Epilepsy Flashcards
what are the differential diagnosis’ of a blackout
Syncope First seizure Hypoxic seizure Concussive seizure Cardiac arrhythmia Non-epileptic attack (narcolepsy, movement disorder, migraine)
what would you ask in a history of a blackout patient
detailed description of observations before and during attacks
- including level of responsiveness, motor phenomena, pulse, colour, breathing, vocalisation
detailed description of behaviour following attacks
what information might be relevant to diagnosis
age
sex
past medical history including head injury, birth trauma and febrile convulsions
past psychiatric history
alcohol and drug use
family history
what is the most common cause of fainting and what causes it
vasovagal syncope
loss of consciousness due to a neurologically induced drop in blood pressure
what is the prodrome (pre symptoms) to fainting
Light-headed, nausea
Hot, sweating
Tinnitus
Tunnel vision
what can trigger vasovagal syncope
Prolonged standing Standing up quickly Trauma Venepuncture Watching/experiencing medical procedures Micturition Coughing
what are the characteristics of syncope
upright posture pallor common gradual onset injury rare incontinence rare rapid recovery precipitants common
what are the characteristics of seizure
any posture pallor uncommon sudden onset injury quite common incontinence common slow recovery precipitants rare
what are hypoxic seizure and how do they occur
seizure caused by lack of oxygen to the brain
Occur when individuals are kept upright in a faint
Can occur in aircraft, at the dentist, when well-meaning passersby help people to their feet….
Patient may have a succession of collapses
Seizure-like activity may occur.
how doe concussive seizures occur
after a blow to the head
what can cause cardiac arrhythmias
structural cardai abnormalities
functional cardiac problems e.g. long QT syndromes
seizures can also cause cardiac arrhythmias
what are some characteristics of non-epileptic attacks
- more common in
- women
- frequent
- may look bizarre
- can be prolonged
- may have a history of other medically un explained symptoms
- history of abuse
- “swoon”
- superficially resemble tonic-clonic seizures
what investigations should be done for a possible first seizure
blood sugar
ECG
consider alcohol and drugs
CT head
what advice must be given to a patient after a first seizure
copies of safety info
info about the first seizure clinic
enquire about employment - they may need to inform their employer
enquire about potentially dangerous leisure activities
explain driving regulations
what are the driving regulations for a first seizure
patient may drive a car after 6 months if their investigations are normal and they have had no further events
may drive an HGV or PSV after 5 years if their investigations are normal, they have no further events and they are not on anti-epileptic medication
when is epilepsy usually diagnosed
after a second unprovoked attack
sometimes can be clear on taking a history after a first seizure
what are the features suggestive of primary generalised epilepsy
no warning
<25yrs
myoclonic jerks - esp first thing in the morning
absences or feeling strange with flickering lights
generalised abnormality of ECG
?family history
what are the features suggestive of focal onset epilepsy
may get an aura
any age
history of deja vu
rising sensation from the abdomen
episodes where they look blank with lip-smacking and fiddling with clothes
focal abnormality on ECG
MRI may show cause
what is an epileptic seizure
an intermittent stereotyped disturbance of consciousness, behaviour , emotion, motor function or sensation
believed to result from abnormal neuronal discharges
what is epilepsy
a condition in which seizures recur - usually spontaneously
what are the different groups epilepsy can be classified into
Generalised seizures:
- Tonic-clonic seizures
- Myoclonic seizures
- Clonic seizures
- Tonic seizures
- Atonic seizures
- Absence seizures
Focal seizures: characterised according to - aura - motor features - autonomic features - degree of awareness or responsiveness
simple focal and complex focal can evolve into generalised convulsive seizure
what investigations can help diagnose epilepsy
EEG - for primary generalised
MRI - for patients <50 with possible focal onset
CT - usually adequate to exclude serious cause in >50
video telemetry - if uncertain about diagnosis
what are the first line treatments for primary generalised epilepsy
Sodium Valproate
Lamotrigine
Levetiracetam
what are the first line treatments for partial and secondary generalised seizures
Lamotrigine
Carbamazepine
