epilepsy Flashcards
what questions should you ask a witness of a suspected epileptic seizure with regards to the patient?
level of responsiveness motor phenomena pulse colour breathing vocalisation
what are some potentially relevant pieces of information you should ask a patient suspected of having epilepsy?
age sex PMH including head injury psychiatric history alcohol and drug use family history
what is the most common cause of fainting?
vasovagal syncope
what are some precursor symptoms of vasovagal syncope?
light headed nausea hot and sweaty tinnitus tunnel vision
what are some triggers for vasovagal syncope?
prolonged standing standing up quickly trauma venepuncture micturition coughing
how quickly do seizures come on when compared to syncope?
seizures have sudden onset, syncope has gradual onset
what kind of posture do seizures occur in vs syncope?
seizures can occur in any posture whereas syncope occurs when the patient is upright
when do hypoxic seizures occur?
when individuals are kept upright in a faint
what do conussive seizures occur?
after any blow to the head
when should you consider particularly the possibility of a cardiac arrythmia?
family history of sudden death
cardiac history
when collapse occurs with exercise
can seizures cause cardiac arrythmias?
yes
what investigations are essential when investigating a first seizure?
blood sugar
ECG
consideration of alcohol and drugs
CT head
what advice would you give to a patient that has had a seizure?
give copies of safety information sheets
enquire about employment - may have to inform employer
explain driving regulations
how long does it take after a first seizure for a patient to be able to drive?
6 months if investigations and circumstances are normal
5 years for HGV
when is epilepsy normally diagnosed?
after a second unprovoked seizure
what are some features that are suggestive of epilepsy?
history of myoclonic jerks
seeing “flickering lights” whilst feeling strange
history of deja vu
rising sensation from abdomen
episodes where the patient looks blank with lip smacking or fiddling with clothes
what are epileptic seizures believed to result from?
abnormal neuronal discharges
what is specific about the seizures in epilepsy?
they recur and are usually spontaneous
what are the different ILAE general classifications of epilepsy?
tonic clonic seizures myoclonic seizures clonic seizures tonic seizures atonic seizures absence seizures
how are focal seizures characterised?
accoring to aura, motor features
autonomic features and degree of awareness of responsiveness
what can focal seizures evolve into?
general convulsive seizures
what is different about the EEG in focal epilepsy compared to primary generalised epilepsy?
the EEG has a generalised abnormaility in primary generalised
it has a focal abnormality on the EEG in focal seizures
what investigations are important in diagnosing epilepsy?
EEG for primary generalised epilepsies
MRI for patients under age 50 with possible focal onset seizures
CT usually adequate in over 50s for diagnosing focal onset seizures
video telemetry if uncertainty about diagnosis
what is first line treatment for primary generalised epilepsy?
sodium valproate
lamotrigine
levetiracetam
what is the first line treatment for partial and secondary generalised seizures?
lamotrigine
carbamazepine
what is first line treatment for absence seizures?
ethosuximide
what is first line treatment for status epilepticus?
lorazepam
midazolam (diazepam)
what are some side effects of sodium valrproate?
tremor weight gain ataxia nausea drowsiness transient hair loss pancreatitis hepatitis
what are some side effects of carbamazepine?
ataxia drowsiness nystagmus blurred vision low serum sodium levels skin rash
what are some side effects of lamotrigine?
skin rash
sleeping difficulties
what are some side effects of levetiracetam?
irritability
depression
what are some side effects of topiramate?
weight loss
difficulty finding words
tingling hands and feet
what are some side effects of zonisamide?
bowel upset
cognitive problems
what are some side effects of lacosamide?
dizziness
what are some side effects of pregabilin?
weight gain
what are some side effects of vigabatrin?
behavioural problems
visual field defects
when can epilepsy patients hold a driving license?
when they have been seizure free for a year or have an established pattern of only sleep related attacks for a year
what is status epilepticus?
prolonged or recurrent tonic-clonic seizures persisting for more than 30 minutes with no recovery period in between seizures
what is first line treatment of TCSE?
midazolam -10mg
lorazepam - 0.07mg/kg
diazepam - 10-20mg IV, can repeat after 15 minutes of necessary
what is second line treatment of TCSE?
phenytoin
valproate
what is third line treatment of TCSE?
anaethesia usually with propofol or thiopentone
what percentage of cases in TCSE in children show a neurological problem following an episode?
24%
