Epilepsy Flashcards
Definition of epilepsy
Seizures occurring as a result of spontaneous abnormal electrical discharge in brain
Prodrome vs aura
Prodrome - precedes fit, usually behavioural changes
Aura - part of seizure that precedes other manifestations eg odd sensations
Investigations for epilepsy
EEG, drugs screen, CT/MRI/LP if thinking structural or infective
Bloods + ECG
What is a partial seizure?
Limited to one area of brain
Simple = no impairment of consciousness
Complex = consciousness impaired
What is a generalised seizure?
Whole brain involved
6 types:
tonic-clonic, absence, myoclonic, tonic, clonic + atonic
What is an absence seizure, what would the EEG show + what are the triggers?
Brief staring spell, usually in children
EEG shows 3 second spike-wave pattern
Triggers = hyperventilation + flashing lights
What is a tonic-clonic seizure + what does EEG show?
Losing consciousness + falling to ground T
onic phase = stiffening, 10-20s
Clonic phase = jerking 30-40s
Causes cyanosis, excessive salivation, tongue biting + incontinence
Bilateral, slow wave, subcortical seizures
What is a tonic seizure?
Sudden onset of maintained increase in tone in extensor muscle - will usually fall
What is a clonic seizure?
LOC and sudden loss of muscle tone followed by limb jerking
What is an atonic seizure?
Drop attack - loss of muscle tone causing person to fall to ground
What are the signs of temporal lobe seizures?
Aura
Automatisms = oral movements like lip smacking, plucking at clothing
Abdominal rising sensation of pain +- vomiting
Dysphasia
Memory phenomena eg deja vu
Delusional behaviour/ bizarre stories
What are the signs of a frontal lobe seizure?
Motor features = posturing, versive movements
Jacksonian march
Motor arrest
Behavioural disturbances
Dysphasia
Todd’s palsy (post ictal)
What are the signs of a parietal lobe seizure?
Sensory disturbances = tingling, numbness, pain
Visual phenomenon eg spots, lines, flashes
Contralateral
What is Todd’s palsy?
Focal CNS signs eg hemiplegia
Follows an epileptic seizure
General post-ictal features
Headache, confusion, myalgia, sore tongue, temporary weakness, dysphasia
Management post first seizure
Urgent assessment (2 weeks) by neurologist
Screen for depression
Non pharmacological management of epilepsy
Annual GP review Education
Driving + epilepsy
Stop driving + notify DVLA
For first fit: 6 months off driving (group 1), group 2 = 5 years off driving
For diagnosed epilsepy: licensed revoked for 1 year after last attack.
For group 2, license revoked for 20 years
When to give drugs for epilepsy
Drug treatment after 2nd seizure
Consider withdrawal if fit free for 2-3 years
Management of absence seizures
Sodium valproate
Lamotrigine
Management of myoclonic seizures
Sodium valproate
Clonazepam
Management of tonic clonic seizures
Sodium valproate
Carbamazepine
Lamotrigine
What other treatments are available for epilepsy?
Surgery = for intractable partial seizures
Vagus nerve stimulation = useful for those refractory to meds
Ketogenic diet = used for refractory epilepsy
What is SUDEP?
Sudden unexplained death in epilepsy
Usually due to respiratory arrest during seizure
Management of seizure (undiagnosed epileptic)
Wait 5 mins then give lorazepam to terminate seizure
IV phenytoin if not successful
Phenobarbital if not terminating >60 mins
Treat with thiamine or glucose if related to alcohol or diabetes
What is status epilepticus?
>30 mins
