Epilepsy Flashcards
What is the differential diagnosis of a black out?
○ Syncope ○ First seizure ○ Hypoxic seizure ○ Concussive seizure ○ Cardiac arrhythmia ○ Non-epileptic attack - narcolepsy - movement disorder - migraine
What questions should you ask when getting a patient history of the blackout?
○ What were they doing at the time?
○ What, if any, warning feelings did they get?
○ What were they doing the night before?
○ Have they had anything similar in the past?
○ How did they feel afterwards?
○ Any injury, tongue biting or incontinence?
What information should you get from the witness of a blackout?
○ 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 is the most common cause of fainting?
Vasovagal syncope
Describe the prodrome to syncope
○ Light-headed, nausea
○ Hot, sweating
○ Tinnitus
○ Tunnel vision
What are the triggers for syncope?
○ Prolonged standing ○ Standing up quickly ○ Trauma ○ Venepuncture ○ Watching/experiencing medical procedures ○ Micturition ○ Coughing
What are the similarities and differences between syncope and seizures?
Syncope
- Upright posture
- Common pallor
- Gradual onset
- Injury rare
- Incontinence rare
- Rapid recovery
- Precipitants common
Seizures
- Any posture
- Uncommon pallor
- Sudden onset
- Injury common
- Incontinence common
- Slow recovery
- Precipitants rare
What are hypoxic seizures?
- Occur when individuals are kept upright in a faint
- Can occur in aircraft, at the dentist, when well-meaning passers-by help people to their feet….
- Patient may have a succession of collapses
- Seizure-like activity may occur
What are concussive seizures?
After any blow to the head
What are cardiac arrhythmias in regards to seizures?
• Structural cardiac abnormalities
• Functional cardiac problems e.g. Long QT syndromes
○ Consider particularly when there is a family history of sudden death, when there is a cardiac history and when collapse occurs with exercise
○ Also remember that seizures can cause cardiac arrhythmias
What are non-epileptic attacks?
- Commoner in women than men
- Can be frequent
- May look bizarre
- Can be prolonged (epileptic attacks tend to be under 5 minutes)
- May have a history of other medically unexplained symptoms
- May have history of abuse
- May superficially resemble a generalised tonic-clonic seizure
- May resemble a “swoon”
- May involve bizarre movements
What investigations should be done for possible first seizures?
○ Blood sugar
○ ECG
○ Consideration of alcohol and drugs
○ CT head
What is epilepsy?
○ An epileptic seizure is an intermittent stereotyped disturbance of consciousness, behaviour, emotion, motor function or sensation which, on clinical grounds, is believed to result from abnormal neuronal discharges
○ Epilepsy is a condition in which seizures recur, usually spontaneously
What are the classifications of epilepsy?
○ Generalised Seizures:
- Tonic-clonic seizures
- Myoclonic seizures (jerky and clumsy)
- Clonic seizures (just jerking)
- Tonic seizures
- Atonic seizures (go down very rapidly)
- Absence seizures (typical in childhood but kids grow out of it)
○ Focal seizures
- Characterised according to aura, motor features, autonomic features and degree of awareness or responsiveness
- May evolve into a generalised convulsive seizure
- (previously described as simple and complex partial seizures with or without secondary generalisation)
What is the first line treatment for epilepsy?
- Sodium Valproate, Lamotrigine, Levetiracetam for primary generalised epilepsies
- Lamotrigine or Carbamazepine for partial and secondary generalised seizures
- Ethosuximide for absence seizures
- Lorazepam ,midazolam (diazepam) first line: Valproate or phenytoin second line for status epilepticus (though levetiracetam iv can also be considered for status/near status)
