Epilepsy Flashcards
Define seizure.
A single episode of neuronal hyperactivity
Define epilepsy.
At least 2 unprovoked episodes of seizure
OR
A single unprovoked episode of seizure with a high risk of recurrence
What are the 2 types of seizure?
Focal/partial seizures
Generalised seizures
Define focal/partial seizures.
Seizures that originate in one specific area of the brain, though neuronal hyperactivity may spread throughout the whole brain
What are focal/partial seizures caused by? (2)
Infection
Trauma
Describe the clinical features of focal seizures. (3)
Focal aura (sensory/motor effects)
Simple motor seizures:
- Convulsive movements of one limb
- Jacksonian march (spread of convulsions from thumb to hand to face)
Complex focal seizures:
- Hallucinations (in any sensory modality)
- Paroxysmal memory disorders
- Automatism
- Amnesia after the episode
Which parts of the brain is affected by complex partial seizures?
Temporal and parietal lobes
Define a generalised seizure.
Seizures that affect the whole brain; usually appearing as generalised tonic-clonic seizures
What causes generalised seizures?
Genetic defects
Describe the clinical features of tonic-clonic (generalised) seizures.
TONIC PHASE: Lack of movement -May involve respiratory muscles (cyanosis) Loss of consciousness Version (head turning)
CLONIC PHASE:
Convulsive movements of whole body
Tongue biting (usually lateral)
Urinary incontinence
What would you think if a tonic-clonic seizure involved version (head turning)?
Frontal lobe origin
Describe the usual resolution of tonic-clonic seizures. (4)
Patient enters a deep sleep
May be very aggressive when roused
Memory loss
Gradual recovery
Describe the clinical features of absence (generalised) seizures. (3)
Brief spells of unconsciousness (few seconds)
Fluttering eyelids
Finger/mouth twitching
Describe the pathophysiology of generalised epilepsy. (2)
- Defects in glutamine and GABA cause rapid transmission of electrical activity through brain
- Electrical activity originates all over the brain
List 4 diagnostic features of focal epilepsy.
Focal aura (e.g. hallucinations, motor convulsions)
Post-attack confusion/drowsiness
Automatism
Nocturnal events
List 4 diagnostic features of generalised epilepsy.
Photosensitivity
Myoclonus
Lack of aura
Abnormal EEG
What investigations would you do for epilepsy? (3)
ECG
-Excludes other conditions
EEG
- Ambulatory EEG
- Video telemetry (records video of seizure)
Systemic provocations
-Tests for seizure triggers
List the differential diagnosis for a seizure. (7)
Syncope Non-epileptic attack disorder Migraine Narcolepsy Cataplexy Transient global amnesia Panic attacks
How would you treat someone having a seizure? (1)
When would you encourage hospital admission? (3)
Recovery position
Hospital admission when:
- Movements do not stop after 5 minutes
- ABCs are impaired
- New neurological deficit
How would you treat long term focal epilepsy? (3)
How would you treat long term generalised epilepsy? (3)
FOCAL EPILEPSY:
Lamotrigine
Carbamazepine
Levetiracetam
GENERALISED EPILEPSY:
Sodium valproate
Levetiracetam
Lamotrigine
Define status epilepticus.
Occurrence of repeated (at least 2) epileptic seizures without any recovery of consciousness between them
OR
Continuous seizure activity for more than 30 minutes
Describe the consequences of status epilepticus. (3)
Increased mortality
Profound systemic damage/disability
Profound neuronal damage
Which anti-epileptic would you use to treat status epilepticus?
Phenytoin
