Epilepsy Flashcards
What are the the features of fall onset to explore in history?
What were they doing? Environment, etc Light-head or other syncopal symptoms What did they look like: • Pallor, breathing • Posturing of limbs, head turning
what are features of a fall itself to explore in the history?
Movement-Tonic phase, clonic movements, corpopedal spasms, rigor
Responsiveness and awareness throughout
what are features of a after a fall to explore in the history?
Speed of recovery, sleepiness/disorientation, deficits
what are the epilepsy risk factors to explore?
Birth, development, seizures in past (inc. febrile fits), head injury (inc. LOC), family history, drugs + alcohol misuse
what parts of the social history are important to explore in falls?
Driving, occupation
what other history is important in falls?
Collateral
which investigations are useful in falls?
ECG
Imaging - MRI CT
CT - acutely
EEG
what are the indications for CT in acute head injuries?
Clinical or radiological skull fracture Deteriorating GCS Focal signs Head injury with seizure Failure to be GCS 15/15 4 hours after arrival Suggestion of other pathology – eg SAH
What are the differentials of falls? (12)
Syncope, Non-epileptic attack disorder • Panic attacks / Hyperventilation attacks • Sleep phenomena • TIAs • Migraine • Hypoglycaemia • Parasomnias • Paroxysmal movement disorders • Cataplexy • Periodic paralyses • Tonic spasms of MS
what are rules about driving and seizures?
o 1st seizure – car = 6 months, 5 years for HGV/PCV
o Epilepsy – car = 1 year or 3years during sleep, 10 years off medication for HGV/PCV
what is the mechanism of syncope?
decrease in blood flow to the brain due to autonomic nervous system
what are the causes of syncope?
AF, murmurs, PE, aortic dissection
Reflex - postural hypotension
Neural - exposure to blood, pain, strong feelings or specific activity such as urination, vomiting or coughing
what are the risk factors associated with syncope?
fasting long hours, taking in too little food and fluids, low blood pressure, low blood sugar, high g-force, emotional distress, and lack of sleep
what is the underlying mechanism of neural causes of syncope?
when blood vessels expand and heart rate decreases inappropriately
what are the clinical features of syncope?
Loss of consciousness and muscle strength
Fast onset, Short duration
Spontaneous and quick recover
Fall
Prior - yawn, sweat, fast breathing, confusion, lightheadness, blurred vision, spots, ringing in ears
what is the management of syncope?
o Put into recover position
o Treat underlying cause
o CVS examination and L+S BP important
what is a non epileptic event?
Looks like seizures but not caused by electrical activity in the brain
what are the clinical features of non-epileptic events?
o Compared to epileptic seizure – coordinated movements
o duration >2mins
o gradual onset, fluctuating course
o violent thrashing movement, side-to-side head movement
o asynchronous movements
o eyes closed
o recall for period of unresponsiveness.
what are the physiological causes of non-epileptic events?
Syncope, paroxysms of acute neurological insults, paroxysmal toxic phenomena, non-toxic organic hallucinosis, non-epileptic myoclonus, sleep disorders, paroxysmal movement disorders, paroxysmal endocrine disturbances and transient ischaemic attacks
what are the psychogenic causes of non-epileptic events?
- Dissociative seizures
- Psychiatric conditions e.g. panic attacks
- Factitious seizures – e.g. Munchhausens sysndrome, fabricated or induced illness by carers
how are non-epileptic events investigated?
o EEG
o ECG
o MRI, Serum prolactin
what is the management of non-epileptic events?
treatment of underlying cause
what is the general mechanism of epilepsy?
- Too much excitation or Too little inhibition
* Changes in cell numbers/types, connectivity, synaptic function, voltage gated ion channel function
What is the main clinical feature of epilepsy?
Seizures
what are the before, during and after features of seizures in epilepsy?
Prior - anxiety/dread spread through body
During - Lie on ground, jerky, tight = during
After - woozy and drowsy, longer to recover
what is the main investigation for epilepsy?
EEG
what drugs worsen symptoms of epilepsy?
aminophylline/theophylline, analgesics e.g. tramadol, antibiotics e.g. penicillins, cephalosporins, quinolones, anti-erretcics e.g. procholrperazine, opioids e.g. diamorphone, pethidine
what are the two types of epilepsy?
Focal and Generalised?
what are the causes of focal epilepsy?
- trauma (penetrating head injuries)
- CNS infection
- Brain tumours
- stroke
what are the mechanisms of focal epilepsy?
structural abnormality
Imbalance of excitatory and inhibitory neurotransmitters and channels
Newer potential mechanisms
what is the consequence of a structural abnormality in focal epilepsy?
CNS insult sets up epileptogenic focus
what is the route of a focal seizure?
initiates as a focal seizure then evolves through the ipsilateral hemisphere. The ictal activity crosses the corpus callosum and then continues in the contralateral hemisphere (in addition to ipsilateral hemisphere)
what is involved in the neural imbalance in focal epilepsy?
imbalance between gamma-aminobutyric acid (GABA)-ergic (inhibitory) and glutaminergic (excitatory) neurotransmitters, voltage-gated sodium channels, T-type voltage-gated calcium channels, and an alpha-2-delta subunit of voltage-gated calcium channels.
what are the newer potential mechanisms involved in epilepsy?
alterations in gap junctions (connexins), SV2A synaptic protein vesicles, G-protein-coupled receptors, A or M voltage-gated potassium channels, and ionotropic glutamate receptors, among others.
what are the 2 types of seizure types?
Simple
Complex
what is a simple seizure?
seizure without impaired consciousness