Epilepsy Flashcards
what are the different causes of a blackout?
Syncopy First seizure Hypoxic seizure Concussive seizure Cardiac arrhythmia Non-epileptic attack (eg narcolepsy)
what is syncope?
Vasovagal syncope is the most common cause of fainting
caused by a fall in blood pressure
what are the early symptoms of syncope?
Light-headed, nausea
Hot, sweating
Tinnitus
Tunnel vision
what are the triggers of Vasovagal syncope?
Prolonged standing Standing up quickly Trauma Venepuncture Watching/experiencing medical procedures Micturition Coughing
what are the symptoms of syncope?
upright posture pallor common gradual onset injury rare incontinence rare rapid recovery precipitants common
what are the symptoms of seizures?
any posture pallor uncommon sudden onset injury quite common incontinence common slow recovery precipitants rare
what are hypoxic seizures?
Occur when individuals are kept upright in a faint
Patient may have a succession of collapses
Seizure-like activity may occur
what are concussive seizures?
After any blow to the head
what can cause cardiac arrythmias?
seizures
describe non-epileptic attacks
women>men Can be frequent May look bizarre May have history of abuse May resemble a generalised tonic-clonic seizure May resemble a “swoon”
what are Features suggestive of primary generalised Epilepsy?
History of myoclonic jerks, esp in morning
absences or feeling strange with flickering lights
what are Features suggestive of focal onset Epilepsy?
History of “deja vu”, rising sensation from abdomen, episodes where look blank with lip-smacking, fiddling with clothes
what is Epilepsy?
is a condition in which seizures recur, usually spontaneously
what are focal seizures characterised by?
aura, motor features, autonomic features and degree of awareness or responsiveness
(May evolve into a generalised convulsive seizure)
describe Primary generalised epilepsies
No warning < 25 years May have history of absences and myoclonic jerks as well as GTCS e.g in juvenile myoclonic epilepsy Generalised abnormality on EEG May have family history
describe Focal/Partial epilepsies
May get an “aura”
Any age – cause can be any focal brain abnormality
Simple partial and complex partial seizures can become secondarily generalised
Focal abnormality on EEG
MRI may show cause
what can an EEG show?
primary generalised epilepsies including hyperventilation and photic stimulation: sometimes sleep deprivation
what can an MRI show?
patients under age 50 with possible focal onset seizures: CT usually adequate to exclude serious causes over this age
what investigation is done if uncertain about diagnosis?
Video-telemetry - much longer recording than a standard EEG
what is the first line treatment of primary generalised epilepsies?
Sodium Valproate, Lamotrigine, Levetiracetam
what is the second line treatment of generalised epilepsies?
Topiramate
Zonisamide
(carbamazepin)
what is the first line treatment of partial and secondary generalised seizures?
Lamotrigine or Carbamazepine
what is the second line treatment of partial seizures?
- Sodium valproate
- Topiramate
- Leviteracetam
what are the side effects of Sodium Valproate?
tremor, weight gain, ataxia, nausea, drowsiness, transient hair loss, pancreatitis, hepatitis
what are the side effects of Carbamazepine?
ataxia, drowsiness, nystagmus, blurred vision, low serum sodium levels, skin rash.
what are the side effects of Lamotrigine?
skin rash, difficulty sleeping
what are the side effects of Levetiracetam?
irritability, depression
what are the side effects of Topiramate?
weight loss, word-finding difficulties, tingling hands and feet
what are the side effects of Zonisamide?
bowel upset, cognitive problems
what is Status Epilepticus?
Prolonged or recurrent tonic-clonic seizures persisting for more than 30 minutes with no recovery period between seizures
when does Status Epilepticus usually occur?
in patients with no previous history of epilepsy (stroke, tumour, alcohol)
what is the first line treatment of tonic-clonic seizures?
Midazolam
Lorazepam
Diazepam
what is the second line treatment of tonic-clonic seizures?
Phenytoin
Valproate
what is the third line treatment of tonic-clonic seizures?
Anaesthesia usually with propofol or thiopentone
when is mortality of tonic-clonic seizures greatest?
very young and very old (29% of those < 1 year)
90% of deaths are a result of the underlying cause
