Epilepsy Flashcards
What is key in the diagnosis of a seizure?
EYE - WITNESS
What should you find out about the seizure?
Before, during and after
What should you find out about the onset of a seizure?
What were they doing?
Environment?
What is an important CVS question to ask?
Did they experience any syncopal symptoms or light headedness?
What sort of things do you want to know when asking what they looked like?
- Pallor
- Breathing
- Posture of limbs
- Head turning
What should you find out about the event itself?
- Types of movement
- Tonic phase, clonic movements
- Carpopedal spasms, rigor
What is a ‘general tonic-clonic seizure’?
Tonic component
- all muscles in the body are rigid
- if the respiratory muscles are involved, person may become blue due to hypoxia.
Clonic component
- jerky movements due to discharge of electrical activity
- clonic component becomes of greater amplitude as discharge rate decreases
What is a ‘general tonic-clonic seizure’?
Tonic component
- all muscles in the body are rigid
- if the respiratory muscles are involved, person may become blue due to hypoxia
Clonic component
- jerky movements due to discharge of electrical activity
- clonic component becomes of greater amplitude as discharge rate decreases
Why may a person become blue during a seizure?
If the seizure is tonic, the respiratory muscles may be involved and will be rigid and the person will become hypoxic
What do carpopedal spasms suggest?
Hyperventillation
In a tonic-clonic seizure, will the person be aware of their surroundings?
NO
What do you want to know about what happened after the seizure?
- Speed of recovery
- Sleepiness/disorientation
- Deficits
Post - epileptic attack, what do patients feel like?
Sleepy and disorientated
Give examples of epilepsy risk factors.
Birth (ie. premature). Development. Seizures in past (inc. febrile fits). Head injury (inc. LOC). Family hx. Drugs. (BENZOS!!!) Alcohol.
What should you reassure a patient with epilepsy of in terms of their occupation?
Reassure pt that they can’t be sacked because of this dx since epilepsy is classed as a disability.
Is an exam carried out in 1st seizure appointment?
NO - history is most important
What exams should be carried out if a diagnosis of syncope is made?
Cardiovascular examination
Lying and standing BP important
What should you never forget to ask about in a history of someone with seizures?
Drugs
What drugs/drug classes are particularly bad for worsening epilepsy?
Aminophylline/Theophylline. Analgesics ie. tramadol. Antibiotics ie. penicillins, cephalosporins, quinolones. Anti-emetics ie. prochlorperazine. Opioids ie. diamorphine, pethidine
What is the biggest cause of death in patents with epilepsy?
Suicide :(
What investigation MUST you always do in a patient who has had a seizure?
ECG
Why should an ECG always be done?
To find out if it was a hypoxic seizure
e.g from prolonged QT
What is prolonged QT a common cause of?
- Seizures
* Cardiac arrest
You don’t need to (+ shouldn’t) CT every person who presents having had a seizure. Who, however, should get a CT scan acutely?
Clinical or radiological skull fracture Deteriorating GCS Focal signs Head injury with seizure Failure to be GCS 15/15 4 hours after arrival Suggestion of other pathology – eg SAH
Who should always get a CT?
Those who you think will need neurological help in the next few days
For what 4 reasons should an EEG be used?
Classification of epilepsy
Confirmation of non-epileptic attacks
Surgical evaluation
Confirmation of non-convulsive status
EEG’s are shite
Pie them off
When should EEG’s absolutely not be used?
To investigate the cause of an ‘attack’
What 4 conditions are commonly confused with epilepsy?
- Syncope
- Non-epileptic attack disorder (pseudopseizures, psychogenic non-epileptic attacks)
- Panic attacks/Hyperventilation attacks
- Sleep phenomena
Seizures doesn’t always mean epilepsy
TRUE
How can risk of recurrence of seizures be decreased?
Avoid alcohol, drugs and lack of sleep
What are the rules with regard to driving a i) car ii) HGV/PCV after the 1st seizure?
i) Can’t drive car for 6 months
ii) Can’t drive for 5 years
What are the rules with regard to driving a i) car ii) HGV/PCV after a diagnosis of epilepsy?
i) Must be seizure free for 1 year
ii) Can drive if had no seizures, and been OFF MEDICATION for 10 years
What is SUDEP?
Sudden Unexpected Death in Epilepsy
What are the risk factors for SUDEP?
Non-compliance with meds.
Drinking/Drugs.
Nocturnal seizures, and don’t have a bed partner
If someone presents with a seizure, what should you assume until proven otherwise?
That the cause of the seizure is a brain tumour
What is epilepsy?
A tendency to recurrent, usually spontaneous, epileptic seizures.
At what age does epilepsy occur?
At any age, but is most common in INFANCY and OLD age
Describe ‘focal’ seizures.
There is a focal abnormality which is a bit more sensitive than other areas of the brain. If the seizure starts there, it usually stays there.
What can focal seizures become?
If it ‘hits’ one of the cortical networks, it can spread more widely, causing a secondary generalized seizure