EPILEPSY Flashcards
define seizure
signs or symptoms due to abnormal excessive or synchronous neuronal activity in the brain
define epilepsy
neurological disorder in which a person experiences recurring seizures
At least two unprovoked seizures occurring more than 24 hours apart
define status epilepticus
prolonged convulsive seizure lasting for 5 minutes or longer, or recurrent seizures one after the other without recovery in between
causes of epilepsy
structural - stroke, trauma, malformation
genetic - ie Dravet syndrome
infectious - meningitis, TB, cerebral malaria, HIV and Zika virus
Metabolic - porphyria, pryridoxine deficiency
immune
risk factors for epilepsy
Premature birth.
Complicated febrile seizures.
A genetic condition that is known to be associated with epilepsy, such as tuberous sclerosis or neurofibromatosis.
Brain development malformations
A family history of epilepsy or neurologic illness.
Head trauma, infections (for example meningitis, encephalitis), or tumours
Comorbid conditions such as cerebrovascular disease or stroke — more common in older people.
Dementia and neurodegenerative disorders (people with Alzheimer’s disease are up to ten times more likely to develop epilepsy than the general population).
complications of epilepsy
sudden unexpected death in epilepsy
injuries
depression and anxiety disorders
absence from school or work
how to assess a patient with seizure
Any subjective symptoms at the start of the seizure (aura) — suggestive of focal epilepsy; these may provide information on where the seizure might arise.
Any potential triggers, for example sleep deprivation, stress, light sensitivity, or alcohol use.
specific features about the 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).
what are the specific features of the seizure
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
what physical examination will one do for a patient who experienced a seizure
Cardiac, neurological, and mental state, and a developmental assessment if appropriate.
Examination of the oral mucosa to identify lateral tongue bites.
Identification of any injuries sustained during the seizure.
what blood tests will be done is you suspect epilepsy
- FBC
- U&Es
- LFTs
- glucose
- calcium
- (ECG).
- blood gases
- set up cardiac monitor and pulse oximetry
DD for epilepsy
- 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.
DD for epilepsy in children
- Febrile convulsions.
- Breath-holding attacks.
- Night terrors.
- Stereotyped/ritulistic behaviour — especially in those with a learning disability.
how do you manage someone with sus epilepsy
1) urgently refer if its first epileptic seizure
2) give info sheet - record future seizures
3) stop driving until confrim of diagnosis, dont do heaby machinery
what do you do if someone has a tonic clonic seizure less than 5 minutes
Look for an epilepsy identity card or jewellery.
Protect them from injury by:
Cushioning their head, for example with a pillow.
Removing glasses if they are wearing them.
Removing harmful objects from nearby, or if this is not possible, moving the person away from immediate danger.
Do not restrain them or put anything in their mouth.
When the seizure stops, check their airway and place them in the recovery position.
Observe them until they have recovered.
Examine for, and manage, any injuries.
what do you do if someone has tonic clonic seizure lasting more than 5 mins or 3 seizures within an hour
Treat with one of the following:
- Buccal midazolam as first-line treatment in the community.
- Rectal diazepam if preferred, or if buccal midazolam is not available.
- Intravenous lorazepam if intravenous access is already established and resuscitation facilities are available.
features of temporal lobe epilepsy (partial epilpesy)
frontal
parietal
occipital
Hallucinations (auditory/gustatory/olfactory)
Epigastric rising/Emotional
Automatisms (lip smacking/grabbing/plucking)
Deja vu/Dysphasia post-ictal)
Head/leg movements, posturing, post-ictal weakness, Jacksonian march
Paraesthesia
Floaters/flashes
what is jacksonian epilepsy
starts in one place and spreads
begin in the corner of mouth, the thumb, index finger or the great toe
then movements spreads on the face or ascend the limb (Jacksonian march)
the affected limb may remain temporarily weak (Todd’s paralysis)
what is epilpesia partialis continua
children under 3 months or adults over 18 years of age
rare condition involving recurrent and sometimes intractable focal onset seizures associated with retained awareness. EPC seizures can occur over hours, days, or even years. The disease can manifest in a variety of ways, a few of which include myoclonic epilepsy, localized myoclonus, Jacksonian epilepsy, or sensorimotor clonic seizures.
what is febrile convulsions
with fever
less than 15 mins
what is infantile spasms (West’s syndrome)
features
Ix
Mx
typically present in the 3-12 months of life
- more common in males
TRIAD
- shock-like flexion of arms, head and neck with drawing up of the knees (salaam attaack)
- multiple bursts of violent flexor spasms last 1/2 s but repeated maybe upto 50 times - baby cry
- progressive learning dfifficulties
most undergo neurodegenerative neuro-encephelatic process.
Ix
EEG abnormality - hypsarrhythmia and burst suppression
CT - diffuse or localised brain disease
Mx
corticosteroids and vigabatrin PERIPHERAL VISUAL LOSS (first line if tuberous sclerosis)
- poor prognosis
name of inhibitory neurotransmitter and receptor
GABA
types of generalised seizures
tonic - stiff flexed atonic - relaxed clonic - convulsions tonic-clonic - stiff and they fit myoclonic - short muscle twitches absence - spaced out
what is generalised seizures
lose consciousness and involves both hemispheres
diagnosis of seizures
MRI
CT
EEG
management for west’s syndrome/ infantile spasms
corticosteroids or vigabatrin PERIPHERAL VISUAL LOSS (first line if tuberous sclerosis)
absence epilepsy in children
stare blank into space - eyes may flutter or roll up
characteristic EEG abnormalities - 3-Hz generalised, symmetrical spike-wave abnormalities
juvenile myoclonic epilepsy (Janz syndrome)
age of onset - 10-20 occurs after eaking - myoclonic - tonic-clonic - absence
polyspike waves
causes of refractory epilepsy
non compliance
pseudoseizures/non epileptic attaks
ass structural brain disease - dev abnormlaitits
alcohol and lifestyle
when to stat antiepileptics after first seizure
after the first seizure if any of the following are present:
- the patient has a neurological deficit
- brain imaging shows a structural abnormality
- the EEG shows unequivocal epileptic activity
- the patient or their family or carers consider the risk of having a further seizure unacceptable
first line treatment for patients with tonic clonic generalised seizure
sodium valporate boys
lamotrigine women childbearing age
