Epilepsy Flashcards
Define epilepsy:
A spontaneous synchronus discharge of cerebral neurons which causes symptoms and signs that are apparent to either the patient or an observer.
What is another word for motor symptoms?
Convulsions
What is a simple focal seizure
When a patient suffers from focal motor or sensory symptoms, but does not lose awareness.
What is a complex focal seizure?
Patient suffers a loss of awareness while experiencing focal sensory or motor symptoms
What is important about a focal seizure?
They do not lose consciousness!
Where in the brain does a focal seizure occur?
Only acts on one hemisphere
Very common in temporal lobe
What is a generalised seizure?
This is when both hemispheres are simultaneously involved.
Patient will experience a loss of consciousness
What is an absent seizure?
This is a form of a generalised seizure
They are brief absences lasting <10seconds
Presents in childhood
Define tonic-clonic seizure:
Patient suffers loss of consciousness
Limbs stiffen (tonic) then begin to jerk (clonic)
Have post ictal confusion and drowsiness
Define myoclonic seizure
This is the sudden jerk of a limb, face or trunk
Patient may be violently thrown by it
What is an atonic seizure?
This is when the patient experiences a sudden loss in muscle tone causing them to fall over but there is no loss of consciousness.
What features are suggestive of parietal lobe involvement?
Sensory disturbances e.g. tingling, numbness and pain (rare)
What features would suggest involvement of the occipital lobe?
Any visual phenomena
What features would occur in frontal lobe involvement?
Motor features such as posturing Versive movements of the head Dysphasia Speech arrest Peddling of the legs Subtle behavioral disturbances
What symptoms would be indicative of a temporal lobe involvement?
Automatism’s* with impaired consciousness and no memory of the event after.
*complex motor phenomena e.g. lip smacking, chewing, fumbling, singing, dysphasia, violence etc
What would suggest hippocampal involvement?
Emotional disturbance
What is important to know when asking about the seizure?
What it provoked by something
Usually provoked seizures tend not to reoccur and are not epilepsy
List some causes of epilepsy?
Idiopathic - (but familial) Developmental problems Vascular Scarring Trauma Metabolic upset Infections Drugs
What is the most common cause of epilepsy in 60< years old?
Vascular problems
When does Juvenile Myoclonic epilepsy tend to present?
In teenage years
What are some triggers for juvenile myoclonic epilepsy?
Strobe lights
Sleep deprivation
Alcohol
What symptoms are displayed in JME?
Generalized tonic-clonic seizures
Myoclonic jerks
Absences (in 1/3rd)
How is epilepsy diagnosed?
Mainly through the history
Bloods done to rule out metabolic causes
ECG must be done in people with LOC
MRI usually done unless clinical picture is definitive. (children less likely to need MRI)
What drugs are first line treatment for both focal and generalised seizures?
Sodium Valproate
Lamotrigine
Carbamazapine
