Epilepsy Flashcards
what is epilepsy
the continuing tendency to have seizures
what is a seizure
a convulsion or a transient abnormal event caused by a paroxysmal discharge of cerebral neurones
classification of seizures
partial or generalised
partial seizures
involve only a portion of the brain at their onset (e.g. temporal lobe) - may later become generalised
are simple or complex (do or don’t affect consciousness or memory)
symptoms depend on the area of the brain where the seizure starts
generalised tonic clonic seizures
grand mal sudden onset of rigid tonic phase followed by convulsion clonic phase in which muscles jerk rhythmically lasts seconds/minutes incontinence followed by coma / drowsiness
typical absence seizures
petit mal disease of childhood child stares and pales for a few seconds 3Hz spike on EEG often develop t-c seizures
myoclonic, tonic and akinetic seizures
isolated muscle jerking (myoclonic)
intense stiffening of the body (tonic)
falling & loss of consciousness (akinetic)
Jackonian (motor) seizures
type of partial seizure originate in the motor cortex typically result in jerking movements opposite side no impairment of consciousness - simple paralysis may follow
temporal lobe seizures
olfactory & visual hallucinations
blank staring
feelings of unreality or undue familiarity with the surroundings
generalised seizures
bilateral
abnormal electrical activity with bilateral motor manifestations and impaired consciousness
egs generalised seizures
absence seizures (petit mal) generalised tonic-clonic seizures (grand mal) myoclonic seizures tonic seizures akinetic seizures
partial seizures egs
simple - no impaired awareness e.g. jacksonian
complex - impaired awareness
aetiology seizures
less than a third = found a cause
flashing lights
cereberovascular disease, cerebral tumours, alcohol, metabolic disturbances
emergency management seizure
ensure little harm done and airway patent prolonged seizure (>3min) or repeated = treated w rectal or iv diazepam or lorazepam
status epilepticus
medical emergency continuous seizures without recovery of consciousness risk of cardioresp failure >5min >30m = medical emergency
rx status epilepticus in and out of hosp
out of hosp - rectal diazepam or buccal midazolam
in hosp - thiamine if nutrition poor / alcohol
urgent: blood gluc, serum electrlytes incl calcium and magnesium, drug screen, anticonvulsant levels - give anticonvulsants e.g. phenytoin
why give thiamine before glucose drip?
thiamine used in glycolytic pathway so need to give it first otherwise more is used up and pt dies
first line rx generalised t-c seizure
sodium valproate
first line rx petit mal
sodium valproate
first line rx focal seizures
lamotrigine carbamazepine
surgery for epilepsy
amputation of the anterior temporal lobe cures in 50%
