Epilepsy and other attack disorders Flashcards
Epilepsy diagnostic criteria
A
At least 2 UNPROVOKED seizures occurring MORE THAN 24 HOURS apart
Epilepsy aetiology
V: vascular
I: infection
T: trauma
A: AV malformation
M: metabolic
I: idiopathic
N: neoplasm
What are the different stages in a seizure?
Prodrome - Change in mood / days before event
Aura - Minutes preceding
* Is AWARE
* e.g. strange feelings in gut, deja vu, strange smells, flashing lights
Ictal Event - Seizure
Focal - Sx reflect location of paroxysmal
Generalized seizure
Post Ictal
Headache
Headache, confusion, myalgia, sore tongue (often bitten)
Frontal- Todd’s Palsy (Temp paresis)
Temporal - Dysphagia
What are the different types of seizures?
Focal seizures - Paroxysmal Firing
Simple partial - Is conscious and aware. NO post-ictal events
Complex partial - Unconscious and unaware. With POST ICTAL event
Generalized seizures: LOC/Unaware
Simultaneous discharge throughout cortex = bilateral/symmetrical motor manifestations
What are the different types of generalized seizures?
Tonic - Muscle rigidity - Stiff and flexed
Atonic - Loss of muscle tone/relaxation - floppy
Clonic - Whole body convulsions / Jerking
Myoclonic - Single limb/ small muscle jerking
Absence - Losing consciousness - ‘spacing out’ (mc in kids)
Tonic clonic - First stiffness followed by convulsions
How would focal seizures present if in frontal lobe?
Frontal lobe: Movement and thought
Posturing and peddling
Jacksonian March (If jerking expand from one limbs to more) - seizures marches up and down the homunculus
Post ictal - TODDS PALSY - Temporary paresis (starts distally at limb then work its way up)
How would focal seizures present if in Temporal Lobe?
Temporal lobe ~ Emotions, Memory and speech
Aura 80%
de javu, Hallucinations , funny smell
Dysphagia
Automatisms e.g. lip smacking and rapid blinking
Anxiety, out-of-body experiences
How would focal seizures present if in Temporal Lobe?
Temporal lobe ~ Emotions, Memory and speech
Aura - Deja vu, jollifications, funny smell
Dysphagia
How would focal seizures present if in Parietal Lobe?
Parietal Lobe ~ Sensory disturbance
Paraesthesia - Tingling and numbness
What a complication of focal seizure?
2/3 of patients go on to develop secondary generalized seizures - TONIC CLONIC MC
How would focal seizures present if in Occipital Lobe?
Visual phenomena e.g. spots, lines, flashes
Non-epileptic seizure characteristics
Entirely situational e.g. metabolic disturbances, low Na+, hypoxia
Typically longer with closed eyes + mouth
Pre-ictal anxiety symptoms
DO NOT OCCUR DURING SLEEP
do not involve incontinence or tongue biting
Epilepsy Ix
1st - Medical history: >2 or more seizures more than 24hrs apart
ELECTROENCEPHALOGRAM (EEG)
Not diagnostic but can help support a diagnosis/type of epilepsy
MRI/CT HEAD
- rules out other potential causes e.g. space-occupying lesion
BLOODS
- rules out other potential causes e.g. metabolic
Genetic testing
e.g. juvenile myoclonic epilepsy
What is a medical emergency associated with seziures?
Status epilepticus - Seizure lasting>5mins
Medical emergency
Treat with benzodiazepine (increases gaba inhibition)
Epilepsy treament?
AED - Anti epileptic drugs
Focal - Lamotrigine or Carbamazepine
Generalized: Sodium valproate CI Lamotrigine
What the mechanism of action of AEDs
Lamotrigine/Carbamazepine blocks Na+ chanels
Benzodiazapine increases GABA receptor activity
What are other differentials for seizures?
Syncope
Non-epileptic seizure (dissociative seizures)/pseudoseizures
What is syncope
Temporary Loss of conciousness due to sudden drop in blood supply:
This can be caused by a sudden drop in BP HR
types: vasovagal syncope, postural syncope, neurological syncope
Syncope vs sizures
Syncopes are situational
typically sitting or standing - never from sleep
+/- jerking
5-30s
Non-epileptic seizure (dissociative seizures)/pseudoseizures
Paroxysmal event causing change in behaviour/sensation or mental appitudee due to an tnvoluntary reflex to either internal or external stimuli such as:
Physiological (panik attack, drugs, arrythmias, hypoglycemia)
or
Pschycogenic (ptsd, psychoses) but not physcial
Non- epileptic seizures vs seizures
Situational
eyes closed
emotions expressed in inctal - crying/speaking
physcological origin
no EEG
1-20mins
What is defined as status epilepticus?
A Seizure lasting over 5 minute without returning to a full level of consciousness
Acute management of status epilepticus
Early status (0-30 minutes)
If in the community:
Buccal Midazolam or Rectal Diazepam
If IV access is obtained and resuscitation facilities are available:
Lorazepam (intravenous) 0.1 mg/kg (usually a 4 mg bolus
2line: Phenytoin/Sodium valproate/ Levitiracetam
