Epilepsy Flashcards
2 broad types of seizure?
Focal seizures and Generalised seizures
types of focal seizures?
Focal Seizure: seizure localised to specific cortical regions (e.g. temporal lobe seizure). These can be further divided into:
COMPLEX partial seizure: consciousness is affected
SIMPLE partial seizure: consciousness is NOT affected
types of generalised seizure?
Generalised Seizure: seizures that affect the whole of the brain. It also affects consciousness. There are different types of generalised seizure:
Tonic-clonic
Absence
Myoclonic
Atonic
Tonic
primary causes of epilepsy?
idiopathic
Primary epilepsy syndromes (e.g. idiopathic generalised epilepsy)
secondary causes of SEIZURES?
Secondary Seizures ;
Tumour Infection (e.g. meningitis) Inflammation (e.g. vasculitis) Toxic/Metabolic (e.g. sodium imbalance) Drugs (e.g. alcohol withdrawal)
Vascular (e.g. haemorrhage)
Neurodegenerative disease (e.g. Alzheimer’s disease)
Malignant hypertension or eclampsia
Trauma
conditions mistaken for epilepsy?
note; lots of things can cause seizures but are not epilepsy.
Non- epileptiform seizure disorder
Syncope - arrhythmias etc
key questions to ask in the hx of a seizure?
Rapidity of onset
Duration of episode
Any alteration in consciousness?
Any tongue-biting or incontinence?
Any rhythmic synchronous limb jerking?
Any post-ictal abnormalities (e.g. exhaustion, confusion)?
Drug history (alcohol, recreational drugs)
How does a Focal seizure present?
A focal seizure is characterised by localised brain activity, which then involves seizing on one specific side of the body or involves one specific body part;
- Aura - dejavu, fear etc (temporal lobe seizure)
- Automatisms - picking at clothes smacking lips
- Staring and loss of contact with the environment
- Poor memory (complex partial seizure - due to LOC)
- Temporary aphasia post-ictally
- May show post-ictal flaccid weakness (Todd’s paralysis)
How does a Generalised tonic clonic seizure present?
Tonic-Clonic (Grand Mal)
Vague symptoms before attack (e.g. irritability)
Tonic phase (generalised muscle spasm)
Clonic phase (repetitive synchronous jerks)
Faecal/urinary incontinence
Tongue biting
Post-ictal phase: impaired consciousness, lethargy, confusion, headache, back pain, stiffness
How does a Generalised absence seizure present?
Absence (Petit Mal)
Onset in CHILDHOOD
Loss of consciousness but MAINTAINTED POSTURE
The patient will appear to stop talking and stare into space for a few seconds
NO post-ictal phase
how does Non-Convulsive Status Epilepticus present?
Acute confusional state
Often fluctuating
Difficult to distinguish from dementia
Ivx of seizures?
Blood glucose - hypo/hyper can cause seizure
Serum prolactin - elevated after complex partial seizures (LOC)
FBC - high WCC can mean CNS infection
Electrolyte - disturbances
Lumbar puncture; high protein or low glucose
CT head - haemorrhage, trauma etc
MRI head - parenchymal abnormalities- sclerosis etc (TEST OF CHOICE)
EEG - can be normal
What is status epilepticus?
a seizure lasting > 30 mins or repeated seizure without recovery and regain of consciousness in between
Management of Status epilepticus?
- supportive care + oxygen
Basic life support measures should be initiated, including securing the airway, delivering 100% oxygen by mask or nasal cannula, and correcting hypotension, hyperthermia, glucose and electrolyte abnormalities, and potential thiamine deficiency. ECG should be monitored.
1a. thiamine + glucose (if hypo)
1b. IV Lorazepam/Diazepam
if 1b not wokring then IV phenytoin
Management of focal seizure?
IV Lorazepam or diazepam + airway maintenance
the whole internet says its; Lamotrigine or Carbamazepine
