Epilepsy Flashcards
Prevalence of epilepsy =
5-10/1000
60% of individuals have what type of seizure
Focal
60-70% of focal seizures originate in which lobe?
Temporal lobe
What % of people become seizure free after treatment with anticonvulsants
60-70%
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)
2 types of seizure =
generalised
focal
focal seizure =
arises from a single lobe in the brain. starts at a particular point (motor, sensory)
What can a focal seizure become?
generalised
types of focal seizure
Focal aware
Focal impaired awareness
Emotional
Focal to bilateral tonic clonic
Focal aware =
No loss of awareness, retains memory
Focal impaired awareness =
Consciousness is affected
Generalised seizures =
Affects both hemispheres of the brain
In a generalised seizure a person will be … (except in myoclonic)
Unconscious
Types of generalised seizures =
Tonic Clonic Atonic Tonic-clonic Myoclonic Absence
Most common type of generalised seizure =
Tonic-clonic
Absence seizure =
lose and regain consciousness.
when a seizure lasts too long/when seizure occurs to close together
Status epilepticus
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
Aetiology of seizures:
Unprovoked Genetic Tumors Hippocampal sclerosis Vascular malformations Malformations of cortical development Cerebral vascular disease Post-traumatic
Mendelian genetic epilepsy
ADNFLE
ADNFLE
Autosomal dominant nocturnal frontal lobe epilepsy
Ex of mendelian disorders in which epilepsy is part of phenotype
Tuberous sclerosis
Non-mendelian genetic epilepsy:
JME
JME =
Junivile myoclonic epilepsy
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
