Epilepsy: Flashcards
What is epilepsy?
A recurrent tendency to spontaneous, intermittent, abnormal electrical activity of the brain, manifesting as seizures.
What is a seizure?
It is the clinical manifestation of dysynchronus neuronal discharge - generalised/focal.
What are primary generalised seizures?
(40%) Bilaterally symmetrical and synchronous discharge involving both hemispheres. No focal brain abnormality
What are partial seizures?
One hemisphere involved at onset. New onset partial seizures represent a focal structural abnormality until proven otherwise.
Give some causes/RF for epilepsy:
- Mostly idiopathic
- Genetic conditions (tuberous sclerosis)
- Cerebrovascular disease
- CNS infection
What are the different types of generalised seizures?
(consciousness lost from start):
- Generalised tonic clonic
- Clonic seizures
- Tonic seizures
- Absence
- Myoclonic seizures
- Atonic seizures
What is a generalised tonic clonic seizure?
Tonic phase (rigid and stiff) to clonic phase (generalised, bilateral, rhythmic jerking lasting seconds to minutes. often bite-tongue and incontinent of urine/faeces)
What is a clonic seizure?
Rhythmic jerking movements
What are tonic seizures?
Sudden sustained increased tone with a characteristic guttural cry/grunt
What is an absence seizure?
Impaired consciousness with mild or no motor involvement. Normal activity resumes without awareness of seizure.
What is a myoclonic seizure?
‘Shock like’ body jerks.
What is a atonic seizure?
Sudden brief loss of tone may call falls
What types of partial seizures are there?
- Simple partial seizures
- Complex partial seizures
- Partial seizures with secondary generalisation
What are the features of simple partial seizures?
Awareness unimpaired - focal motor, sensory, autonomic or psychic symptoms.
No post-ictal symptoms
What is a complex partial seizure?
Alteration of consciousness (LOC, automatisms, lip smacking, chewing, autonomic aura such as epigastric rising sensation)
What characteristic appear based on the lobe affected?
Temporal lobe:
- Aura
- Deja-vu
- Auditory hallucinations
Frontal lobe:
- Motor features
- Jacksonian March (seizure marches up or down the motor homunculus)
Parietal lobe:
- Sensory disturbances (tingling/numbness)
Occipital lobe:
- Visual phenomena
Give 3 DD for epilepsy:
- Syncope
- Cardiac arrhythmias
- TIA
How is epilepsy diagnosed?
From history:
- need at least 2 unprovoked seizures occurring >24hrs apart to diagnose epilepsy
What investigations are performed in epilepsy?
EEG - 3Hz wave seen in absence seizures
FBC, U&Es and LFTs to rule out metabolic causes.
MRI - identify structural abnormalities
Genetic testing (e.g. juvenile myoclonic epilepsy)
What is the management for epilepsy?
Primary generalised - Valporate
Absence seizures - valporate
Partial seizures - carbamazepine
What must patients do if they are diagnosed with epilepsy?
Inform DVLA. Cannot drive until they have been free of daytime seizures for at least one year
What can be a severe complication of epilepsy?
Sudden unexpected death in epilepsy (SUDEP).
What is status epilepticus?
Seizure lasting >30mins or reccurent seizures with no full recovery in between
What is the management for status epilepticus?
- ABCDE (protect from injury, check glucose)
- Rectal diazepam - repeat x2
- Phenytoin loading
- If still fitting, anaesthetist involvement for anaesthetic and ventilation.
