Epilepsy Flashcards
What is epilepsy
A recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain, manifesting as a seizure
What are convulsions the motor signs of?
Electrical discharges
What does an aura imply?
A focal seizure
What symptoms may be present post-ictally from a seizure in the motor cortex
Headache
Confusion
Myalgia
Temporary weakness
What is post ictal weakness often called?
Todd’s palsy
What symptom may be present post-ictal from a seizure in the temporal lobe
Dysphasia
What proportion of seizures are idiopathic
2/3
List some other causes of seizures
Cortical scarring - head injury years before onset
Developmental - dysembryoplastic neuroepithelial tumour or cortical dysgenesis
Space occupying lesion
Stroke
Hippocampal sclerosis
Vascular malformations
Tuberous sclerosis
Sarcoidosis
SLE
PAN
Antibodies to voltage gated potassium channels
How is epilepsy diagnosed?
Diagnosis is difficult due to the heterogenous nature of the disease
All patients with a seizure must be referred for specialist assessment and investigation within 2 weeks
What must be established in the history of a seizure?
Tongue biting
Collateral from witness
Slow recovery
Funny turns/odd behaviour
Deja vu and odd episodic feelings of fear may be relevant
Any triggers? Alcohol, stress, flickering lights, TV. Triggering attacks tend to recur
List the 3 types of focal seizure
Simple - without impairment of consciousness
Complex - with impairment of consciousness
Secondary generalised - Evolving to bilateral, convulsive seizure
Describe the features of a simple seizure
Awareness unimpaired
Focal motor, sensory, autonomic or psychic symptoms
No post ictal symptoms
Describe the features of a complex seizure
Awareness is impaired
Either at seizure onset or following a simple partial aura. Most commonly arise from the temporal lobe in which post ictal confusion is a feature
Describe the features of a secondary generalised seizure
In 2/3 patients with partial seizures, the electrical disturbance, which starts focally, spreads widely, causing a generalised seizure, which is typically convulsive
Describe focal seizures
Originating within networks linked to one hemisphere and often seen with underlying structural disease
Describe generalised seizures
Originating at some point within and rapidly engaging bilaterally distributed networks leading to simultaneous onset of widespread electrical discharge with no localising features referable to a single hemisphere
List some examples of generalised seizures
Absence seizure Tonic-clonic seizure Myoclonic seizure Atonic (akinetic seizure) Infantile spasms
Describe absence seizures
Brief (<10s) pauses
Presents in childhood
Describe tonic-clonic seizures
Loss of consciousness
Limbs stiffen (tonic) then jerk (clonic)
May have one without the other, Post ictal confusion and drowsiness
Describe myoclonic seizures
Sudden jerk of the limb, face and trunk
The patient may be suddenly thrown to the ground or have a violently disobedient limb
Describe atonic seizure
Sudden loss of muscle tone causing fall
No LOC
What are infantile spasms commonly associated with?
Tuberous sclerosis
Give some features of a temporal lobe seizure
Automatisms Dysphasia De ja vu Emotional disturbance Hallucinations of smell, taste and sound Delusional behaviour Bizarre associations
Give some features of a frontal lobe seizure
Motor features such as posturing or peddling movements of the legs
Jacksonian march - spreading focal motor seizure with retained awareness often starting with the face or thumb
Motor arrest
Subtle behavioural disturbance
Dysphasia or speech arrest
Post ictal todds palsy
