Epilepsy Flashcards
What can cause a blackout? [5]
- Vasovagal Syncope
- Hypoxic Seizure
- Concussive Seizures
- Cardiac Arrhythmia
- Non-epileptic attacks
Define Vasovagal syncope [3]
Symptoms [5]
Syncope may be defined as a transient loss of consciousness [1] due to global cerebral hypoperfusion [1] with rapid onset, short duration and spontaneous complete recovery [1].
- Light headed
- Nausea
- Hot/Sweating
- Tinnitus
- Tunnel Vision
What could trigger vasovagal syncope? [5]
- Prolonged Standing or standing up too fast
- Trauma
- Venepuncture
- Urination
- Coughing
Whats the difference between a seizure and syncope?
- Syncope tends to happen when your upright
- Pallor is common in syncope
- Syncope has a gradual onset vs a sudden onset seizure
- Injury & incontinence are rare in syncope
- Recover rapidly from syncope but not seizure
- Syncope is triggered, precipitants for seizures are rare
How does a hypoxic seizure occur? Which setting would this most commonly occur? [2]
People who faint and then are kept upright keep fainting and dont breath –> Seizure
Occurs a lot in aircraft where people cant end up lying down
What is a non-epileptic attack? [1]
Gender epidemiology [1]
Links [3]
Management [1]
F > M
‘pseudoseizures’
They are often linked to:
- Stress
- Past abuse
- History of medically unexplained symptoms
Require psychological input not AEDs
When you have a patient who blacked out what do you want to know?
- What they were doing
- Any warning feelings or Aura
- Similar previous history
- Any injury or incontinence
- How responsive are/were they, what collour did they go, did they move or make sound
- Whats their pulse like
- Past medical, psych, alcohol/drug and family history
If someone’s had their first seizure how would you investigate? [4]
- Bloods - metabolic causes e.g., hyponatraemia
- Brain imaging
- CSF exam if systemic illness - HSV, autoimmune encephalitis
- EEG
- Advanced functional imaging can localise seizure focus
What features on a first seizure would suggest generalized epilepsy [3]
What features on a first seizure would suggest focal epilepsy [3]
Primary Generalised Epilepsy:
- History of myoclonic jerks (particularly in morning)
- Absences
- Feeling strange +/- flickering lights
Focal Onset Epilepsy:
- Deja Vu
- Rising in abdomen
- Episodes where they look blank and smack lips
How would you advise someone who’s just had their first seizure? [3]
- Driving Regulations
- Inquire about employment or potentially dangerous activities
- Refer to epilepsy clinic for routine follow up
Define Epilepsy [3]
- A neurological disorder marked by sudden recurrent episodes [1] of sensory disturbance, loss of consciousness, or convulsions, [1] associated with abnormal electrical activity in the brain. [1]
- Caused by predisposition to neuronal hyperexcitability
Epilepsy epidemiology [1]
Causes of epilepsy [5]
More common in extremes of age
- 6 in 10 unknown cause
- Difficult birth
- Brain infection
- Stroke
- Serious brain injury
In what groups is epilepsy more common? [1]
People with learning difficulties (22% of people with LD)
What are the classifications of Epilepsy [2]
Generalised Epilepsy (Generally congenital and young)
Partial Epilepsy (Any age, due to focal brain damage)
What are the types of Primary Generalised Epileptic Seizure [6]
- Tonic Clonic (Tense-Jerky)
- Myoclonic (Very brief twitch contractions)
- Clonic
- Tonic
- Atonic (Very rapid collapse to floor)
- Absence (most common in kids, tends to grow out by age 12)
How are focal onset seizures different? [2]
Name the 3 subtypes
In which type of seizure classification is family history relevant? [1]
They vary by which area of the brain is affected. May come with aura which may localise where the seizure is happening in the brain.
They may retain awareness/responsiveness (Simple) OR may have impaired awareness (Complex)
Can develop into a secondary generalized seizure
called ‘Focal to Bilateral seizure’ or secondary generalized seizure
Family history association in generalized but not in focal epilepsy
How does an EEG change between focal/partial and generalized epileptic seizures?
What could an MRI/CT show us to differentiate between focal and generalized?
An EEG would show generalised vs focal abnormalities of brain waveform
An MRI or CT may show a physical cause in a focal epileptic but not primary generalised
How would you make epilepsy visible in order to test with an EEG? [3]
Hyperventilation
Photic Stimulation
Sleep Deprivation
Will show up best in Generalised Epilepsy
What other test can be done for epilepsy if you didn’t find anything on EEG? [2]
Video-Telemetry
Basically an EEG with a camera over several days
What are the rules for driving with epilepsy?
Normal licenses:
- Seizure Free for a year Or had seizures but only from sleep.
- If you have a daytime seizure ever then you will need 3 yrs of none or purely nocturnal seizures
HGV/PSV:
- Seizure and medication free for 10yrs
Treatment for epilepsy
Describe all first line drugs for generalized, focal and absence [3]
In which instances are abortive drugs used? [1] State what drugs these are [1]
Describe second line drugs for generalized and partial [2]
1st line:
- Sodium Valproate (Anti-convulsant) for Generalised
- Carbamazepine (Anti-convulsant) for Focal
- Ethosuximide for Absence seizures
Abortive drugs such as lorazepam are used in generalised and status epileptics
2nd line:
- Generalised: topiramate
- Focal: sodium valproate
Side effects of Sodium valproate [4] and Carbamezapine [4]?
Sodium Valproate:
- Tremor/Ataxia
- Weight Gain
- Hair Loss
- Pancreatitis/Hepatitis
Carbamazepine:
- Ataxia
- Low Serum Na
- Severe Skin rash
- Nystagmus/Blurred Vision
What is Status Epilepticus? [1]
Whats the most common type?
Aetiology [4]
Sequelae [1]
A prolonged or recurrent seizure that lasts for 5 mins with no recovery period in between
(Most common type is TCSE - Tonic Clonic Status Epilepticus)
Usually caused by stroke, tumour, haemorrhage or alcohol and 90% of deaths are due to the underlying cause not the seizure itself
Can lead to neuro problems (brain damage) in children
How do we treat TCSE?
1st line - IV lorazepam 4mg, midazolam buccal/IM/IV, diazepam oral/rectal/IV.
2nd line - Phenytoin slow infusion 15-18mg/kg at 50mg/min
3rd line - GA e.g. propofol
NPA airways may be more practical than oral airways.
Alternative uses for carbamazepine [1]
As well as being an anticonvulsant it treats nerve pain in conditions such as Trigeminal Neuralgia
Partial seizure
Frontal lobe seizures
State 2 types
Explain Todd’s paralysis [1]
Jacksonian motor seizures - ‘march’ of involuntary movement from one muscle group and then spreads [1]
Adverse seizure - patient’s eyes and head turn away from the site of the focal origin [1]
Todd’s paralysis is common after motor seizure - affected limb remains weak for some hours after [1]
Partial seizure
Point of origin in cortex [1]
Parietal lobe seizures
Presentation [2]
Arising in sensory cortex
Paresthesia in extremity or on face
Distortion of body image