Epilepsy Flashcards
what are focal and generalised seizures?
focal = one part of the brain
generalised = larger part of the brain
who tends to suffer from focal and generalised seizures?
focal more common in 50s
generalised more common <30 as tend to be genetic
what are provoked seizures?
alcohol
sleep deprivation
hypoglycaemia
are provoked seizures classed as epilepsy?
no
what is important to ask about to determine epileptic seizure vs faint?
what happens before/after
eye witness
how would you describe an epileptic event?
lose awarness and go stiff
what exam must be carried out if investigating syncope?
cardiovascular exam
what is used to investigate epilepsy?
ECG
cerbral hypoperfusion and hypotension (watch for prolonged QT syndrome)
is an EEG manatory when investigating epilepsy?
no- 1 in 5 will show abnormal activity but not have epilepsy, likewise people will have nromal result when they do have epilepsy
when will an EEG be used?
in those <30 to differentiate between focal/generalised
how would an epileptic seizure affect someones ability to drive?
first seizure: car 6 months, HGV 5yrs
epilepsy: car 1yr, HGV 10yrs
how does focal epilepsy affect the brain?
one part of brain is structurally abnormal which predisposes to seizures i.e. sensory cortex gives sensory seizure
how can seizures propagate through the brain?
cortical networks
if a focal epilepsy results in a generalised siezure by propagating through brain what is this then termed?
secondary generalised seizure
what part of the brain is affected in generalised epilepsy?
abnormality already in cortical network so will always get generalised seizures
what are the kinds of generallised seizure people can experience?
absence
myoclonic
atonic
tonic
tonic clonic
what drug can be given to treat focal epilepsy?
carbamazepine
lamotrogine
what is side effect of carbamazepine?
lessens effects of other drugs i.e. COCP, chemo
wgt gain
hair loss
fatigue
what is used to treat genrealised epilepsy?
sodium valproate
what do you need to consider when prescribign sodium valproate?
teratogenic so muct be given contraception if child bearing age
lamotrogine can cause which syndrome if given too quickly?
steven-johnson syndrome
how long should it take to titrate up lamotrogine?
3 months
what drug should never be given to treat generalised epilepsy?
carbamazepine
can phenytoin be used to treat epilepsy?
used acutely- 6months to 1 year
what other anti-epileptic can be used as few drug interaction but can cause mood swings?
levetiracetam
carbamazepine, oxcarbazepine, phenobarbital, phenytoin, primidone and topiramate are all what kind of anti-epileptic drug?
enzyme inducing AEDs
what is status epilepticus?
recurrent epileptic seizures without full recovery of consciousness >30mins
status epilepticus can last >30mins, at what point is it treated?
10 mins as chances of self-terminating after then are near 0
what is generalised convulsive status?
generalised convulsions without cessation
what can cause generalised convulsive status?
severe metabolic disease
withdrawal of anti-convulsant
head trauma
sub-arachnoid haemorrhage
what is the management of generalised convulsive state?
stabalise patient- ABS and identify cause
anticonvulsant: benzo, phenytoin, sodium valproate
if possible hypo give glucose/if alcohol give thiamine
what is the max dose of benzodiazepine that can be given when suffering seizure?
max 2 doses
what is teh name given to continous focal seizures with consciousness preserved?
epilepsia partialis continua
what is an absence seizure?
interrupts activity with pause i.e. makes you stop what youre doing then start again
what will be seen in frontal lobe seizure?
motor signs i.e. stiffness, twitching or spasm
what will be seen in parietal lobe seizure?
sensory manifestations i.e. tingling, numbness, pain
what will be seen seizures in occipital lobe seizures?
visual phenomena such as flashing lights, colours or hallucinations
what will be seen in temporal lobe seizure?
change in mood or behaviour
rising epigastric sensation is common manifestation
hippocampal sclerosis is the most common cause of temporal lobe epilepsy typically assoc w what type of seizure?
complex partial seizures
(focal)
what is a complex partial seizure?
arises in one lobe of the brain rather than whole brain itself
what are the three components seen in complex partial seizures?
aura
absence
automatism
what is classically seen on EEG in absence seizure?
3Hz generalised spike-wave
clonic seizures are most frequent in which age groups?
neonates and young children
what imaging is helpful in those who develop epilepsy before the age of 2?
MRI
what is teh MoA of carbamazepine and phenytoin?
Na+ channel inactivation
what is the MoA of lamotrogine?
blocks voltage-gated Na+ channels
what is the MoA of sodium valproate?
Na+ channel inactivation with increase GABA concentration
what is first line treatment in community and in hospital for status epilepticus?
community: buccal or rectal midazolam
hospital: IV lorazepam
IV phenobarbital or phenytoin if sezures persist
describe absence seizures?
brief, sudden lapse in consciousness
describe myoclonic seizures?
sudden, jerking spasms of teh muscle/ muscle groups
describe atonic seizures?
aka ‘drop seizure’
partial or compelte loss of muscle tone
describe a tonic seizure?
sudden stiffness in muscles of arms/ legs/ trunk
uncoordinated, can last 20 secs
describe a tonic clonic seizure?
loss of consciousness
stiffening of muscles followed by jerking movements (muscles relaxing: stiff/relax/stiff/relax)
