Epilepsy Flashcards
Differential diagnosis for blackout / fainting?
- Syncope
- First seizure
- Hypoxic seizure
- Concussive seizure
- Cardiac arrhythymia
- Non-epileptic attack (narcolepsy / migraine etc.)
Important questions for the patient after blackout episode?
- Feelings before / after
- Level of responsiveness during / after attack
- Motor involvement?
- Breathing / vocalization
- Behaviour after attack
- Incontinence?
Most common cause of syncope? Prodrome symptoms?
- Vasovagal syncope: fainting due to overreaction to certain triggers (emotion / sight of blood etc.)
Prodrome:
- Light headedness / nausea / sweating / feeling warm
- Tinnitus (noise/ringing in ears)
- Tunnel vision
What is a hypoxic seizure? Concussive seizure?
Hypoxic:
- Occurs when person kept upright during a faint, patient may have a succession of collapses & seizure-like activity may occur
Concussive:
- Occurring after any blow to the head
How are cardiac arrhythmias and seizures related?
- Cardiac arrhythmia can cause blackout
- Seizures can cause cardiac arrhythmias
How does a non-epileptic attack present? Who is at risk?
- Can resemble a seizure, may involve bizarre body movements
- More common in women, people with a history of abuse
Investigations of suspected first seizure?
- Blood glucose
- ECG
- Alcohol & drug history
- CT head
- Calcium / Magnesium / U&E / LFT / EEG
What is an epileptic seizure?
- An intermittent disturbance of consciousness, behaviour, emotion, motor function or sensation that is believed to be due to abnormal neural discharges
- Epilepsy is a condition in which seizures occur
What are the different classes of seizure according to the International League Against Epilepsy (ILEA)?
- Tonic-clonic seizures
- Myoclonic seizures
- Clonic seizures
- Tonic seizures
- Atonic seizures
- Absence seizures
How are focal seizures different from generalized seizures?
- Focal seizures are due to disruption of electrical impulses in one part of the brain
- Generalized seizures due to abnormal electrical discharge involving the entire brain
How can focal seizures progress?
Simple focal and complex focal seizures can become secondary generalized seizures
Difference between a simple partial/focal seizure and a complex partial/focal seizure?
- Simple: Person is aware they are having a seizure
- Complex: person is unaware
What age do generalized and focal seizures tend to occur? Is there a prodrome for either?
Generalized:
- people <25 years old, no warning before seizure
Focal/Partial:
- Any age, may get an aura before
Differences in causes of generalized and focal seizures?
Generalized:
- Usually genetic/idiopathic/metabolic etc., may have history of myoclonic jerks
Focal:
- Cause can be any focal brain abnormality
Investigations when suspected epilepsy?
- EEG for primary generalized epilepsy
- MRI / CT for patients with possible focal onset seizure
- Video-telemetry if uncertain about diagnosis
Treatment for primary generalized epilepsies?
- Sodium valproate
- Lamotrigine
- Levetiracetam
Treatment for partial/focal and secondary generalized epilepsies?
- Lamotrigine
- Carbamazepine
What is an absence seizure? Treatment?
- Seizure causing lapse in awareness, “staring into space”
- Ethosuximide
Treatment for status epilepticus?
First line:
- Lorazepam (buccal/intra nasal), Midazolam (oral), Diazepam (IV / rectally)
Second Line:
- Valproate, Phenytoin
Side effects of the different drugs used to treat seizures?
cba typing them now but in the slides
What is status epilepticus?
According to slides: prolonged or recurrent tonic-clonic seizures persisting for more than 30mins with no recovery period between seizures
According to google: a single seizure lasting more than 5 mins or two or more seizures within 5 mins without the person returning to normal between them
Who is usually affected by status epilepticus?
- Usually occurs in patients with no previous history of epilepsy (stroke, tumour, alcohol)
Prognosis of status epilepticus attack?
- Mortality greatest in the very young and the very old (29% for those <1 year old)
- 90% of deaths due to underlying cause, mortality greatest when secondary to stroke, encephalitis, mass lesions & trauma
Possible causes of epilepsy?
- Idiopathic
- Genetic
- Metabolic (alcohol withdrawal / low glucose)
- Post-trauma
- Hypoxic damage
- Brain tumours
- Cerebrovascular disease
- Alzheimers disease
