Epilepsy and Seizure Flashcards
Statistics about epilepsy
Prevalence
Duration
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
Relevance (stats - 3-4 lines)
Specific to MH?
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
Definition
Seizure vs Epilepsy
Epilepsy is a disease characterised by recurrent, unprovoked seizures (ILAE)
associated with abnormal electrical activity in the brain
Classification of Seizures:
How are they grouped?
Who introduced this?
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.
Myoclonus
Jerking arrhythmically
Clonus
Jerking rhythmically
Atonic
Limp
Tonic
extension or flexion postures
Spasm
Trunk flexion
Hyperkinetic
thrashing / pedalling
Word Changes! (due to 2017 ILAE)
Partial
Simple Partial
Complex partial
Dyscognitive
Partial-> Focal
Simple Partial-> Focal aware
Complex partial-> focal impaired awareness
Dyscognitive -> focal impaired awareness
Onset types ?
Focal onset
Generalised onset
Unknown onset - idiopathic
Focal Seizures - what are they?
What is another type of focal seizure?
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)
Generalised Seizures - what are they?
Where is affected?
Originate at some point within and rapidly engaged bilaterally distributed networks
Can include cortical and sub-cortical structures but not necessarily entire brain complex
Aetiology of seizures:
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
Name some Common Co-morbities
% of children with epilepsy who also have MH problems?
ADHD
LD
ASD
59% of children with epilepsy also have MH problems
Tuberous Sclerosis - what is it?
Complex, rare genetic condition that causes mainly benign tumours to develop - structural, metabolic, genetic.
Focal Aware Seizure
- Previously named?
- Clinical presentation?
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.
Focal Impaired Awareness Seizure (FIAS)
- Previously named?
- Clinical presentation?
- Particular location?
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
Focal seizures - examples of motor symptoms?
Lip-smacking Atonic Stiffness of limbs Jerking Screaming Crying
Focal seizures - examples of non-motor symptoms?
deja vu
Unusual sensations
Intense emotions
Hallucinations
Focal to bilateral tonic clonic
- Previously named?
- Clinical presentation?
AKA secondary generalised seizure
tonic-clonic - convulsive or shaking seizure
If this happens quickly, they may not be aware that it began as focal
Generalised onset seizures
- Clinical presentation?
- Location?
Both hemispheres
Unconscious except myoclonic seizures
Won’t remember
Tonic-clonic
Clinical presentation:
- Pre
- During
- Post
Pre:
Unsconscious Stiffness Fall down Cry Bite tongue
During:
Jerk and Shake
Breathing difficulties,
Cyanosis
Incontinence
After:
Tired, confused, headache, want to sleep
Clonic Seizures
- Clinical presentation?
- Location?
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)
Tonic
Atonic
What happens? Post?
Tonic - stiff, fall backwards, brief seizure
Atonic - drop attack - muscles suddenly relax
Quick recovery usually unless collapse caused trauma
Myclonic seizures
What are they?
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
Absence Seizure
- Previously named?
- Clinical presentation?
Atypical absence - e.g.?
Previously petit mal
Unresponsive blank
Appears to be daydreaming
If walking, may continue
Atypical - includes change in muscle tone
Types of epilepsy
give a few examples
Status Epilepticus
Most seizures less than 5 minutes,
SE is 30 minutes +, life threatening
Others - catamenial or photosensitive epilepsy
Pathophysiology
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
What would you see on an EEG?
Abnormal with spikes of electrical activity
Brain - weight / CO
% of weight?
% of cardiac output?
ml per minute required for brain?
2% weight
20% cardiac output
Needs 750mls cerebral blood flow per minute, extracts 40% of oxygen from arterial bed
Seizures thought to result from…?
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
Causes - previously discussed?
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
Seizure threshold - causes:
Genetically determined - parents
Why so serious?
1000 die each year in England
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
Diagnosis & Tests
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
EEG Wave types
Alpha - Resting state, here and now
Theta -
Alpha - Bridge between conscious and subconscious
Beta - conscious states, reading thinking calculating
Gamma - conscentration complex tasks
Assessment
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
ACVPU
A
V
P
U
