Epilepsy Flashcards
What is epilepsy?
The recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain, manifesting in seizures. It is an ongoing liability to recurrent epileptic seizures.
What is an epileptic seizure?
Paroxysmal / unprovoked event in which changes of behaviour, sensation or cognitive processes are caused by excessive, unusually synchronised neuronal discharges in the brain.
How long does an epileptic seizure usually last?
They normally last 30 -120 seconds
Can epilepsy go into remission?
Yes
What are the main differences between a normal seizure and an epileptic seizure?
Non-epileptic seizures are
- Situational
- Longer, closed mouth / eyes during tonic-clonic movement, pelvic thrusting, do not result from sleep
- No incontinence or tongue biting
- Normally no medical cause (might be psychological)
What are the three elements of a seizure?
- Prodrome
- Aura
- Postictally
What are the two classifications of a seizure?
- Primary, generalised
- Partial/focal
What are the features of a generalised seizure?
- Simultaneous onset of electrical discharge throughout whole cortex (involving both hemispheres)
- Bilateral symmetrical and synchronous motor manifestations
- Always associated with loss of consciousness or awareness
What are the features of a partial/focal seizure?
- Focal onset, with features referable to a part of one hemisphere eg temporal lobe
- Often seen with underlying structural disease
- Electrical discharge is restricted to a limited part of the cortex of one cerebral hemisphere
- These may later become generalised (eg secondarily generalised tonic-clonic seizures)
What are 3 risk factors for epilepy?
- Family history
- Premature born babies who are small for their age
- Childhood febrile convulsions
- Abnormal blood vessels in brain
- Alzheimer’s or dementia
- Use of drugs eg cocaines
- Alcohol withdrawal
- Stroke / brain tumour / infection
- Trauma
- Cortical scarring (eg head injury, cerebrovascular disease)
What are the 5 types of generalized seizure?
- Generalised Tonic-clonic seizure
- Typical Absence Seizure
- Myoclonic Seizure
- Tonic seizure
- Atonic seizure
What is a tonic-clonic seizure?
Tonic phase
- Rigid stiff limbs -person will fall to floor if standing
Clonic phase
- Generalised, bilateral, rhythmic muscles jerking lasting seconds - minutes
- Eyes remain open and tongue is often bitten
- May be incontinence
- Followed by a period of drowsiness, confusion or coma for several house postictally
What is an absent seizure?
A loss and regain of consciousness. Patient may stop and stare into space.
Who do absent seizures most commonly occur in?
Children
What is a myoclonic seizure?
- Sudden isolated jerk of a limb, face or trunk
- Patient may be thrown suddenly to the ground, or have a violently disobedient limb
What is a tonic seizure?
- Sudden sustained increased tone with a characteristic cry’grunt
- Intense stiffening of body (tonic)
Stiffening NOT FOLLOWED by jerking
What is an atonic seizure?
- Sudden loss of muscle tone and cessation of movement resulting in a fall
What are the three types of partial/focal seizure?
- Simple partial seizure
- Complex partial seizure
- Secondary generalised seizure
What is the difference between a simple partial seizure and a complex partial seizure?
Simple = remains conscious Complex = loss of consciousness
What investigations would you do if you suspected epilepsy in someone?
- EEG
- MRI
- CT head
- Blood tests
- Genetic testing
What are the two main complications with epilepsy?
- Status Epilepticus
- Sudden unexpected death epilepsy (SUDEP)
What is Status Epilepticus?
Continuous seizures without recovery of consciousness (more than 10 min or 2 more more seizures without recovery of consciousness between them over a similar time frame). This is a medical emergency.
Give 3 emergency measures you would have to consider before treatment in an epileptic patient?
- Glucose levels
- Patient if of no harm to themselves
- Prolonged seizures - treat with rectal/ IV diazepam or lorazepam
- Effectiveness of benzos will reduce over time
What drugs would you use in the treatment of epilepsy?
- Oral sodium valproate
- Oral lamotrigine
- Oral carbamazepine
