Epilepsy and seizure 3A Flashcards
What is the acronym for the many causes of seizures?
VITAMIN DE
What does Vitamin DE stand for?
Vascular
Infection
Trauma
Autoimmune eg. SLE
Metabolic diseases
Idiopathic –> EPILEPSY
Neoplasms (cancer)
Dementia + drugs (cocaine)
Eclampsia + everything else
RF for seizures?
Congenital (NFM 1, tuberous sclerosis, CP)
Acquired (meningoencephalitis, febrile convulsions)
Dementia
What is the pathology behind seizures/epilepsy?
Normal balance between GABA (-) & Glutamate (+) shifts towards glutamate
Neurones synchronously active (at same time)
More excitatory = Increased glutamate stimulation = Increased GABA inhibition
what meds / conditions decrease seizure threshold?
Hypoglycaemia
alcohol
stress
Meds : TCA, Lithium, ciprofloxacin, Clozapine, AED non adherence, tramadol, antipsychotics
What is epilepsy?
What classifies epilepsy from a one off seizure?
Idiopathic cause of seizures
>2 episodes more than 24hr apart
2 RF for epilepsy?
Familial inherited
Dementia (10x more likely)
What 3 things differ an epileptic and non epileptic fit?
eyes OPEN
synchronous movements
can occur in sleep
How long do epileptic seizures last?
less than 2 mins
What are the different phases before/after a seizure?
Prodrome
Aura
Ictal event
Post ictal
What happens in prodrome?
mood changes
days before
What happens in Aura?
Mins before
Deja Vu and Automatisms (lip smacking and rapid blinking)
Not always present, mostly seen in temporal lobe epilepsy
What is the ictal event?
Seizure
What happens in the post ictal period?
headache
Confusion and reduced GCS
Amnesia (what the heck happened)
Todd’s paralysis
Dysphasia
Sore Tongue - only in epileptic seizures, not in syncope (tongue often bitten)
What are the 2 classifications of epileptic seizures?
Generalised
Focal
Generalised seizures
Unilateral or bilateral?
LOC?
Bilateral (both hemispheres)
Always Loss of consciousness
What are the diff types of Generalised seizures?
Tonic
Atonic
Tonic Clonic
Myoclonic
Absence
What happens in tonic clonic seizures?
Bilateral, LOC
No aura
Tonic phase = rigid/stiff, fall to floor
Clonic = Jerking of limbs, convulsions
+ up gazing open eyes, incontinence, tongue bitten
What happens in absence seizures?
Which age group?
Childhood
Stare off blankly for a few moments (secs - mins) then carry on where they left off
3 Hz spike on EEG
What is Tonic seizures?
Just rigid
What happens in myoclonic seizures?
Short muscle twitches
What happens in Atonic seizures?
Relaxed, sudden floppy limbs and muscles
What are focal seizures?
Which part of brain do they effect?
Features confined to one region of brain eg. temporal
May progress to 2^ generalised
What are the 2 types of focal seizures?
simple focal
complex focal
What happens in simple focal?
LOC?
No LOC, Px aware + awake
Just uncontrollable muscle jerking
What is complex focal?
LOC?
LOC, Px unaware, post ictal period
What do the Sx depend on?
where the focal neurology is
What Sx are seen if frontal lobe affected?
Jacksonian march - Starts in one part of the body and spreads
Todd’s palsy - motor cortex affected - temporary paralysis and muscle weakness after
What Sx are seen if parietal lobe affected?
Parasthesia (sensory loss)
What Sx are seen if occipital lobe affected?
Visual change
What Sx are seen if temporal lobe affected?
Aura (mood change)
Dysphasia
Post ictal period
Hearing disturbances
What requirement must be to consider epilepsy?
must have had 2 or more seizures 24hr apart
What investigations are done?
Bloods - rule out metabolic cause, infection, electrolytes or hypoglycaemia
ECG
Lying and standing BP (LSBP)
CT head + MRI
(examine hippocampus, check bleeds, SOL)
GS = EEG - 3Hz wave in absence
what is high in a true epileptic seizure? Not in mimics
Prolactin and lactate are high
Tx for epilepsy?
Sodium valproate to all (increases GABA)
Tx for seizures:
Focal?
Gen tonic clonic?
Absence?
Myoclonic?
Focal = Lamotrigine or Levetiracetam
Gen tonic clonic =
M = Sodium valproate
F = Lamotrigine or Levetiracetam
Absence = Ethosuxamide
Myoclonic =
M = Sodium valproate
F = Levetiracetam (Keppra)
Who is sodium valproate not given to and why?
Females of child bearing age (15-45)
It is teratogenic
What is given instead?
Lamotrigine
What is a complication?
status epilepticus (neuro emergency)
What happens in status epilepticus?
Epileptic seizures without a break back to back
or
Seizure lasting more than 5 mins
Tx for status epilepticus?
- Lorazepam (4mg IV) or buccal midazolam or rectal diazepam
- IV Lorazepam 4mg
- IV phenytoin / sodium valproate / carbamezapine
- IV phenobarbital under specialist guidance + ITU
SE of Sodium valproate?
mechanism?
GABA - Ergic
- Teratogen (spina bifida, cleft palate)
- Hepatotoxic in kids
SE of Lamotrigine?
Stevem Johnson syndrome - flu Sx + purple/red rash
SE of carbamezapine?
mechanism?
P450 inducer
SIADH
Ataxia
SE of ethosuximide?
Agranulocytosis
erythema nodosum
SE of phenytoin?
-Gingival hyperplasia
-Teratogenic (fetal hydantoin syndrome - CHD, cleft lip, limb hypoplasia, hirsutism)
-Hirsutism
-Lymphadenopathy
