Epilepsy Flashcards
What is a seizure?
Sudden irregular discharge of electrical activity in the brain causing a physical manifestation
What is a convulsion?
Uncontrolled shaking movements of the body due to rapid and repeated contraction and relaxation of muscles
What is an aura?
A perceptual disturbance experienced
e. g
- strange light
- unpleasant smell
- confusing thoughts
What is epilepsy?
Neurological disorder marked by sudden recurrent episodes of sensory disturbance, LOC or convulsions, associated with abnormal electrical activity in the brain
What is status epilepticus?
Epileptic seizures occurring continuously without recovery of consciousness between
How are seizures classified?
Partial
General
How are partial seizures further classified?
Simple
Complex
How are general seizures further classified?
Absence Myoclonic Tonic-clonic Tonic Atonic
What is a partial seizure?
Seizure with a single focus
What is a generalised seizure?
Seizure spread uncontrolled throughout brain
What is a simple partial seizure?
No loss of consciousness
What is a complex partial seizure?
Loss of consciousness
What are common types of partial seizures?
Temporal lobe epilepsy
Frontal lobe epilepsy
What are the features of temporal lobe epilepsy?
Hallucinations
Automatisms
Rush of memories
What are features of frontal lobe epilepsy?
Head/leg movements
Posturing
Post-ictal weakness
What is a tonic-clonic seizure?
2 parts
- muscles tense
- convulsions
What is an absence seizure?
Loss of awareness
‘daydreaming’
What is a myoclonic seizure?
Brief shock-like muscle jerks
What is an atonic seizure?
Loss of tone
‘Drop attacks’
What is a tonic seizure?
Increased tone
What are other features of tonic-clonic seizures?
Pre-seizure aura
Tongue biting
Incontinence
Prolonged post ictal phase
How are seizures investigated?
EEG
MRI brain
ECG Bloods - FBC - U&Es - calcium
How are single seizures managed?
Confirm diagnosis
Establish cause
Discuss implications
How is the diagnosis of epilepsy made?
> 2 seizures in >24 hours
How are generalised seizures managed?
Sodium valproate
Lamotrigine
Phenytoin
How are complex partial seizures managed?
Carbamazepine
Lamotrigine
Levetiracetam
What is the mechanism of sodium valproate?
Increases GABA activity
What are side effects of sodium valproate?
Liver damage
Hair loss
Tremor
Lowers vit D - needs regular monitoring
Teratogenic - women of child bearing age need 2 forms of contraception
What is the mechanism of lamotrigine?
Sodium channel blocker
What are the side effects of lamotrigine?
SJS
Leucopenia
What is the mechanism of phenyotin?
Sodium channel blocker
What are the side effects of phenytoin?
Folate deficiency
Vit D deficiency
Megaloblastic anaemia
Osteomalacia
What is the mechanism of carbamazepine?
Sodium channel blocker
What are the side effects of carbamazepine?
Agranulocytosis
Aplastic anaemia
P450 inducer
What is the mechanism of levetiracetam?
Blocks pre-synaptic calcium release
What are the side effects of levetiracetam?
Headache
Drowsiness
SJS
What are the driving rules for a single unprovoked seizure with normal brain imaging and EEG?
6 months off
What are the driving rules for a single unprovoked seizure with an abnormality detected?
12 months off
What are the driving rules for confirmed epilepsy?
12 months seizure free
What are the driving rules for epilepsy medication withdrawal?
Do not drive during withdrawal and for 6 months after
