Epilepsy Flashcards
What is epilepsy?
A recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain, manifesting as seizures
What fraction of epilepsy is idiopathic?
2/3
What are some causes of epilepsy?
Cortical scarring, space-occupying lesions, stroke
What is a prodrome?
Change in mood or behaviour lasting hours or days before a seizure
What does it suggest if a patient experiences an aura?
A partial seizure
What might a patient experience postictally?
Headache, confusion, myalgia, sore tongue, temporary weakness after focal seizure in motor cortex, dysphagia after a temporal lobe seizure
What is a focal/partial seizure?
Focal onset with features that can be referable to a single lobe
What are the subcategories of focal seizure?
Simple partial seizure, complex partial seizure, partial seizure with secondary generalisation
What manifestations are typical of a temporal focal seizure?
Aura, deja vu or jamais vu, auditory hallucinations, anxiety, automatisms
What manifestations are typical of a frontal focal seizure?
Motor features, Jacksonian march, post-ictal Todd’s palsy
What manifestations are typical of a parietal focal seizure?
Sensory disturbances
What manifestations are typical of an occipital focal seuzure?
Visual phenomena
What are generalised seizures?
Simultaneous electrical discharge throughout the whole cortex, bilateral and symmetrical motor manifestations and always associated with loss of consciousness and lack of awareness
What is an absence seizure?
Pale and stare blankly for a few seconds
What is a tonic-clonic seizure?
Grand mal, loss of consciousness, limbs stiffen and then jerk
What is a myoclonic seizure?
Sudden jerk of limb, face or trunk
What is an atonic seizure?
Sudden loss of muscle tone causing a fall
What could be provoking causes of a seizure?
Trauma, stroke, haemorrhage
What investigations would you do?
EEG, MRI/CT, bloods to rule out potential causes, genetic testing
How are seizures due to non-epileptic attack disorder different to epileptic seizures?
More gradual onset, prolonged, abrupt termination, closed eyes
What is first line management of focal/partial seizures?
Carbamazepine or lamotrigine
What is first line management of generalised tonic-clonic seizures?
Sodium valproate if not able to child bear, lamotrigine if able to
What is first line management of absence seizures?
Sodium valproate if not able to child bear, ethosuximide if able to
What is first line management of myoclonic seizures?
Sodium valproate if not able to child bear, levetiracetam/topiramate if able to
What is first line management of tonic or atonic seizures?
Sodium valproate if not able to child bear, lamotrigine if able to
What is a common side effect of sodium valproate?
Nausea
What is a common side effect of lamotrigine?
Rash
How should you switch AEDs?
Introduce the new drug slowly then withdraw the old drug once the new one is established
When might you consider surgery?
If single epileptogenic focus can be identified
What are some potential complications?
Falls, injuries, sudden unexpected death in epilepsy
What are some risk factors?
FH, Premature babies, abnormal cerebral blood vessels, drugs
What is a tonic seizure?
High tone and therefore rigid, stiff limbs
What is a clonic seizure?
Rhythmic muscle jerking
What is a simple partial seizure?
No affect on consciousness or memory, no post-ictal symptoms
What is a complex partial seizure?
Memory/awareness affected, most commonly from temporal lobe, post-ictal confusion if temporal
What is a partial seizure with secondary generalisation?
Partial start that develops into a generalised seizure
How do you manage prolonged seizures?
Benzodiazepines
Generally, what drugs would you give?
Sodium valproate to males, lamotrigine to females
