Epilepsy Flashcards
What are the differential diagnoses of blackouts?
- syncope
- first seizure
- hypoxic seizure
- concussive seizure
- cardiac arrhythmia
- non-epileptic attack (narcolepsy, movement disorder, migraine)
What information would you want to find out following an attack?
History from patient: warning signs, what they were doing at the time/night before, what happened after, any incontinence or tongue biting. Any trauma including head injury, birth trauma or febrile convulsions? Psych, drug, alcohol and FH.
History from witness: level of responsiveness, breathing, colour, pulse, behavior
What is vasovagal syncope?
Fainting due to body overreacting to a certain trigger eg blood. This triggers a drop in BP and HR –> reduced blood flow to brain –> faint.
What are the prodromes of vasovagal syncope?
Lightheadedness, nausea, hot, sweating, tinnitus and tunnel vision.
What can trigger vasovagal syncope?
Prolonged standing, venepuncture, watching medical procedures, trauma, micturition, coughing, standing up quickly.
How common is epilepsy?
Aside from stroke, it is the most common neurological condition.
What are the main differences between syncope and seizure?
Syncope:
- upright posture, pallor common, due to a precipitating factor (eg standing for too long), injury and incontinence rare, rapid recovery and gradual onset
Seizure:
- any posture, pallor uncommon, sudden onset, injury and incontinence common, precipitating factors rare and slow recovery
What is a hypoxic seziure and when would this occur?
Caused by reduced supply of O2 to the brain. Occurs when people are brought to their feet too quickly after a faint.
When would a concussive seizure occur?
After any blow to the head.
Give an example of a cardiac arrhythmia that can cause seizures.
Long QT-syndrome - look at FH.
Describe the features of non-epileptic attacks.
- more common in women
- history of abuse
- may look like a tonic-clonic seizure
How is a possible first seizure investigated?
- take blood sugar (could be a hypo)
- ECG (looking for arrhythmias)
- are they under the influence of alcohol or drugs?
- CT head
What are the driving regulations after a seizure?
Suspected:
- may drive after 6 months if investigations are normal and no further seizures
- if investigations abnormal or alcohol related they cannot drive for 1 year
- HGV or PSV after 5 years if not on any meds, no further events and investigations are normal
Diagnosed:
- can drive after 1 year if seizure free or only sleep attacks
- HGV/PSV after 10 seizure free years and no anti-epileptics
Describe some features suggestive of epilepsy.
History of myoclonic jerks in the morning (like when you’re leg twitches when you are falling asleep); absences; feeling strange when lights are flickering; fidgeting with clothes; deja vu etc.
What is epilepsy?
An intermittent, stereotyped disturbance of consciousness, behaviour, emotion, motor function or sensation which is believed to result from abnormal neuronal discharges –> seizures recur spontaneously.
How many people in the UK have active epilepsy?
Over 300000.
What are the 2 main groups of seizures?
Generalised and focal/partial (ILEA classification)
Name the different types of generalised seizures.
- tonic-clonic
- myoclonic
- clonic - person loses consciousness and falls to the floor
- tonic - arms and legs move rhythmically and in jerking movements
- atonic - breif lapse in muscle tone
- absence - blanking out
What are focal seizures characterised by?
Aura, motor features, autonomic features and degree of awareness/responsiveness.
Can develop into generalised convulsive seizure.
Define status epilepticus.
Prolonged or recurring tonic clonic seizures for more than 30 minutes with no recovery period in between seizures. 5-10% mortality.
Describe the differences between primary generalised and focal epilepsy.
Primary generalised:
- no warning
- < 25
- may have a history of absences/myoclonic jerks
- generalised abnormality on ECG
- may have FH
Focal/partial:
- aura
- any age
- can become secondary generalised
- focal abnormality on ECG
- MRI may show cause
What are the investigations for epilepsy?
EEG, photic stimulation and hyperventilation. MRI for patients under 50 with possible focal onset seizures.
Which drugs are 1st line for primary generalised epilepsy?
Sodium valproate, lamotrigine and levetiracetam.
Which drugs are 1st line for partial and secondary generalised?
Lamotrigene or carbamazepine.
Which drug is 1st line for absence seizures?
Ethosuximide.
Which drugs are 1st line for status epilepticus?
Midazolam, lorazepam or diazepam - enhance the effects of GABA.
