Epilepsy Flashcards by Ryley Cornfield

Prevalence of epilepsy =

5-10/1000

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60% of individuals have what type of seizure

Focal

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60-70% of focal seizures originate in which lobe?

Temporal lobe

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What % of people become seizure free after treatment with anticonvulsants

60-70%

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Seizure vs epilepsy =

Seizure - abnormal paroxysmal discharge of cerebral neurones enough to cause clinically detectable intermittent disturbance of consciousness, behaviour, emotion, motor or sensory function.

Epilepsy - seizures reoccur, usually spontanoeously (2+ in calendar year)

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2 types of seizure =

generalised

focal

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focal seizure =

arises from a single lobe in the brain. starts at a particular point (motor, sensory)

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What can a focal seizure become?

generalised

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types of focal seizure

Focal aware
Focal impaired awareness
Emotional
Focal to bilateral tonic clonic

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Focal aware =

No loss of awareness, retains memory

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Focal impaired awareness =

Consciousness is affected

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Generalised seizures =

Affects both hemispheres of the brain

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In a generalised seizure a person will be … (except in myoclonic)

Unconscious

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Types of generalised seizures =

Tonic
Clonic
Atonic
Tonic-clonic
Myoclonic
Absence

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Most common type of generalised seizure =

Tonic-clonic

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Absence seizure =

lose and regain consciousness.

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when a seizure lasts too long/when seizure occurs to close together

Status epilepticus

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Things that can cause a status epilepticus

Active part of tonic clonic lasts >5 mins
Person goes into second seizure without recovering consciousness first
Repeated seizures for 30 mins or longer

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Aetiology of seizures:

Unprovoked
Genetic
Tumors
Hippocampal sclerosis
Vascular malformations
Malformations of cortical development
Cerebral vascular disease
Post-traumatic

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Mendelian genetic epilepsy

ADNFLE

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ADNFLE

Autosomal dominant nocturnal frontal lobe epilepsy

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Ex of mendelian disorders in which epilepsy is part of phenotype

Tuberous sclerosis

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Non-mendelian genetic epilepsy:

JME

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JME =

Junivile myoclonic epilepsy

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Neuro disorders occur commonly in

Mitochondrial disorders

Frontal lobe function

``` Intellectual functions Inhibiton Bladder continence Saccadic eye movement Motor function Expression of langauge ```

Features of frontal lobe seizures =

``` Jacksonian seizures Adversive seizures Todds paresis Hyperkinetic behaviour Vocalisation ```

Consciousness in frontal lobe seizures =

Retained

Jacksonian seizures =

One side (march)

Todds paresis

Paresis after seizure in focal part of body

Diagnose: 52 year old lady with episodes of twitching of right face and shaking of right arm and leg lasting for 2 minutes. Fulling conscious but difficulty speaking during attacks.

Frontal lobe seizure

Function of parietal lobe:

Sensory integration | Receptive language

Features of parietal lobe seizures:

Positive sensory disturbances

Differential diagnosis for parietal lobe seizure?

TIA - tends to be negative symptoms

68 year old lady with episodes of right sided tingling lasting 30 seconds.

Parietal lobe

Function of temporal lobe:

``` Memory Smell Hearing Vestibular Emotion ```

Features of temporal lobe epilepsy:

``` Aura Auditory/visual hallucinations - Speech arrest - Motionless - Automatism - Odd behaviour - Confusion, headache, dysphasia ```

Time line of temporal lobe seizure =

Gradual evolution over 1-2 mins and lasts for 2-5 mins

Aura can be =

smell taste dejavu fear

Automatisms ex

lip smacking fidgeting fumbling

9 year old lady with episodes of going ‘blank’ associated with strange behaviour of lip smaking and undressing. She says she is not aware of the above but has a wanring in the form of an odd smell prior to the attacks.

Temporal lobe

Function of occipital lobe:

Vision

Features of occipital lobe seizures:

Unfomrmed, circular, multicoloured, confined to hemifield

Visual disturbance: migraine vs occipital

Migraine: black and white, zig-zag, transverse field Occipital: colour, circles, hemifield

24 year old man who has intermittent attacks where he sees colours blobs lasting 30 seconds. Has several attacks a day. Eye tests normal, no heaches.

Occipital lobe

Factors to consider when taking a Hx:

``` Speed of onset Circumstances surrounding Symptoms prior to attack Duration and evolution +ve and -ve symptoms Awareness Stereotyped Recovery time ```

Why are circumstances surrounding important?

Disgust, pain etc - syncope

DDs for seizures:

TIA Syncope Migraine Hyperventilation

Aura in migraine vs epilepsy

``` Migraine = throughout Epilepsy = start ```

What may happen before syncope?

Nausea | Lightheaded

Incontinence can occur when

Syncope | Epilepsy

Epileptic seizures DD

``` Brief Stereotypical Multiple Not situational Positive symptoms Come around later ```

'Stereotypical'

Same all the time, one person doesn't have a variety of symptoms

TIA DD

Quick onset | Negative symptoms

Migraine has what kind of symptoms =

Positive and negative

Syncope =

Sudden impairment of consciousness with loss of postural tone

Why does injury not occur in syncope

Loss of postural tone

Causes of syncope:

Reduced cerebral perfusion: - arrthymia - postural hypotension/orthostatic - vasovagal (situational)

16 year old girl with recent LOC. Wittnessed by mum who describes convulsitons with urinary incontinence. Similar blackout 1 year ago. Severe abdo pain, felt lightheaded with greying of vision. Got up to go to toilet, nausea, then LOC. Came round on the floor, incontinent, no injury, violently sick.

Syncope

43 year old remale admitted with overdose. Husband posted in Iraq. Having attacks of palpitations and hypervenitlation. Also awaiting neuro appointmet as some of these are followed by LOS and shaking.

Seizure in temporal lobe (anxiety doesn't have LOC)

Things that suggest organic cause:

Early morning myoclonic jerks Absences Aura/deja vu

Red flags:

FHx Hx of trauma, childhood seizures Drugs and alcohol

Management of single seizure:

- Explanation - DVLA - occupation - Precipitating factor advice - what to do if further attack

Risk of reoccurance of seizure after 1

30%

DVLA after single seizure =

6 month driving ban

Precipitating factors of seizures -

Lack of sleep, stress, alcohol, meds, metabolic problems, drugs

How to investigate epilepsy:

EEG CT MRI

EEG of epilepsy

Spike and wave

EEG cannot

Exclude epilepsy

Management of epilepsy:

- Explantaion: condition, side effects of drugs - DVLA - Occupation - Precipitaing factors - What to do about attacks - Psychological support

DVLA for epilepsy

1 year ban

Drugs for idiopathic generalised epilepsy:

``` Sodium valporate Lamotrigine Levetriacetam Topiramate Phenobarbitone ```

Drugs for focal seizures:

``` Sodium valporate Lamotrigine Leveltriacetan Topiramate Phenobarbitone Carbamazepine ```

Surgery for epilepsy

VNS | Lobectomy

VNS =

Vagal nerve stimulation