Epilepsy Flashcards
What are the possible causes of a blackout?
Syncope First seizure Hypoxic seizure Concussive seizure Cardiac arrhythmia Non-epileptic attack (narcolepsy, migraine etc)
What is the most common cause of fainting?
Vasovagal syncope
What symptoms usually occur pre-syncope?
Light-headedness Nausea Patient is hot Sweating Tinnitus Tunnel vision
What are the triggers for vasovagal syncope?
Prolonged standing Standing up quickly Trauma Venepuncture Watching/experiencing medical procedures Micturition Coughing
What characteristics differentiate syncope from seizure?
Syncope-
Upright posture, pallor common, gradual onset, injury rare, incontinence rare, rapid recovery, precipitants common
Seizure-
Any posture, pallor uncommon, sudden onset, injury relatively common, incontinence common, slow recovery, precipitants rare
What is the cause of hypoxic seizures?
Occur when individuals are kept upright in a faint- can occur in aircraft, at the dentist or when passers by try to help someone to their feet
What is the cause of concussive seizures?
Can occur after any blow to the head
What is the aetiology of non-epileptic attacks?
Commoner in women than men
May have a history of other medically unexplained symptoms
May have history of abuse
What are the characteristics of a non-epileptic attack?
May resemble a generalised tonic-clonic seizure
May resemble a “swoon”
May involve bizarre movements
How is a first seizure investigated?
Blood sugar testing
ECG
Consideration of alcohol and drugs
CT head
What advice should be given to a patient following a first seizure?
Information about first seizure clinic
They may need to inform their employer
Enquire about potentially dangerous leisure activities
Explain driving regulations (can drive car after 6 months or HGV/PSV after 5 years if investigations are normal and they have no further events)
What features are suggestive of primary generalised epileptic seizures?
History of myoclonic jerks (especially first thing in the morning)
Absences or feeling strange with flickering lights
What features are suggestive of focal onset epileptic seizures?
History of “deja vu”
Rising sensation from abdomen
Episodes where look blank with lip-smacking and fiddling of clothes
What are the different kinds of epilepsy as described by ILAE classification?
Generalised seizures Tonic-clonic seizures Myoclonic seizures Clonic seizures Tonic seizures Atonic seizures Absence seizures
How is primary generalised epilepsy characterised?
No warning of seizures <25 years old May have history of absences and myoclonic jerk Generalised abnormality on EEG May have family history
