epidemiology: 2% UK,
What are some genereal advice we can givento pts?
Dont resteict life a lot,
Avoid swimming alone, dangerous sports eg rock climbing, leave the door open when taking a bath.
Can drive motorbike not public or heavy goods, seizure free for 1Y or only night fits for 3Y.
Epilepsy
PC: 1st fit?/ known epilepsy?
HPC: Loss of consciousness , urinary incintinence, tongue biting, postictal confusion, drowsiness/paresis
Participants: flashing lighys/hyperventilation/sleep/lack of
Parial s: psychogenic/cognitive phenomena/hallucinations
Limb jerking
SH- alcohol abuse-
DH- AEDs- dose, regimne, compliance. Any new drugs that interfere
Drugs that lower seizure threshold: antibiotics, antipsychotics, aminophylline
Whats is a DDx of convulsions?
Syncope, pseudoseizure, hyperventilation,
Panic disorser, TIA, hypoglycaemia, moevement disprder,
Alcoholic black outs, migraine
Confuional
Narcoplesy
Whatbare some differences of syncope and seizures?
Time of onset: seizure: day or night, syncope: Day
Position: Any, syncope: upright
Onset: sudden or brief, syncope: gradual
Aura: seizure: possible, syncope: light headed sensation
Colour: normal or cyanotic. Sync: pallor
ANS: uncommon outside ictal phase, sync: common- diaphoresis
Duration: brief or prolonged, sync: brief
Incontenece: common. Syn: possible but rare.
Post ictal: in tonic clonic or complex partial, not syncopes.
Motor: common, symcope: brief jerks
Inury: common, lateral tongue biting, sync: rare unless fall.
Automatisms: common in abscence or complex partial, not in syncope.
EEG: abnormal, normal w/ syncope
What are some classic examples differentiating seizures from pseudoseizures?
Triggeres: s- uncommon, pseido- e otional distirbance
Duration: brief or prolonged, pseudo- may be prolonged
Motor activity: synchronous, STEROTYPIC, automatisms, lateral to gue biting, eyes rolled back maybe. oseudo: opisthotonos, rigidity, FORCED EYE CLOSE, crying, tongue biting at tip ❗️
Timing: s- day or night. Pseudo: day, other ppl present,
Pgysical injury may occu
