Epilepsy and black outs Flashcards
Key thing on making the diagnosis of epilepsy
HISTORY
What can potentially increase th erisk of having a seizure
alcohol, illicit drug use, sleep deprivation,
What to ask about i the history
What happened in the run up (last day and also just before the event) , during and also what happened afterwards.
ANY PREVIOUS EPISODES!
Things to look for
At the time: standing/postural change, pain, vomiting, passing urine, coughing, exercising
Just before: any warning symptoms eg palpatations/light headed/ odd taste/smell
During: Awareness, tongue biting, incontinance,
After: confusion, pain
WITNESS ACCOUNT!!
If bitng tounguewhat do you wan tot find out?
Where on the tongue: sides are more common for a seizure whereas the tip of the toungue is more common in syncope
Most common causes og black outs
Vasovagal (drop in bp) 20%
Unknown 34%
Reflex syncope 14%
Cardiogenic syncope (18%)
What are the three categories of syncope?
Orthostatic - issue with fluid - dehydration/meds (antihypertensive), endocrine/autonomic
Cardiogenic - issue with heart of aorta - arrhythmias/aortic stenosis
Reflex (Neuro-cardiogenic) - issue with the situation - eg having blood taken/situation such as weeing (micturation)
Why do we have syncope?
Caused by lack of blood flow in the brain and so if we can faint and be lying down then it will be easier for that blood to reach the reach the brain
Presentation of a syncope episode, the we do what?
Patient history of event (very detailed), witnes view (if there is one).
Examinations: heart sounds, pulse, postural bp.
ECG - look for heart block and QT ratio, may need a 24h ecg
Cardiogenic syncop - what investigations and why
ensure to ask about any palpatations/chest pain/SOB in history. Check came around fairly quickly and if they felt clammy/sweaty
-Family history
-refer to cardiology urgently
What is a pseudoseizure and what investigations would we do
Something that looks a bit like a seizure but in fact have no crazy brain activity that you see in epileptic seizures. Often due to stressors or triggers and are more psychological.
Good history- self and witness.
Ideally you want an EEG capturing a typical episode
Wat are common things that can provoke seizures?
Withdrawl (Alcohol/stroke)
head injury (within days)
stroke/neurosurgery (within 24h)
Severe electrolyte disturbance
Eclampsia
What is epilepsy?
Tendency for unprovoked seizures
Due to disrupted background electrical activity of neurones
What can be indicating factors of subsequent siezures after 1 siezure? (And diagnosis of epilepsy can be made?)
Stroke/tumour in area of brain
abnormality on EEG (spike and wave)
What can cause seizures?
Something that can cause disturbance to the background activity of the neurones, soooooo….:
-Too much activity (ion channnel issues/glutamate issues or excititory amino acids)
-Too little activity (gaba receptor issues)
-Stroke/trauma/tumour/developmental causes
Factors in epileptic patients that can cause seizure risk
-stress/anxiety
-missing meds
-sleep disturbance/fatigue
-hormonal changes
-drug/alcohol interactions
-some patients are photosensitive
What do the main seizure/epileptic rugs ia to do?
dampen down the neuronal synapses. Notably Valproate qwhich increases the GABA turnover, decreases the Na channels and NMDA receptors
What are the 2 groups of epi;e[s
Focal and generalised
Focal = focal part of the brain that is involved, more specific, might get an auora, cna become secondary generalised.
Generalised is the whole of the brain, may just be the whole of the brain from the onset or it could start in one particular location and rapidly spread across the whole of the brain. Give your typical Myoclonic seizures. More commonly diagnosed in children. No warning. Possible family history
Tonic conic seizure, usually is indicative of what type of seizre
Tonic (stiffening) clonic (jerking) is the typical seizure you might think of. Is an unpredictable generalised seizure, although might be irritable before the seizure occuring.
PMH -complications at birth, Feb conv, trauma, menigitis, brain injuries
Complex partial siezure
Temporal lobe seizure
History preceding events:
-Rising feeling in stomach,
-Funny smell/taste
-De ja vu (familiar experience)
No recollection of seizure - but from witess will be staring
blankly into space, might pick clothes and smakc lips)
disorientated afterwards
Clinical assesment of seizures
-Refer to first seizure clinic
- ECG, routine bloods (Glc)
-A+E will often arrange a CT
From Neurology clinic:
- MRI for focal lesion
- EEG (Usually in <40yrs)
- Anti-epileptic drugs
-Refer to Epilepsy nurse (post diagnostic information)
-Discuss driving (inform DVLA)
What is Absence seizures and who do they present most in?
Mainly in children, unaware, but stare into space and stop what they are doing. Is a type of generalised seizure.
frontal lobe seizures
“Brief, bizarre and motor”
Often confused with non-epileptic attacks
What ages are we most likely to see people with epilepsy and having seizures? What can make it or common to develop epilepsy?
Children (due to discovering they have epilepsy and that sort of thing) and older people (due to strokes etc)
Much more common to develop epilepsy if they have learning difficulties
SO general investigations: adulsts and younger people
Younger people - more likely to have generalised seizures and so an EEG - also might be able to treat the seizure and remove the bad area through surgery
Adults - more likely to have focal seizures and so often a CT willl be performed to rule out more sinister and then likely to have an MRI
