Epilepsy Flashcards
Causes of epilepsy
- Idiopathic
- Congenital
- Acquired
- Non-epileptic/provoked: Withdrawal, metabolic, raised ICP, infection
Prodrome of a seizure
Change in mood or behaviour lasting hours/days
Not part of seizure
Aura of a seizure
Simple partial seizure (usually temporal) which may precede other manifestations
Epigastric rising, Deja/Jamais vu, Automatisms, Smells, Lights etc
Partial/Focal seizure
Only one hemisphere
Primary generalised seizure
No aura/warning
Affects whole cortex not one hemisphere
Simple seizure
Awareness unimpaired
Complex seizure
Awareness impaired
Secondary generalised seizure
Focal seizure –> generalised seizure
aura–>tonic-clonic
Epilepsy history
Aura Specific trigger (lights) Lateral tongue biting Tonic clonic movements Cyanosis Post-ictal phase
Simple partial seizure features
Focal motor, sensory, autonomic or psychic symptoms
Complex partial seizure features
Aura
Autonomic: change in skin colour, temp, palpitations
Awareness lost
Automatisms: lip smacking, fumbling, swallowing
Amnesia
Absence seizure features
(Petit mal) ABrupt onset/offset Short <10s Eyes glazed, blank stare Normal intelligence, brain scan, examination Clonus or automatisms EEG 3Hz spike and wave Stimulated by hyperventilation and photics
Tonic Clonic seizure features
(Grand Mal) LOC Tonic: limbs stiffen Clonic: rhythmic jerking \+/- cyanosis, incontinence, tongue biting Post ictal confusion and drowsiness
Myoclonic seizure features
Sudden jerk of limbs, trunk or face
Atonic seizure features
Sudden loss of muscle tone –> fall
No LOC
West syndrome/infantile spasms
Head nodding and arm jerks
EEG hypsarrhythmia
Temporal localising seizure features
Automatisms: lip smacking, chewing, fumbling
Deja/jamias vu
Delusional behaviour
Abdominal: rising, n/v
Emotional disturbance: terror, panic, anger, elation
Tastes, smells
Frontal localising seizure features
Motor features
Parietal localising seizure features
Sensory disturbance
Occipital localising seizure features
Visual phenomena
Diagnosis of epilepsy
Need more than 1 seizure Bloods Raised serum prolactin 10 min after fit Urine toxicology ECG EEG MRI
Tonic Clonic seizure treatment
1) Valproate
2) Lamotrigine
Absence seizure treatment
1) Valproate/ethosuximide
2) Lamotrigine
Tonic, atonic, myoclonic seizure treatment
1) Valproate
2) Levetiracetam
Focal +/- secondary generalised seizure treatment
1) Lamotrigine
2) Carbamazepine
Lamotrigine side effect
Skin rash (stephen johnson syndrome)
Valproate side effects
Appetite ↑ → ↑wt. Liver failure: monitor LFTs over 1st 6mo Pancreatitis Reversible hair loss Oedema Ataxia Teratogenicity, Tremor, Thrombocytopaenia Encephalopathy: due to ↑ ammonia
Carbamazepine side effects
Leukopenia
Skin reactions
Diplopia
Syndrome of inappropriate ADH (SIADH) –> hyponatraemia
Phenytoin side effects
Gingival hypertrophy Hirsutism Cerebellar syndromes: Ataxia, Nystagmus, Dysarthria Peripheral sensory neuropathy Diplopia Tremor
Status epilepticus definition
Seizure > 30mins or repeated seizures without regain of conciousness
Investigations for status epilepticus
BM
Bloods
ECG
EEG
Treatment of status epilepticus
1) Lorazepam: 2-4mg bolus over 30s, 2nd dose if don’t respond in 2 mins
2) Phenytoin: 18mg/kg IV infusion
3) Diazepam infusion
4) Dexamethasone
Pregnancy and epilepsy treatment
Don’t give valproate
Give lamotrigine and folic acid
