Epilepsy and seizure 3A Flashcards by Manaal Arif

What is the acronym for the many causes of seizures?

VITAMIN DE

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What does Vitamin DE stand for?

Vascular
Infection
Trauma
Autoimmune eg. SLE
Metabolic diseases
Idiopathic –> EPILEPSY
Neoplasms (cancer)
Dementia + drugs (cocaine)
Eclampsia + everything else

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RF for seizures?

Congenital (NFM 1, tuberous sclerosis, CP)

Acquired (meningoencephalitis, febrile convulsions)

Dementia

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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

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what meds / conditions decrease seizure threshold?

Hypoglycaemia
alcohol
stress
Meds : TCA, Lithium, ciprofloxacin, Clozapine, AED non adherence, tramadol, antipsychotics

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What is epilepsy?
What classifies epilepsy from a one off seizure?

Idiopathic cause of seizures
>2 episodes more than 24hr apart

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2 RF for epilepsy?

Familial inherited
Dementia (10x more likely)

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What 3 things differ an epileptic and non epileptic fit?

eyes OPEN
synchronous movements
can occur in sleep

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How long do epileptic seizures last?

less than 2 mins

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What are the different phases before/after a seizure?

Prodrome
Aura
Ictal event
Post ictal

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What happens in prodrome?

mood changes
days before

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What happens in Aura?

Mins before
Deja Vu and Automatisms (lip smacking and rapid blinking)

Not always present, mostly seen in temporal lobe epilepsy

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What is the ictal event?

Seizure

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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)

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What are the 2 classifications of epileptic seizures?

Generalised
Focal

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Generalised seizures
Unilateral or bilateral?
LOC?

Bilateral (both hemispheres)
Always Loss of consciousness

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What are the diff types of Generalised seizures?

Tonic
Atonic
Tonic Clonic
Myoclonic
Absence

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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

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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?

1. Lorazepam (4mg IV) or buccal midazolam or rectal diazepam 2. IV Lorazepam 4mg 3. IV phenytoin / sodium valproate / carbamezapine 4. 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