Epilepsy And Blackouts Flashcards
What is epilepsy
Chronic disorder characterised by recurrent seizures which may vary from a brief lapse of attention or muscle jerks, to severe or prolonged convulsions
What are the differential diagnosis of a sudden collapse
Vasovagal syncope Seizure Cardiac syncope Cataplexy Hypoglycaemic attacks
What is a vasovagal syncope (faint)
Syncope is a sudden impairment of conscioussness with loss of tone caused by reduced blood/oxygen to the brain
What are the provoking factors for vasovagal syncope
Blood
Pain
Dehydration
What are the pre-syncopal symptoms
Ligh headednes
Warm
Dizziness that builds up in intensity
Loss of vision
What is a seizure
Abnormal synchronous cortical dishcharges
What can happen with a seizure
Post event confusion for longer than 2 minutes
Deeply bitten lateral border of the tongue
Prolonged tonic then clonic movement lasting more than 1 min
Deep cyanosis
What are the cardiac syncope clues on a 12 lead ECG
Long QT interval Prior MI Anterior (v1-3) inversion, QRS duration on v1-3/4-6 less than 1.2 Ectopy Bradycardia Av conduction delay/block Bifasciular block Ventricular hypertrophy
What is cataplexy
Attacks of postural tone and provoked by emotion
What is the definition of an epilepsy
Tendency to have a spontanous recurrent seizure (2 or more seizures)
What are the causes of epilepsy
Any disease of the brain: Brain tumour Infection Degenerative Trauma Genetic
What are the classification of seizures
Partial or generalised
What is partial seizure
When the seizure starts in a particular area of the brain
What is a generalised seizure
When the seizure starts in both hemispheres of the brain
What can partial seizure be further classed into
Simple: aware
Complex: not aware
What can a generalised seizure be classed into
Tonic: muscle stiffness
Clonic: rythmic jerking
Tonic clonic: muscle stiffness then rhythmic jerking
Myoclonus: brief jerking
Absence: losing and gaining consciousness can be like
Atonic
What are the investigations for a seizure
EEG
MRI
What can a MRI show
Hippocampal sclerosis (scarring in the hippocampus) in the temporal lobe
When do yout start treating seizures
When there is 2 spontanous seizures
Which anti-epileptic drug has teratogenic effects
Valproate
What is the mechanism of action of valproate
Increase in GABA and inhibits sodium channels
What is the action of barbiturates
Increase in GABA
Which seizure type is barbiturates used in
Partial seizure
What is the mechanism of action of benzodiazepines
Increase in GABA
When is benzodiazepine used
Status epilepticus
What is the mechanism of action of carbamazepine
Inhhibits sodium channels
What seizure is carbamazepine used in
Tonic clonic
What is the mechanism of action of phenytoin
Inhibits sodium and calcium channles
When is phenytoin used
Status epilepticus
What is status epielpticus
Seizures that last more than 5 minutes in totl
What are the first line drugs for status epilepticus
Benzodiazepine
Phenytoin
What is the mechanism of action of valproate
Increase gaba
Inhibit sodium channle
When is valproate used
Partial, tonic clonus and absence seizures
