Epilepsy Flashcards
Define epilepsy:
chronic disorder characterised by recurrent seizures which may vary from a brief lapse of attention or muscle jerks to severe and prolonged convulsions (spontaneous)
tendency to have spontaneous recurrent seizures
2 or more seizures without clear symptomatic provocation
What are the key elements to assessing a blackout?
clinical diagnosis is key to determining investigations/management/treatment Mis-diagnosis is common e.g. seizure/cardiac syncope can have significant consequences, or diagnosing a seizure when actually it was a faint- end up with inappropriate drug treatments, and life changing consequences (driving)
What are the differential diagnosis of “blackout”?
faint (vasovagal syncope) - very common seizure cardiac syncope cataplexy hypoglycaemic attacks (very rare but significant)
What are the most useful diagnostic tools for diagnosing a blackout?
witness account
develop clear understanding of what happens before, during and after the episode
What is a faint?
sudden impairment of consciousness with loss of tone
due to reduced blood/oxygen to the brain
frequent provoking factors - blood, pain, dehydration
Usually come round where they fell
stiffening and jerking is common
urinary and faecal incontinence may occur
What are presyncopal symptoms?
light headedness
warm, dizzy builds in intensity then may be loss of vision or hearing before loss of consicousness
What are the helpful features that indicate its likely to be a seizure?
post event confusion longer than 2 mins
deeply bitten lateral border of tongue
prolonged tonic then clonic movement lasting greater than 1 min
deep cyanosis
Define seizure:
clinical phenomenon due to abnormal, synchronous, cortical discharges
provoked seizure does not equal epilepsy
What are some of the aetiologies of epilepsy in adults?
mainly cryptogenic
trauma, idiopathic, cerebrovascular, degenerative, neoplasm
What is your prognosis with epilepsy?
70% enter spontaneous remission - therefore most it is good
poor prognosis - failure of 2 first line drugs because of efficacy- <10% of entering remission
such patients should be considered for epilepsy surgery programme
What is the impact in terms of QoL of epilepsy?
impaired QoL resulting from: - comorbidity- cognitive and mood disturbance - lifestyle restrictions: driving, employment, social life - stigma and discrimination - medication side effects increased risk of injury premature mortality - underlying cause of epilepsy - accidents - SUDEP
Define drug resistant or chronic epilepsy?
continuous seizures despite effective trials of at least 2 appropriately selected antiepileptic drugs
What is the ILAE classification of seizures?
FOCAL
- characterised by one or more features; aura, motor, autonomic, awareness altered
- may evolve to bilateral convulsive response
GENERALISED
- absence
- myoclonic
- atonic
- tonic
- tonic-clonic
What does it mean by “complex” partial seizures?
impaired consciousness or awareness clinical manifestations vary with site of origin and degree of spread - presence and nature of aura - automatism - other motor activity
What are the different types of aura and which region of the brain tends to be affected?
somatosensory - R parietal lobe = tingling in L arm
Visual - L occipital lobe = colourful flashing lights, temporal, parietal-occipital junction = complex dream like visions
olfactory - temporal = hallucination of a familiar unpleasant smell
auditory - temporal = hearing a familiar song
autonomic - temporal mainly = rising abdominal sensation
emotional = temporal - fear, anger, sadness or sexual arousal
psychic - temporal = multisensory attacks, deja vu
What are absence seizures?
petit-mal seizures
dominant seizure type in idiopathic generalised syndromes of childhood and juvenille absence epilepsy
momentary lapse in awareness - patient may stop what they are doing, stare, blink or look vague before carrying on what you were doing
simple if just LoC and complex if also accompanied by motor activity
often don’t recollect attacks
How can epilepsy syndromes be characterised?
grouping of pts that share similar:
- seizure types
- age of onset
- eeg pattern
- natural history/prognosis
- genetics
- response to treatment
How are epilepsy syndromes categorised?
partial = cryptohenic or structural metabolic
Generalised = presumed genetic or structural metabolic
What investigations are carried out for syncope or seizures?
Syncope - ECG and discharge with advice
Seizure - MRI (good at detecting subtle abnormalities) commonly, EEG maybe
What are the DVLA rules around seizures?
new rules 2010 - single seizure “imaging” and EEG unsupportive of epilepsy = 6 months
Epilepsy = 12 months seizure free
What is MOA of barbiturates and what type are they used for?
increases GABA
partial seizures
What is MOA of benzodiazepine and what type are they used for?
increases GABA
status
What is MOA of carbamazepine and what type are they used for?
inhibits Na channels
Tonic clonic
What is MOA of phenytoin and what type are they used for?
inhibits Na and Ca
status
