Epilepsy Flashcards
Causes of epilepsy
- Idiopathic
- Congenital
- Acquired
- Non-epileptic/provoked
Non epileptic causes of seizure
Withdrawal
Metabolic
Raised ICP
Infection
Prodrome of a seizure
Change in mood or behaviour lasting hours/days
Not part of seizure
Aura of a seizure
Simple partial seizure (usually temporal) which may precede other manifestations
Epigastric rising, Deja/Jamais vu, Automatisms, Smells, Lights etc
Partial/Focal seizure defintion
Only one hemisphere
Primary generalised seizure
No aura/warning
Affects whole cortex not one hemisphere
Simple seizure
Awareness unimpaired
Complex seizure
Awareness impaired
Secondary generalised seizure
Focal seizure –> generalised seizure
(aura–>tonic-clonic)
Epilepsy history
Aura
Specific trigger (lights)
Lateral tongue biting
Tonic clonic movements
Cyanosis
Post-ictal phase
Simple partial seizure features
Focal motor, sensory, autonomic or psychic symptoms
Complex partial seizure features
Aura
Awareness lost
Automatisms
Autonomic
Amnesia
Automatisms
Lip smacking
Fumbling
Swallowing
Autonomic changes of seizures
Change in skin colour
Temp
Palpitations
Absence seizure features
(Petit mal)
Abrupt onset/offset
Short <10s
Eyes glazed, blank stare
Trigger for absence seizure
Hyperventilation
Tonic Clonic seizure definition
(Grand Mal)
LOC
Tonic: limbs stiffen
Clonic: rhythmic jerking
Other features of tonic clonic seizures
Cyanosis
Incontinence
Tongue biting
Post ictal confusion and drowsiness
Myoclonic seizure features
Sudden jerk of limbs, trunk or face
Atonic seizure features
Sudden loss of muscle tone –> fall
No LOC
West syndrome / infantile spasms
Head nodding and arm jerks
EEG hypsarrhythmia
Temporal localising seizure features
Automatisms
Deja/jamias vu
Delusional behaviour
Abdominal: rising, n/v
Emotional disturbance
Emotional disturbance of temporal localising seizure
Terror
Panic
Anger
Elation
Tastes, smells
Frontal localising seizure features
Motor features
Parietal localising seizure features
Sensory disturbance
Occipital localising seizure features
Visual phenomena
Diagnosis of epilepsy
Need more than 1 seizure
Ix for epilepsy
Raised serum prolactin 10 min after fit
EEG
Tonic Clonic seizure treatment
1) Valproate
2) Lamotrigine
Absence seizure treatment
1) Valproate/ethosuximide
2) Lamotrigine
Tonic, atonic, myoclonic seizure treatment
1) Valproate
2) Levetiracetam
Focal +/- secondary generalised seizure treatment
1) Lamotrigine
2) Carbamazepine
Lamotrigine side effect
Skin rash (stephen johnson syndrome)
Valproate side effects
(VALPROATE)
Appetite ↑ → ↑wt.
Liver failure
Pancreatitis
Reversible hair loss
Oedema
Ataxia
Teratogenicity, Tremor, Thrombocytopaenia
Encephalopathy: due to ↑ ammonia
Carbamazepine side effects
Leukopenia
Skin reactions
Diplopia
SIADH –> hyponatraemia
Phenytoin side effects
Gingival hypertrophy
Hirsutism
Cerebellar syndromes
Peripheral sensory neuropathy
Diplopia
Tremor
Status epilepticus definition
Seizure > 30mins (or 5 mins still don’t know)
or repeated seizures without regain of conciousness
Treatment of status epilepticus
1) Lorazepam/Midazolam: 2nd dose if don’t respond in 2 mins
2) Phenytoin IV
3) Diazepam infusion
4) Dexamethasone
5) General anaesthetic
Pregnancy and epilepsy treatment
Don’t give valproate
Give lamotrigine and folic acid
