Epilepsy Flashcards

1
Q

Define epilepsy

A

Epilepsy – tendency to recurrent (at least 2) unprovoked seizures

Seizure – abnormal and excessive synchronised discharge of a set of cerebral neurones
Generalised – affect both sides of the brain at once, loss of consciousness
• Focal – arise in specific loci of the cortex in one hemisphere
• Simple – a small part of one of the lobes is affected, conscious
• Complex – a larger part of one hemisphere is affected, reduced/LOC

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2
Q

What are the causes/risk factors of epilepsy?

A
Primary – idiopathic
Secondary
• Vascular – haemorrhage, infarction
• Infection – meningitis, encephalitis, abscess
• Trauma
• Alcohol withdrawal (drugs)
• Metabolic – hypo/hypernatraemia, hypo/hyperglycaemia, hypoxia
• Inflammation – vasculitis
• Neoplasm – tumour
• Degenerative – Alzheimer’s disease

Seizure mimics
• Syncope
• Migraine
• Non-epileptic seizures

Triggers
• Flashing lights
• Drugs
• Sleep deprivation
• Metabolic
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3
Q

What are the signs and symptoms of epilepsy?

A
Simple focal/partial seizures
Temporal lobe:
• a ‘rising’ feeling in
the stomach
• déjà vu
• olfactory/gustatory
hallucinations
• a sudden intense
feeling of fear or
joy
Frontal lobe:
• a strange feeling
like a ‘wave’ going
through the head
• stiffness or
twitching in part
of the body e.g.
Jacksonian march
– spasm
spreading from
mouth or digit
Parietal lobe:
• a feeling of
numbness or
tingling
• a sensation that
an arm or leg feels
bigger or smaller
than it actually is
Occipital lobe:
• visual
disturbances such
as coloured or
flashing lights
• hallucinations 
Complex focal/partial seizures
Temporal lobe:
• picking up objects for no
reason or fiddling with
clothing
• chewing or lip-smacking
movements
• muttering or repeating
words that don't make
sense
• wandering around in a
confused way
Frontal lobe:
Automatisms
• making a loud cry or
scream
• strange repetitive postures
or movements such as
cycling or kicking
Parietal/occipital lobe:
• Less common
• Affect senses or visio
• Usually last around 15 - 30
seconds
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4
Q

What investigations are carried out for epilepsy?

A
• Bloods
- FBC – anaemia (hypoxia), infection
- U&Es – electrolyte imbalance
- LFTs
- Glucose
- Prolactin – transient rise after true seizure
-Toxicology screen
• ABG
• EEG – epileptiform activity
• CT/MRI – exclude SOL or haemorrhage
• Lumbar puncture – infection
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5
Q

What is the management for epilepsy?

A

Aim is for monotherapy (single AED) – if switching drugs, taper doses

Focal seizures
• Lamotrigine
• Carbamazepine

Generalised seizures
• Sodium valproate

Other AEDs
• Phenytoin
• Levetiracetam
• Topiramate
• Gabapentin
• Vigabatrin
• Ethosuximide (absence)

Patient education
• Avoid triggers
• Inform DVLA – drive only after 6-12 seizure free months
• Teratogenicity of AEDs in pregnancy

Status epilepticus
• Airways, Breathing, Circulation, don’t ever forget Glucose
• IV lorazepam or diazepam
- Repeat after 15mins if needed
- IV phenytoin if they fail to respond
- General anaesthesia and intubation if they still fail to respond

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6
Q

What are the complications of epilepsy?

A
• Refractory seizures
• Fractures
• Head trauma
• Sudden unexpected death in
epilepsy (SUDEP)
• Drug side effects
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