Epilepsy Flashcards
Define epilepsy
A recurrent tendency to have unprovoked seizures.
Define seizure
An abnormal paroxysmal discharge of cerebral neurons
Define convulsion
the motor signs of electrical discharges
Which neurotransmitters balance excitation and inhibition
Excitation:
Glutamate
Aspartate
Inhibition:
GABA
Causes of secondary seizures (4)
Tumours
Infection
Inflammation
Trauma
What should you always establish at the start when taking a collapse history in OSCE?
Whether there was a witness
Triggers of an epileptic seizure (5)
Lack of sleep Flickering lights Alcohol Stress No trigger
What can happen before an epileptic seizure
Aura
strange feeling in the gut, deja vu, strange smells, flashing lights
How long does an epileptic seizure last
Under three minutes
Things that are associated with happening during a seizure (3)
Tongue biting
Incontinence
Jerking movements
Speed of recovery from an epileptic seizure
Slow
Things that are associated with happening post-ictal (3)
Post-ictal confusion
Post-ictal headache
Post-ictal myalgia
What is Todds paresis
is a syndrome associated with weakness or paralysis of part or all of the body after a focal-onset seizure. It most commonly affects one limb or one half of the body but can have a wide range of presentations. Approximately 13% of all seizures show signs ofTodd paresisin onepresentation or another.
What is a syndrome associated with weakness or paralysis of part or all of the body after a focal-onset seizure known as
Todds paresis
How long does Todds paresis last for
This postictal syndrome may last anywhere from minutes to days, with the vast majority of patients seeing spontaneous and complete resolution within 36 hours. Complete resolution of symptoms is seen within 15 hours on average
What should you ask about regarding before an epileptic seizure (2)
Triggers: alcohol, stress lack of sleep, lights
Aura: rising epigastric sensation, deja-vu, out of body experience
What should you ask about regarding during an epileptic seizure (5)
< 3 minutes LOC Tongue biting Jerking Incontinence
What should you ask about regarding after an epileptic seizure (5)
Slow recovery Post-ictal headache Confusion myalgia Todd’s paresis
2 main types of seizures
Focal and generalised
3 types of focal seizures
Focal impaired awareness seizures
Focal aware seizures
Focal seizures with secondary generalised weakness
6 types of generalised seizures
Tonic-clonic seizures Myoclonic seizures Clonic seizures Tonic seizures Atonic seizures Absence seizures
What happens during the tonic phase
all the muscles go stiff
What happens during the clonic phase
there is quick and rhythmical jerking of the limbs.
What happens in a tonic clonic seizure
there is first a tonic phase and then a clonic phase.
What is the most common type of epileptic seizure
tonic clonic
in which phase is there quick and rhythmical jerking of the limbs.
clonic
in which phase do all the muscles go stiff
tonic
What is a tonic clonic seizure also known as
grand mal
What is a grand mal seizure also known as
tonic-clonic
What is a petit mal seizure also known as
absence
What is a absence seizure also known as
petit mal
Which type of seizure is most common in puberty
Myoclonic
When are atonic seizures most common
in children
When are absence seizures most common
children
Whats the difference between clonic and myoclonic seizures
Myoclonic are loads of small contractions whereas clonic are big contractions
What happens in a atonic seizure
Loss of muscle tone
What happens in a temporal lobe focal seizure (3)
Aura (epigastric discomfort, epigastric discomfort)
Automatisms (playing with fingers, lip smacking)
Hallucinations
What happens in a occipital lobe focal seizure (3)
Visual phenomena (spots, lines, flashes)
What happens in a parietal lobe focal seizure (3)
Sensory disturbances (pain, tingling, numbness)
What happens in a frontal lobe focal seizure (4)
Motor symptoms
Jacksonian march: muscular spasm spreads from distal part of limb to larger area of the body
Post-ictal flaccid weakness (Todd’s palsy)
Involuntary actions (disinhibition)
What is the diagnostic criteria for epilepsy
2 or more unprovoked seizures occurring more than 24 hours apart
Ix for suspected epilepsy
EEG
Bloods
Brain imaging (CT, MRI)
What do we request in the bloods of someone suspected of epilepsy and why (4)
Blood glucose (hypoglycaemia can cause seizures) FBC (evaluate systemic or CNS infection) Electrolyte panel (electrolyte disturbances can provoke seizures) Serum prolactin (can be transiently elevated following seizures)
Which AEDs are recommended for focal seizures
Carbamazepine
Lamotrigine
Which AEDs are recommended for generalised seizures
1st line: sodium valproate
2nd line: carbamazepine
SE’s of most AED’s
Psychiatric symptoms e.g. depression
Weight gain
S.E’s of carbamazapine
Neutropenia and osteoporosis
S.E’s of lamotrigine
Stevens-Johnson syndrome (severe skin reaction)
Which AED’s are recommended for pregnancy (1) and which should be avoided (2)
Avoid sodium valproate and phenytoin
Lamotrigine is preferred
What is the definition of status epilepticus
seizure lasting > 5 minutes or repeated seizures
without recovery or regain of consciousness in between
Triggers of status epileptics (3)
non-adherence to medication
alcohol abuse,
OD & toxicity
Mx of status epilepticus (6 steps)
ABC approach
We should secure airway and give 100% oxygen
IV access and continuous monitoring of sats, BP, ECG and glucose
IV lorazepam
Repeat after 10 minutes if seizure doesn’t terminate
If after 10 minutes it still hasn’t terminated give phenytoin
Then transfer to ITU
What should we always monitor in status epilepticus (4)
Sars BP ECG and !glucose!
Which trigger of status epilepticus should you immediately exclude and how do you resolve it
Hypoglycaemia - 50ml of 50% glucose should be given immediately
What type of drug is the first line treatment for SE
Benzodiazepine
How do BZD’s work
bind to the gamma-aminobutyric acid (GABA)-A receptors, increasing channel opening frequency at the receptor, with subsequent increased chloride conductance and neuronal hyperpolarization, leading to enhanced inhibitory neurotransmission and antiepileptic action
Complication of epilepsy (4)
SUDEP (sudden death in epilepsy)
Behavioural problems
Fractures (from seizures)
Complications from drugs
A 16-year-old boy presents to A & E after collapsing on a cricket game. According to his cricket coach, the boy was unconscious for about one minute during which time, he was moving his arms and legs around. Further review revealed that he had experienced a similar episode a month before. What is the most appropriate drug for this patient?
Sodium valproate
