epilepsy Flashcards
epilepsy
Epilepsy is associated with reduced GABA levels in the brain
- This leads to abnormal cell-cell message propagation
- Less stimulation for neuron to fire on a communication
- Abnoraml chain reaction set up
- Discharge of lots of neurons from one particular area of the brain or throughout brain
Abnormal discharge of neurons from brain
febrile seizure
- NOT EPILEPTIC*
- Same symptoms as tonic-clonic epilepsy
Only in children
- Once had one – likely to have another
Managed acutely – like other seizures
Usually when child has a fever
- Cool hot children (above 38o at risk of seizure)
- Ibuprofen
- Paracetamol
- Remove clothes
- Cool sponging
- Cool bath
2 classifications of epilepsy
generallised
partial
3 types of generalised epilepsy
tonic/clonic
absence (petit mal)
myoclonic /atonic
yellow arrow pointing at
Focal area within the brain with abnormal neuronal discharge – associated with epilepsy
3 types of partial epilepsy
simple partial
complex partial
simple sensory
possible epilepsy triggers
- Idiopathic – unknown
- Trauma - head injury
- CNS disease
- tumour, stroke (vascular degenerative diseases)
- CJD, meningitis, encephalitis
- Social
- Late nights, alcohol, hypoglycaemia – can be caused by alcohol overuse)
- Flashing lights
epileptic focus in generalised epilepsy
- Central focus sends signal out to all parts of cortex
- all parts of body involved in seizure
epileptic focus in partial epilepsy
- Focus closer to a particular part of cortex so primarily affects that area
- Any neural modality
- Motor, perception, sensation e.g. see, hear, smell, taste something that isn’t there due to seizure – consider when pt presents with symptoms with no obvious cause
- Any neural modality
electrical changes in generalised seizure seen on EEG
- Change from normal wave form to a larger more erratic pattern
tonic clonic seizures
prodromal aura
- awareness of change in their brain function, may not be able to communicate this but can see characteristic changes e.g. awareness, actions before seizure
loss of consciousness/continence
initial tonic (stiff)
- all voluntary muscles in body contract together – strain on skeleton – particular spine - damage possible
clonic - (contraction/relaxation)
- jerk, spasm
post-ictal drowsiness
- Usually spontaneously terminate in 1-3 mins
- Drowsy until consciousness
Status epilepticus possible
status epilepticus in tonic clonic seizures
recurrent seizures
Dangerous
- Normal breathing muscles cannot work during tonic-clonic seizures
hypoxic
petit mal (absence) seizures
may not be obvious unless closely watching
- short lived episodes (5-15 seconds)
- loss of awareness
- eyelids flutter, vacant stare, stops activity, loss of response, failed to respond
- CHILDHOOD usually
Can be multiple attacks in a single day
tonic-clonic seizures medical impact (2)
INJURY
asphyxia
tonic clonic seizures lead to injury
muscles uncontrolled, fall to ground – hit head
- protect where possible remove objects from around them, help control fall if possible
- Remove objects from the mouth IF POSSIBLE
partial seizures are
focus located close to one area of brain
different types
- sensory
- simple partial
- complex partial
simple partial seizures
Motor localised to ONE region of the brain
- may move/spread to other motor areas
- E.g. Jacksonian seizure – wrist, up upper limb, shoulder, neck
surgery for epilepsy
- Removal of focal neurological lesions
- Brain tumours (benign)
- Focal seizures
- Identifiable point of origin within the brain
- Not well controlled by medication
- Identifiable point of origin within the brain
Clearly identify focus that is poorly controlled prior
varying extent - lobes or just damaged area
determining epileptic focus site
- Identifying focus is key – damage, start or spread of seizure
- Stereotactic surgery in 3D to remove the focal point through craniotomy
