Epilepsy Flashcards
define epilepsy?
a tendency to recurrent unprovoked seizures
criteria of diagnosing epilepsy?
> 2 seizures
what are the types of seizure?
- focal impaired awareness
- focal aware
- generalised
what are the types of generalised seizure?
- Tonic-clonic
- Absence
- Myoclonic
- Atonic
- Tonic
what are some causes of secondary seizures?
o Tumour
o Infection (e.g. meningitis)
o Inflammation (e.g. vasculitis)
o Toxic/Metabolic (e.g. sodium imbalance)
o Drugs (e.g. alcohol withdrawal)
o Vascular (e.g. haemorrhage)
o Congenital abnormalities (e.g. cortical dysplasia)
o Neurodegenerative disease (e.g. Alzheimer’s disease)
o Malignant hypertension or eclampsia
o Trauma
which conditions can be easily mixed up with seizures?
o Vasovagal syncope
o Migraine
o dissociative disorder
epidemiology of seizures?
- COMMON
- 1% of the general population
- Typical age of onset: CHILDREN and ELDERLY
features of temporal lobe seizure?
Hallucinations (auditory/gustatory/olfactory),
Epigastric rising/Emotional,
Automatisms (lip smacking/grabbing/plucking),
Deja vu/Dysphasia post-ictal)
features of a frontal lobe seizure?
Head/leg movements, posturing, post-ictal weakness, Jacksonian march Can have secondary generalisation
features of parietal lobe seizure?
Paraesthesia
features of occupital lobe seizure?
Floaters/flashes
features of tonic clonic seizures?
- Vague symptoms before attack (e.g. irritability)
- Tonic phase (generalised muscle spasm)
- Clonic phase (repetitive synchronous jerks)
- Faecal/urinary incontinence
- Tongue biting
- Post-ictal phase: impaired consciousness, lethargy, confusion, headache, back pain, stiffness
features of absence seizures?
- Onset in CHILDHOOD
- Loss of consciousness but MAINTAINTED POSTURE
- The patient will appear to stop talking and stare into space for a few seconds
- NO post-ictal phase
features of non convulsive status epilecpticus?
- Acute confusional state
- Often fluctuating
- Difficult to distinguish from dementia
what might the bloods show?
- prolactin might increase post-ictal
what might an EEG achieve?
o Helps to confirm diagnosis
o Helps classify the epilepsy
o Ictal EEGs are particularly useful
what might a CT/MRI show?
o Shows structural, space-occupying or vascular lesions
what is status epilepticus?
a seizure lasting > 30 mins or repeated seizure without recovery and regain of consciousness in between
how to manage status epilepticus?
o Check GLUCOSE
o IV lorazepam OR IV/PR diazepam - REPEAT again after 10 mins if seizure does not terminate
o If seizures recur following the next dose of lorazepam or diazepam, consider IV phenytoin
o If this also fails, consider general anaesthesia
o Treat the CAUSE
how to treat newly diagnosed epilepsy?
o Only start anti-convulsant treatment after > 2 unprovoked seizures
o FOCAL Seizure 1st Line: carbamazepine
o GENERALISED Seizure 1st Line: sodium valproate
what does one have to be careful about when giving sodium valporate?
o Sodium Valproate cannot be given to females of child bearing age – offer lamotrigine as a back-up
how to stop AED?
o Medication can be stopped over 2-3 months if seizure free for >2 years.
what advice can be given to patients?
o Avoid triggers
o Use seizure diaries
o Particular consideration for women of child-bearing age because the sodium valproate can have teratogenic effects
o Be careful of drug interactions
• Surgery may be considered for refractory epilepsy
• Ketogenic diets can be helpful in children with epilepsy
what are the complications of epilepsy?
- Fractures from tonic-clonic seizures
- Behavioural problems
- Sudden death in epilepsy (SUDEP)
- Complications of anti-epileptic drugs:
prognosis of epilepsy?
• 50% remission at 1 year
