Epilepsy Flashcards
What is epilepsy?
Recurrent tendency to spontaneous intermittent, abnormal electrical activity in part of the brain manifesting as a seizure. Convulsions are the motor signs of these electrical signals. Epilepsy is characterised by recurrent, unprovoked seizures, having at least 2 seizures which are more than 24 hours apart
What is a pre-ictal prodrome?
Prodrome – some patients experience a warning sign that can last hours or days
What is a post-ictal phase?
Post-ictal phase – usually headache, confusion, myalgia, temporary weakness or dysphasia for about 15 minutes
What causes epilepsy?
Majority are idiopathic Structural – cortical scarring e.g. from head injury or stroke, developmental and SOL etc. Tuberous sclerosis Sarcoidosis SLE Antibodies to VGSC
What is the most important thing to get during the history of a seizure?
Collateral history is extremely important – before, during and after.
Having a post ictal phase, tongue biting and incontinence of urine are key features
Can epilepsy be diagnosed from one seizure?
Cannot diagnose epilepsy on just one seizure
Which provoking causes should be ruled out before diagnosing epilepsy?
Rule out provoking causes – very easy to induce a seizure but these wouldn’t be classed as epilepsy e.g. trauma, stroke, haemorrhage, raised ICP, alcohol or benzo withdrawal, metabolic disturbance, hypoglycaemia, infection, raised temperature and drugs.
What signs would suggest a seizure focused in the temporal lobe?
- Complex motor phenomena including lip, smacking, chewing, swallowing
- Dysphasia
- Déjà vu or jamais vu
- Emotional disturbance
- Hallucinations of smell, taste or sound
- Delusional behaviour
- Bizarre associations
What signs would suggest a seizure focused in the frontal lobe?
- Motor features such as posturing or peddling movements, Jacksonian march
- Motor arrest
- Dysphasia or speech arrest
- Post-ictal weakness (Todd’s palsy)
What signs would suggest a seizure focused in the parietal lobe?
• Sensory disturbance – tingling, numbness and pain
What signs would suggest a seizure focused in the occipital lobe?
• Visual phenomena such as spots, lines and flashes
What is a focal seizure and what are the 3 classifications of a focal seizure?
Focal seizure (previously termed partial)– originating with symptoms linked to one hemisphere, often seen with underlying structural disease. Subclasses include: • Focal aware – awareness is unimpaired usually with focal motor, sensory, autonomic or psychic symptoms. No post-ictal symptoms • Focal impaired awareness – awareness is impaired at seizure onset or following an aura. Commonly arise from temporal lobe and post ictal confusion is common • Focal to bilateral seizure – 2/3 of patients with a focal seizure the focal electrical signal spreads widely resulting in a generalised seizure, typically convulsive
What is a generalised seizure?
Generalised Seizure – Rapidly involving both hemispheres and widespread electrical discharge with no localising features referable to a single hemisphere.
• Absence seizures – brief 10s pauses where patients stop what they were doing then carries on. Usually present from childhood
• Tonic-Clonic seizures – loss of consciousness, limb stiff (tonic) then jerk (clonic). Post ictal confusion and drowsiness.
• Myoclonic seizures – sudden jerk of limb, face or trunk. Patient may be thrown suddenly to the ground or have a violently disobedient limb
• Atonic (akinetic seizures) – sudden loss of muscle tone causing a fall but no LOC
• Infantile spasms – commonly associated with tuberous sclerosis
What investigations should be done in a patient presenting with a seizure
Consider EEG although unlikely to tell you much
MRI looing for structural lesions
Blood glucose and UE
ECG if worried about cardiac differentials
What general precautions should be given to a patient diagnosed with epilepsy?
After any seizure must counsel about dangers and precautions: swimming, driving, heights until the diagnosis is known. Once it is known give personalised advice regarding sport, insurance and conception. After an epilepsy diagnosis should contact the DVLA and must be seizure free for a year before you can start again. Start anti-epileptic after second seizure.
