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Pathophysiology of ill-health > Epilepsy and Seizure > Flashcards

Epilepsy and Seizure Flashcards

1
Q

Statistics about epilepsy

Prevalence

Duration

A

Epilepsy is a chronic non-communicable disease of the brain that affects people of all ages.

One of the oldest recognised conditions c 4000 BC

1/200 people have epilepsy - 1/100

250 million people world

5 million people are diagnosed with epilepsy each year

500,000 in UK have epilepsy diagnosis

4-10 / 1000 - active epilspsy with seizures or in need of treatment

The most common serious brain disorder in the world with no age, class, ethnic, geographic boundaries

Seizures are the most common child / maternal neurological condition

Over 50% cases begin in childhood or adolescence.

0.5% global burden of disease

70% of those living with epilepsy could be seizure free if well treated

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2
Q

Relevance (stats - 3-4 lines)

Specific to MH?

A

More prevalent in LD - 1/3 have epilepsy

3 x risk of premature death than general pop - 1000 deaths per year in England

70% of those living with epilepsy could be seizure free if well treated

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3
Q

Definition

Seizure vs Epilepsy

A

Epilepsy is a disease characterised by recurrent, unprovoked seizures (ILAE)

associated with abnormal electrical activity in the brain

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4
Q

Classification of Seizures:

How are they grouped?

Who introduced this?

A

Grouped depending on:

  • Onset location?
  • Awareness affected?
  • Other symptoms? e.g. movement

In 2017 the International League Against Epilepsy (ILAE) introduced new method to group.

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5
Q

Myoclonus

A

Jerking arrhythmically

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6
Q

Clonus

A

Jerking rhythmically

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7
Q

Atonic

A

Limp

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8
Q

Tonic

A

extension or flexion postures

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9
Q

Spasm

A

Trunk flexion

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10
Q

Hyperkinetic

A

thrashing / pedalling

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11
Q

Word Changes! (due to 2017 ILAE)

Partial
Simple Partial
Complex partial
Dyscognitive

A

Partial-> Focal
Simple Partial-> Focal aware
Complex partial-> focal impaired awareness
Dyscognitive -> focal impaired awareness

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12
Q

Onset types ?

A

Focal onset
Generalised onset
Unknown onset - idiopathic

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13
Q

Focal Seizures - what are they?

What is another type of focal seizure?

A

Originate within networks limited to one hemisphere

May be discretely localised or more widely distributed.

Can spread to both sides of the brain (called a focal to bilateral tonic-clonic seizure - the focal seizure is then a warning, sometimes called an ‘aura’ that another seizure will happen)

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14
Q

Generalised Seizures - what are they?

Where is affected?

A

Originate at some point within and rapidly engaged bilaterally distributed networks

Can include cortical and sub-cortical structures but not necessarily entire brain complex

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15
Q

Aetiology of seizures:

A

Structural - brain injury, genetic abnormality,

Brain dysfunction due to infection
Metabolic issues, e.g. problems with glucose, sodium or potassium,

  • Structure
  • Genetic
  • Infection
  • Metabolic
  • Immune
  • Unknown
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16
Q

Name some Common Co-morbities

% of children with epilepsy who also have MH problems?

A

ADHD
LD
ASD

59% of children with epilepsy also have MH problems

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17
Q

Tuberous Sclerosis - what is it?

A

Complex, rare genetic condition that causes mainly benign tumours to develop - structural, metabolic, genetic.

18
Q

Focal Aware Seizure

  • Previously named?
  • Clinical presentation?
A

AKA Partial seizure

In FAS the person is conscious (aware and alert), will usually know that something is happening ‘feel strange’ and will remember the seizure afterwards.

19
Q

Focal Impaired Awareness Seizure (FIAS)

  • Previously named?
  • Clinical presentation?
  • Particular location?
A

Previously Complex partial seizure

Affect a bigger part of one hemisphere

May be confused and difficult to communicate with. Afterwards they may be confused for a while, tired or not able to remember.

esp. temporal lobes

20
Q

Focal seizures - examples of motor symptoms?

A 
Lip-smacking
Atonic
Stiffness of limbs
Jerking
Screaming 
Crying
21
Q

Focal seizures - examples of non-motor symptoms?

A

deja vu
Unusual sensations
Intense emotions
Hallucinations

22
Q

Focal to bilateral tonic clonic

  • Previously named?
  • Clinical presentation?
A

AKA secondary generalised seizure

tonic-clonic - convulsive or shaking seizure

If this happens quickly, they may not be aware that it began as focal

23
Q

Generalised onset seizures

  • Clinical presentation?
  • Location?
A

Both hemispheres

Unconscious except myoclonic seizures

Won’t remember

24
Q

Tonic-clonic

Clinical presentation:

  • Pre
  • During
  • Post
A

Pre:

Unsconscious
Stiffness
Fall down
Cry
Bite tongue

During:

Jerk and Shake
Breathing difficulties,
Cyanosis
Incontinence

After:

Tired, confused, headache, want to sleep

25
Q

Clonic Seizures

  • Clinical presentation?
  • Location?
A

Repeated rhythmical jerking movements of one side or part or both sides of body, depending where seizure starts

Seizures can start in one part of brain (focal motor) or affect both sides of the brain (generalised clonic)

26
Q

Tonic

Atonic

What happens? Post?

A

Tonic - stiff, fall backwards, brief seizure

Atonic - drop attack - muscles suddenly relax

Quick recovery usually unless collapse caused trauma

27
Q

Myclonic seizures

What are they?

A

muscle jerk

Not always due to epilepsy, often happen in clusters, close together, shortly after waking

Conscious but classified as generalised as likely to have other

28
Q

Absence Seizure

  • Previously named?
  • Clinical presentation?

Atypical absence - e.g.?

A

Previously petit mal

Unresponsive blank

Appears to be daydreaming

If walking, may continue

Atypical - includes change in muscle tone

29
Q

Types of epilepsy

give a few examples

A

Status Epilepticus

Most seizures less than 5 minutes,

SE is 30 minutes +, life threatening

Others - catamenial or photosensitive epilepsy

30
Q

Pathophysiology

A

Brains cells need to work in harmony

Nerve impulses to one another,muscles and glands - action potentials baby

AP’s driven by Sodium potassium pump

31
Q

What would you see on an EEG?

A

Abnormal with spikes of electrical activity

32
Q

Brain - weight / CO

% of weight?
% of cardiac output?
ml per minute required for brain?

A

2% weight
20% cardiac output
Needs 750mls cerebral blood flow per minute, extracts 40% of oxygen from arterial bed

33
Q

Seizures thought to result from…?

A

Abnormal hyperactive neurons that form an epilogenic focus

Abnormal and excessive discharge of AP’s
These stimulate contractions in skeletal muscle
Subside due to a lack of neurotransmitter in the synapse

34
Q

Causes - previously discussed?

A 
Structural
Infectious
Metabolism
Immune
Unknown
Brain damage 
Stroke
Malnutrition - protein, 
Alcohol - 
Pre-natal or perinatal causes
Pyrexia - high temperature
Hyperglycaemia - glucose
Hyponatraemia (sodium)
Hypocalcaemia - calcium req. for AP
Diarrhoea & Vomitting - potassium loss
Eclampsia - blood pressure on brain tissue
Pregnancy - circulatory volume increases, BP falls
35
Q

Seizure threshold - causes:

A

Genetically determined - parents

36
Q

Why so serious?

1000 die each year in England

A

Cerebral oxygen consumption can increase by up to 60% - more ATP

seizures cause metabolic requirements to increase, resulting in elevation of cerebral blood flow and cerebral blood volume

supply demand abnormality - need more oxygen but get less - > hypoxia

Need oxygen - BUT

oxygen and glucose consumption by skeletal muscle

Apnoea - temporary ceasing of breathing

Problems with
hypoxemia - low levels of oxygen in the blood
hypercapnia - elevated co2 in the blood
hypoglycaemia - low blood sugar

seizures cause metabolic requirements to increase, resulting in elevation of cerebral blood flow and cerebral blood volume

hypoxia -> acidosis

lactate 0.5-1:1,3,5,10
blood pH - 6.8= death irreversible neuronal destruction

cell death & lyosomal activation

37
Q

Diagnosis & Tests

A

Family history - type, cause, duration, previous treatments, current status

Physical examination - neurological deficits associated with recent or remote lesions

Diagnostic tests:
- EEG - electrical activity
- MRI - small lesions and scars
- CT or CAT - structure
- Ambulatory EEG (24-48 hours)
Video telemetry - video + EEG
PET Scan - glucose usage
38
Q

EEG Wave types

A

Alpha - Resting state, here and now
Theta -
Alpha - Bridge between conscious and subconscious
Beta - conscious states, reading thinking calculating
Gamma - conscentration complex tasks

39
Q

Assessment

A

Monitor through ABCDE approach

Looking for the cause

Prevent additional seizures

Provide safe environment

ABCDE:

Assess for safety, early call for help, PPE
Introduce yourself

A - Look listen and feel: Airway occlusion, tongue biting or thrusting, excessive saliva, don’t touch
B - Look listen and feel - respiratory distress, apnoea, cyanosis, high flow oxygen

rate depth cough conversation, accessory muscles, cyanosis, gurgling wheezing stridor, equal chest expansion?

C - Work way up the arm - capillary refill, cardiovascular instability due to hypoxia, bladder and bowel incontinence,
D - glucose and level of consciousness ACVPU - unconscious? GI symptoms, abnormal movements, glucose could go down
E - warm, privacy and dignity, fractures rashes or bleeding, after seizures, place in recovery position

40
Q

ACVPU

A

A
V
P
U

Pathophysiology of ill-health (16 decks)

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