Epilepsy Flashcards
What is epilepsy?
A neurological disorder where a person experiences recurrent seizures
At least two unprovoked seizures occuring more than 24 hours apart
A single seizure with investigation findings suggesting tendency to recurrence eg. abnormal image, abnormal EEG (spike and wave)
Examples of provoked seziures
Alcohol withdrawal Drug withdrawal Eclampsia Electrolye imbalance Within 24 hrs of stroke Within 24 hrs of surgery Within few days after head injury
Define a seizure
transient occurrence of signs or symptoms due to abnormal excessive or synchronous neuronal activity in the brain
Different ways seziures can manifest
Disturbance of consciousness, behaviour, cognition, emotion, motor function or sensation
What is a generalised seziure?
Originates in bilaterally distributed networks, can include cortical and subcortical structures - separate into motor and non-motor (abence)
What is a focal seziure?
Originates in networks limited to one hemisphere, can be localised or widely spread. Separate into those with retained awareness and those without
In how many people is the cause of epilepsy identified?
A third of people with epilepsy
Name some causes of epilepsy
Structural - stroke, trauma, malformation of cortical devlopment; visible on imaging
Genetic- not necessarily inherited, mutation in which seizures common to disorder - Dravet’s syndrome
Infection- tuberculosis, HIV, cerebral malaria, Zika virus
Metabolic - porphyria, amino acidopathies, pyridoxine deficiency
UK prevalence of epilepsy
5-10 per 1000
Risk factors for predisposition to epilepsy
Premature birth Complicated febrile seizure Genetic conditions - tuberous sclerosis or neurofibromatosis. Brain development malformations FH of neurological illness or epilepsy Head trauma, infections, tumours Cerebrovascular disease - stroke, dementia
Complications of epilepsy
Sudden Unexpected Death in Epilepsy (SUDEP)
Injuries - drowning, road accidents, falls (generalised tonic-clonic)
Depression and anxiety disorders
Absence from work and school
Assessment if presenting with first seizure
Any risk factors
Clinical features suggesting other cause of seizures
Patient and eyewitness account of before, during and after seizure
- any aura
- any triggers
- Short-lived (less than 1 minute), abrupt, generalised muscle stiffening (may cause a fall) with rapid recovery — suggestive of tonic seizure.
Generalised stiffening and subsequent rhythmic jerking of the limbs, urinary incontinence, tongue biting —suggestive of a generalised tonic-clonic seizure.
Behavioural arrest — indicative of absence seizure.
Sudden onset of loss of muscle tone — suggestive of atonic seizure.
Brief, ‘shock-like’ involuntary single or multiple jerks —suggestive of myoclonic seizure.
Residual symptoms after the attack (post-ictal phenomena), such as drowsiness, headaches, amnesia, or confusion (usually occur only after generalised tonic and/or clonic seizures).
Physical examination to diagnose epilepsy
Cardiac
Neurological
Mental state
Developmental assessment
Examine oral mucose for anyt tongue bites
Identify any injuries sustained during seizure
Baseline tests for investigating epilepsy
Bloods - FBC, u&Es, LFTs, glucose, calcium
12 lead ECG
Differential diagnoses
Vasovagal syncope. Cardiac arrhythmias. Panic attacks with hyperventilation. Non-epileptic attack disorders (psychogenic non-epileptic seizures, dissociative seizures, or pseudoseizures). Transient ischaemic attack. Migraine. Medication, alcohol, or drug intoxication. Sleep disorders. Movement disorders. Hypoglycaemia and metabolic disorders. Transient global amnesia. Delerium or dementia — altered awareness may be mistaken for seizure activity.
Differentials specifically in children
Febrile convulsions
Breath-holding attacks
Night terrors
Stereotype/ritualistic behaviours - particularly if LD
Managing suspected epilepsy
Referral to confirm diagnoses - details of first seizure
Family and patient education - how to recognise and manage seizures - epilepsy.org
Encourage recording of further episodes by diary and video
Driving and occupational advice
Activities such as swimming restricted
Find written safety advice from Eilepsy Action
Lifestyle factors - sleep, alcohol, drugs
Safety net - contact GP about further episodes
Managing a tonic-clonic seizure
Note the time seizure started, continue to time. If less than 5 minutes
- Look for epilepsy ID card
- Protect from injury; cushion head, remove objects (glasses), position away from danger
- Do not restrain
- Check airway, place inrecovery position
- Observe, examine, manage injuries
- Arrange emergency admission if first seizure, another seziure occurs shortly after, injured, having trouble breathing, difficult to wake up
Managing a tonic clonic seziure > 5 minutes/ more than 3 seizures in one hour
Buccal midazolam (not licensed for under 3 months or over 18 Rectal diazepam (not under 1 year old) IV lorazepam
Under which circumstances should an emergency call be made for person having seizures
No response to treatment Responds to treatment but seziures were prolonged/recurrent before treatment given First seizure High risk of recurrence Developed into status epilepticus Difficulty monitoring patients condition
