Epilepsy Flashcards
What are the requirements for a clinical diagnosis of epilepsy?
At least 2 seizures more than 24 hours apart.
1 unprovoked seizure and probability of another seizure greater than the general population.
At what point can it be said that Epilepsy has been resolved?
Seizure free for 10 years, medication free for 5 years.
What investigations need to be done to rule out incidental causes of epilepsy symptoms?
EEG - some people have abnormal brain activity but not epilepsy - structural pattern
- EEG would show abnormal photo paroxysmal response
MRI - rue out structural cause
Genetic - epilepsy syndrome in children
Hyponatraemia/infection - elderly
Video/witness of the seizure
What are the differential diagnoses of epilepsy?
Movement disorders (focal, frontal seizure) TIA Narcolepsy Cardiovascular - syncope and arrhythmias Hyperventilation Hypoglycaemia Infection Panic attacks Non-epileptic seizures
What is status epilepticus?
seizure lasting longer than 5 minutes
or
more than three seizures without recovery
How do you manage status epilepticus?
ABC - secure airway, high flow oxygen, large bore IV access
Take bloods - ABG, FBC U&E, tox screen, electrolytes
GCS, head injury, glucose
IV lorazepam 0.1mg/kg (4mg)
5 mins later: IV lorazepam 0.1mg/kg (4mg)
Another 5 mins: IV phenytoin 20mg/kg at 50mg/min and cardiac monitor/ 10mg/kg in 200mg bolus over 2 mins every 5 mins
Bleep ITU and anaesthetics
Long term management for epilepsy
Avoid triggers
AEDs after 2nd seizure or if risk of second seizure is high
Monotherapy - sodium valproate/carbamazapine
(beware of interactions with contraception) (need double dose of emergency contraception)
During pregnancy need 5mg folic acid OD
Keep a seizure diary
When would you consider stopping AEDs?
after no seizures for 2 years
What’s the definition of a seizure?
Transient occurrence of sign or symptoms due to abnormal electrical activity in the brain, leading to a disturbance of consciousness, behaviour, emotion, motor function or sensation.
What are the types of generalised seizure?
Absence Myoclonic Atonic Clonic Tonic Tonic clonic
How would you recognise an Absence seizure?
loss of consciousness
How would you recognise a myoclonic seizure?
jerks
How would you recognise a atonic seizure?
drop attacks, loss of tone
How would you recognise a clonic seizure?
rigidity
How would you recognise a tonic seizure?
moving
How would you recognise a tonic clonic seizure?
combination of movement and rigidity
rhythmic jerking
What are the different types of focal seizure?
start in one hemisphere
simple
evolving
focal dyscognitive
How would you recognise a simple focal seizure
retain awareness
How would you recognise a focal evolving seizure?
start simple and spread
How would you recognise a focal dyscognitive seizure?
consciousness affected
What are the signs and symptoms of a frontal lobe seizure?
motor most common uncontrolled emotion - giggling, screaming last about 30 seconds not an impairment of consciousness can be frequent - stress induced
What are the signs and symptoms of temporal lobe epilepsy?
most common form of focal seizure 80% start in the hippocampus visual hallucinations motion sickness deja vi unusual smell
What are the signs and symptoms of parietal lobe epilepsy?
rare somatosensory body image complete hallucinations pain in the face and arm
What are the signs and symptoms of occipital lobe epilepsy?
image stuck on vision
colour, lights, flashing
eyelid fluttering
nystagmus, eyes rolling around
what EEG results suggest absence seizures
a synchronous discharge
management of absence seizures
ethosuximide
