Epilepsy Flashcards
What is epilepsy?
A recurrent tendency to spontaneous intermittent abnormal electrical activity in part (or all) of the brain manifesting as seizures
What is a prodrome?
- A change in mood or habit lasting hours or days that may precede a seizure
- It is not part of the seizure
What is the aura?
- A feeling that a seizure is about to come on. The patient is aware of this preceding the seizure
- It is part of the seizure
What does post-ictal mean?
Afetr the seizure
What symptoms are associated with post-ictal patients?
- Headache
- Confusion
- Myalgia
- Sore tounge
What are the causes of epilepsy?
- 2/3 are idiopathic (often familial)
- Structural → Cortical scarring, developmental, space occupying leision, stroke, hippocampal scleriosis, vascular formations, vascular malformations.
- Other→ Tuberous sclerosis, SLE, Sarcoidosis
What is the major differential diagnosis to a seizure that needs to be ruled out?
Syncopal attack → Reflex anoxic convulsions give a seizure like appearance but with no post-ictal symptoms.
What is a partial seizure?
- Has a focal onset
- Each focal area has symptoms associated with it.
- Temporal, frontal, Parietal, Occipital
What are the associated symptoms of a temporal lobe focal seizure?
Post-ictal confusion is common
- Automatism → Complex motor phenomena with impaired awareness and little recollection afterwards
- Abdominal rising sensation or pain
- Dysphasia
- Memory phenomena → De javue or jamais vue (everything seems strange)
- Hippocampal involvment→ Emotional involvment (eg. sudden terror)
- Uncal involvment → Hallusination of smell or taste
- Delusional behaviour
What are the associated symptoms of a frontal lobe focal seizure?
characterised by rapid recovery and little post-ictal symptoms
- Motor features → Posturing, versive movements of the head and eyes, peddeling of the legs
- Jacksonian march → spreading focal motor seizure with retained awareness
- Motor arrest
- Subtle speach disturbance
- Aphasia
- Post-ictal todds palsy → transient neurological defecit (paresis)
What are the associated symptoms of a occipital lobe focal seizure?
• Visual phenomena → spots, lines, flashes
What are the associated symptoms of a parietal lobe focal seizure?
- Sensory disturbance → Tingling, numbness, pain
* Motor disturbance
What are the 2 main types of epileptic seizure?
Generalised and partial
What are the 3 types of partial seizure?
- Simple partial → Aweareness is unimpaired. No post-ictal symptoms
- Complex partial → Awareness is impaired. Commonly start in temporal lobe.
- Partial seizure with secondary generalisation → Focal start to seizure (simple or complex) that then becomes general
What are the 5 types of generalised seizures?
- Absence seizure → Stops mid sentence and then continuos where they left off. Presents in childhood
- Tonic clonic seizure → Loss of consciouness with (tonic) limb stiffness followed by (clonic) jerks. post-ictal confusion and drowsiness
- Myoclonic seizures → Sudden jerk of limb face or trunk → Violent
- Atonic seizures Sudden loss of muscle tone causing a fall. No LOC
- Infantile spasms → Commonly assoc. with tuberous sclerosis
What drugs should be advised after 1 fit?
NONE! psych! unless risk of reccurence is high → Structural brain leision etc.
What drugs are prescribed for generalised tonic-clonic seizures?
- 1st line → Sodium valporate and lamotrogine
- 2nd line → Carbemazepine or topiramate
- 3rd line → levetiracem, oxcarbazapine, clobazam
What drugs are prescribed for absence seizures?
• sodium valporate, Lamotrigine, ethosuxamide
What drugs are prescribed for tonic, atonic and myotionic seizures?
Avoid Carbemazepine or oxcarbazapine!!!
- 1st line → Sodium valporate and lamotrogine
- 2nd line → topiramate
- 3rd line → levetiracem, clobazam
What drugs are prescribed for partial and secondary generalised seizures?
1st line → Carbemazipine
2nd line → Sodium valporate, lamotrigine
What is a non-epileptic attack disorder associated with?
- Traumatic childhood experience
- biting tip of tounge
- Essentially faking it.
What is the leading cause of generalised idiopathic epilepsy thought to be?
Febrile convulsions causing scarring of the hippocampus
What is status epilepticus?
- A seizure lasting more than 30 mins or repeat seizures without regaining consciousness.
- Aim to terminate seizures in <20 mins
What is a differential diagnosis for a pateint with status epilepticus if they are pregnant?
Eclampsia
What is the 1st step in treating status epilepticus?
Basic life support!
What is the 1st treatment oriented step in treating status epilepticus?
- IV lorazepam
* if IV is not possible then buccal medazolam
What is the 2nd treatment oriented step in treating status epilepticus if fits continue?
• IV phenytoin
What is the 3rd treatment oriented step in treating status epilepticus if fits continue?
• IV Diazapam
What is the 4th treatment oriented step in treating status epilepticus if fits continue?
• IV dexamethasone
What is the 5th treatment oriented step in treating status epilepticus if fits continue?
• General anaethesia
