Epilepsy Flashcards
What are general causes of blackouts?
Syncope First seizure Hypoxic seizure Concussive seizure Cardiac arrythmia Non-epileptic attack - narcolepsy, movement disorder, migraine
Differences between syncope and seizures?
Syncope usually when upright, seizures in any posture
Pallor in syncope, not usually with seizure
Gradual vs sudden
Incontinence rare with syncope
What investigations might be done after suspected seizure?
Detailed history from patient and witness - what they were doing - feelings - previous? - feelings after - injury? (tongue, incontinence) Blood sugar ECG CT head EEG - generalised epilepsies MRI for <50yo with possible focal onset seizures Video-telemetry
What features are suggestive of epilepsy?
History of myoclonic jerks (especially in morning)
Absences or light sensitivity
Deja Vu
Fidgeting
What are the different types of seizure?
Generalised
- tonic-clonic
- myoclonic
- clonic or tonic alone
- atonic
- absence
Focal
- characterised by aura, motor, autonomic, awareness
What is status epilepticus?
Prolonged/recurrent tonic-clonic seizures persisting >30 minutes with no recovery between
Mortality 5-10%
What is the first line treatment for epilepsy?
Sodium valproate
Lamotrigine
Levetiracetam
(All primary generalised)
Lamotrigine
Carbamazepine
(Partial, secondary generalised)
Ethosuximide
(Absence)
Lorazepam
Midazolam
(Status epilepticus)
Other epilepsy treatments?
Topiramate
Zonisamide
Carbamazepine
Valproate Topiramate Leviteracetam Gabapentin Pregabalin Zonisamide Lacosamide Perampanel BDZs
What are the driving regulations with regards to epilepsy?
May drive car 6 months after first seizure assuming normal investigations and no further events
- (5 years for HGV/PSV same criteria + no medication)
If diagnosed, can drive after a year of seizure free, or seizures only from sleep
- (HGV, PSV - 10 years free and no medication)
