Epilepsy Flashcards
What is it
Condition where brain is affected by recurrent seizures
Types of seizures
Partial
Generalised
Describe partial seizure
Seizure that occurs in one discrete part of the brain
These seizures may be simple or complex
What is meant by a partial seizure being simple or complex
Simple - Without alteration in consciousness
Complex - With alteration in consciousness
Describe generalised seizure
Seizures that affect the brain globally
Consciousness is always altered
Examples of generalised seizures
Absence seizure Tonic-clonic seizure Atonic seizure Myotonic Secondary generalised
Describe Absence seizure
Often picked up in children who ‘stare into space’
Usually only lasts for afew seconds
Describe Tonic-clonic seizure
Involves convulsions and muscle rigidity
Usually lasts minutes
Describe Atonic seizure
Involves a loss of muscle tone
Describe myotonic seizure
Involves jerky muscle movement
Describe secondary generalised seizure
Generalised seizure that originates from a partial seizure
Cause of seizures
Abnormal paroxysmal neuronal discharges in the brain, which result from some form of traumatic brain injury.
These discharges display hypersynchronisation.
3 types of causes of epilepsy
Idiopathic
Cryptogenic
Symptomatic
What is meant by idiopathic cause
Cause is unknown
What is meant by cryptogenic cause
Cause is unknown
Signs suggesting it may be linked to brain injury e.g. patient has autism or learning difficulties
What is meant by symptomatic cause
Cause known
Symptomatic causes of epilepsy
VINDICATE Vascular - history of stroke Infection - history of meningitis or malaria Neoplasms - brain tumour Drugs - alcohol and illicit drug use Iatrogenic - drug withdrawal Congenital - family Hx of epilepsy Autoimmune - vasculitis Trauma - history of brain injury Endocrine - Low Na+, Low Ca2+ or Loe/High Glucose
What do Signs and symptoms of epilepsy depend on
The region of the brain affected
Signs and symptoms of seizure affecting frontal lobe
JAM
Jacksonian march
pAlsy (postictal Todd’s palsy)
Motor features
Signs and symptoms of seizure affecting the temporal lobe
ADD FAT Aura that the epileptic attack will occur Deja vu Delusional behaviour Fear/panic (hippocampal involvement) Automatisms Taste/smell - uncal involvement
Signs and symptoms of seizure affecting the temporal lobe - what part of brain is also involved is presentation of Fear/Panic
Hippocampus
Signs and symptoms of seizure affecting the parietal and occipital lobe
Visual and sensory dsturbances
Other Signs and symptoms of seizure (not resulting from seizures of particular lobes of brain)
Partial or generalised seizure with or without convulsions
Tongue biting
Migraines
Depression
Investigations
Bloods - FBC, U and Es, LFTs, ESR, glucose, calcium levels
Radiology - CT scan, MRI scan
Other - ECG, LP, EEG
Conservative treatment
Patient and family education Inform DVLA (UK)
Medical treatment
Anticonvulsant therapy
Surgical treatment
Anterior temporal lobe resection
Corpus callosotomy
Tumour removal
Examples of Anticonvulsants
Carbamazepine Phenytoin Sodium valproate Ethosuximide Phenobarbital
How does carbazepine or phenytoin work
Blocks voltage dependent Na+ channels
How does ethosuximide work
Inhibits T-type Ca2+ channels
How does phenobarbital work
Acts of GABA receptors - enhancing synaptic inhibition
Complications
Injuries whilst having seizure Depression Anxiety Brain damage Sudden unexplained death in epilepsy (SUDEP)
Differential diagnosis
Migraine Hypoclycaemia Dystonia Cardiogenic syncope Hyperventilation
Is it epilepsy?
Causes of blackouts
Primary disturbance of brain function
Secondary disturbance of brain function
Examples of secondary disturbances of brain function
Low blood pressure
Related to heart
Examples of primary disturbances of brain function
Dissociative/non-epileptic seizures (psychological)
Epileptic seizures
Types of epileptic seizures
Genetic generalised epilepsy
Unclassifiable epilepsy
Structural/metabolic epilepsy
What is an Epileptic seizure
Paroxysmal event in which changes of behaviour, sensation or cognitive processes are caused by excessive (too much voltage), hypersynchronous neuronal discharges in the brain
Duration of epileptic seizure
30-120 seconds
Features of epileptic seizures
Postictal symptoms (Positive-itcal symptoms)
Stereotypical seizures
May occur from sleep
May be associated with other brain dysfunction
What is meant by postictal symptoms
“positive” of something (feeling touch when not being touched; hearing something thats not there etc) - opposite of negative symptoms
Examples of typical seizure phenomena
Lateral tongue bite
Deja vu
Differences between an epileptic and non-epileptic seizure
Non-epileptic tends to last longer
Eyes open in Epileptic
Non-epileptic involved hip thrusting
Incontinence associated with Epileptic
Pathophysiology of an epileptic seizure
Excessive, unsynchronised neuronal discharges
Causes paroxysmal changes in behaviour, sensation and cognitive processes
Example of antiepileptic and side effect
Carbamazepine
Heart problems
