Epilepsy Flashcards
What is epilepsy?
Tendency to recurrent seizures
Or investigation shows >60% likelihood of recurrence over 10 years
Background electrical activity is disrupted
What should be a top priority when assessing collapse?
Obtain 3rd party account
What are some underlying causes of cardiogenic syncope?
Aortic stenosis
Arrhythmia
What are some underlying causes of orthostatic syncope?
Dehydration
Anti-hypertensive meds
Endocrine
Autonomic nervous system
What are some underlying causes of reflex (neuro-cardiogenic) syncope?
Cough
Urination
Medical procedures such as taking blood
What are some clinical components in the assessment of syncope?
Heart sounds
Blood pressure
Heart block
QT ratio
What situations may provoke a seizure?
Alcohol withdrawal Drug withdrawal Within a few days of head injury Within 24 hours of a stroke Within 24 hours of neurosurgery Severe electrolyte disturbance Eclampsia
What is a myoclonic seizure?
Brief muscle jerk
Patient awake and able to think clearly throughout
What are some post hoc features of a generalised tonic clonic seizure?
Lateral sever tongue biting
Incontinence
First recollection in ambulance or hospital
Muscle pain
What may a 3rd party report of a generalised tonic clonic seizure?
Groaning sound
Rigid phase
Eyes open
Mouth foaming
What are some features of absence seizures?
May be provoked by hyperventilation or photic stimulation Sudden arrest of activity Brief staring Eyelids may flutter Re-start what they were doing
What are some features of juvenile myoclonic epilepsy?
Provoked by alcohol or sleep deprivation
Can have absence and GTC seizures
Will often have brief limb jerks in the morning
What are the first steps in managing seizures?
Refer to first seizure clinic Do an ECG Routine bloods (Glc) CT MRI EEG
What medications may be used to treat primary generalised epilepsies?
Sodium valproate
Lamotrigine
What medications may be used to treat focal and secondary generalised seizures?
Lamotrigine
Carbamezepine
Whaat medication may be used to treat absence seizures?
Ethosuximide
What medication may be used to treat seizures in an acute setting
Lorazepam
Midazolam (diazepam)
Valproate or phenytoin for status epilepticus
What are some side effects of phenytoin?
Arrhythmia
Hepatitis
Medication interactions
What are some side effects of Sodium Valproate?
Tremor Weight gain Ataxia Nausea Drowsiness Hepatitis
What are some side effects of Carbamazepine?
Ataxia
Drowsiness
Hepatitis
(Avoid in women of child bearing age)
What are some side effects of Lamotrigine?
Skin rash
Difficulty sleeping
What are some side effects of Levetiracetam?
Irritability
Depression
What are the driving regulations for after a single seizure?
A patient may drive a car after 6 months if their investigations are normal and they have had no further events
What are the driving regulations for a patient with epilepsy?
Patients with epilepsy can drive a car once they have been seizure free for a year or have only had seizures arising from sleep for a year
What is status epilepticus?
Prolonged or recurrent tonic-clonic seizures persisting for more than 30 minutes with no recovery period between seizures
What is the first line treatment of SE?
Midazolam
Lorazepam
Diazepam
Describe some characteristics of a pseudoseizure.
Patient may descrobe what others said during the episode but little of the events themselves
Witnesses may identify stress as a trigger
