Epilepsy Flashcards
What 2 types of focal onset seizures are there
- simple partial
- complex partial
the above 2 may then develop into secondary generalised tonic clonic
What 3 types of generalised seizures are there
- generalised tonic clonic
- absence
- myoclonic
Difference between simple and complex partial seizures
Simple: awareness not affected (often referred to as aura)
Complex: loss of awareness
What are common seizure automatisms that one should ask witnesses about
- lip smacking/ licking
- fidding with things eg clothes
What question should you ask to find out if a person really was confused after they woke up
Ask about next memory of waking up
If passers-by fussing over them = syncope
If in ambulance with paramedics = like seizure (will take longer to recover)
Symptoms of focal epilepsy in occipital lobe
Visual disturbance
Symptoms of focal epilepsy in parietal lobe
Unusual sensations throughout body, lasting a few seconds
Symptoms of focal epilepsy in frontal lobe
Starts with thumb twitching on 1 side. Spreads to arms, trunk, leg.
Symptoms of focal epilepsy in pre-frontal lobe
Patient going into weird stretched postures
Symptoms of focal epilepsy in medial temporal lobe
- Fear/panic
- Epigastric rising sensation (like dip in roller coaster)
- Olfactory hallucinations
- Deja vu
- Impaired awareness
- Automatisms
Common cause of focal epilepsy in medial temporal lobe
Hippocampal sclerosis
How to differentiate generalised tonic clonic vs secondary generalised seizure
-type of symptoms
generalised tonic clonic: tonic clonic movements start immediately
secondary generalised: will start off with focal symptoms (1 sided) before becoming full on tonic clonic
How to differentiate absence vs complex partial seizure
-age of onset
Absence: childhood onset (never onset in adulthood)
Complex partial: onset at any age
How to differentiate absence vs complex partial seizure
-presence of aura
Absence: no aura
Complex partial: often has aura
How to differentiate absence vs complex partial seizure
- duration of seizure
- presence of confusion after
Absence: rarely last >10s, no post-ictal confusion
Complex partial: Usually lasts at least 30s, presence of post-ictal confusion
How to differentiate absence vs complex partial seizure
-presence of photosensitivity
Absence: may have photosensitivity
Complex partial: never photosensitive
Important differential diagnosis to epilepsy in someone with seizures
Non-epileptic attack disorder (NEAD)
aka dissociative/ pseudo/ functional seizures
How to differentiate Non-epileptic attack disorder (NEAD) from epilepsy
In NEAD, EEG will have absence of epileptic neuronal activity
What features of a seizure would suggest NEAD over epilepsy
- Sobbing (in usual seizure, people are too unaware to show emotion)
- Normal/ rapid breathing (no hypoxia)
- Asynchronous limb convulsions (tonic clonic seizures are synchronous)
Why must an ECG be done in patients who have had a seizure
Severe cardiac syncope can progress to anoxic seizures
What 3 features on ECG may indicate severe cardiac syncope
- Heart block (any kind)
- Evidence of ischaemia/ previous MI
- Prolonged QT interval (torsade du pointes)
Risk of recurrence of seizure after the first one
40-50%
Which 2 drugs are used to treat generalised epilepsy
- Sodium valproate (most effective)
2. Lamotrigine (first line for women. Less effective but less teratogenic than valproate)
Which 2 drugs are used to treat focal epilepsy
- Carbamazepine
- Lamotrigine
Both equally effective but Lamotrigine better tolerated
Main side effects of sodium valproate
- Tremor, parkinsonism
- Weight gain
- Teratogenic
Main side effects of carbamazepine
- Ataxia (not good for elderly, causes fall risk)
- Rash
- CYP450 inducer
Main side effects of lamotrigine
Rash (leading to Steven Johnson’s)
Main side effects of levetiracetam
Irritability and depression
When would you give benzodiazepines to an epileptic patient
When they are in status epilepticus
Definition of status epilepticus
Seizure lasting >5min
or 2 or more seizures within 5min (without patient returning to normal between them)
Risk factors for epilepsy
- Genetics (parent or siblings with epilepsy)
- Head trauma
- Infections: meningitis, encephalitis, AIDS
- Alzheimer’s, stroke, brain tumours
- Birth complications, infections during pregnancy
