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2a neuro > Epilepsy and seizures > Flashcards

Epilepsy and seizures Flashcards

1
Q

Define epilepsy

A

Idiopathic recurrent tendency to have seizures, chronic disorder (minimum of 2 more than 24 hrs apart)

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2
Q

Define seizures

A

Spontaneous, intermittent, uncontrolled electrical brain activity

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3
Q

Define prodrome

A

Nonspecific symptoms that precede an epileptic attack

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4
Q

Define aura

A
  • Sensory disturbances that precede an attack, usually by minutes
  • More specific
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5
Q

Define ictus

A

The epilepsy attack

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6
Q

Describe the pathophysiology of epilepsy

A

Normal balance between GABA (-) and glutamate (+) shifts towards glutamate
- More excitatory, glutamate stimulation increased, GABA inhibition

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7
Q

What is the epidemiology of epilepsy?

A
  • Common
  • Age dependent: Highest below 20 and after 60
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8
Q

What are the risk factors of epilepsy?

A
  • Familial inherited
  • Dementia (10x more likely)
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9
Q

What are causes of seizures?

A

VITAMIN DE

Vascular
Infection
Trauma
Autoimmune
Metabolic (eg hypocalcaemia)
IDIOPATHIC
Neoplasms
Dementia + drugs (cocaine)
Eclampsia

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10
Q

How long do epileptic seizures last?

A

Under 2 minutes

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11
Q

Describe the lead up to an epileptic seizure and afterwards

A
  1. Prodrome - mood change, days before
  2. Aura - minutes before, deja vu + automatisms (lip smacking, rapid blinking), not always present, mostly seen in temporal lobe epilepsy
  3. Ictal event - seizure
  4. Post ictal period
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12
Q

What symptoms are seen in the post ictal period in epilepsy?

A
  • headache
  • confusion, reduced GCS
  • Todd’s paralysis - if motor cortex affected, may have temporary paralysis + muscle weakness
  • Dysphasia
  • Amnesia
  • SORE TONGUE - only in epileptic seizures (often bitten) not in syncope
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13
Q

What are the 2 main types of seizures?

A

Primary generalised + Partial/focal seizures

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14
Q

Describe features of generalised seizures

A
  • Generalised – 30-40%
  • Originates in the midbrain or brainstem
  • Electrical discharge in both hemispheres (bilateral)
  • Associated with LOC or awareness

(can be anywhere in the brain)

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15
Q

Describe features of partial/focal seizures

A
  • Partial/focal – 60-70%
  • Focal onset, electrical discharge is restricted to one area of the brain
  • May develop into generalised (secondary)

(only in one specific area)

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16
Q

What are 2 further types of generalised seizures?

A
  • Tonic-clonic (grand-mal)
  • Absence (petit-mal)
17
Q

Describe tonic-clonic seizures

A
  • Often no aura
  • Tonic phase (10-60 secs) – Rigid, fall to the floor, tongue biting, incontinence, no breathing during this phase
  • Clonic phase (seconds-minutes) – Convulsions, limb jerking, eye rolling, uncoordinated breathing
  • These seizures are usually self-limiting
  • Physical injuries are common, drowsy, confused, headache
18
Q

Describe absence seizures

A
  • Childhood onset
  • Moments of staring blankly into space (secs-mins) then carrying on where they left off
  • Can occur many times a day and be debilitating
  • Conscious but unresponsive
  • Normal function resolves quickly
  • 3Hz spike on EEG
19
Q

What are the 3 features of generalised seizures?

A
  • Tonic
  • Myoclonic
  • Atonic
20
Q

Define tonic

A

Just rigid
- Sudden increased tone, rigid
- No jerking

21
Q

Define myoclonic

A

Just jerking limbs
- Sudden isolated jerk of a limb, face, trunk
- May fall suddenly to the ground

22
Q

Define atonic

A

Sudden floppy limbs + muscles
- Sudden loss of muscle tone + movement
- Resulting in a fall

23
Q

Describe the further types of focal/partial seizures

A
  • Simple
  • Complex
  • Secondary generalised
24
Q

Describe simple partial seizures

A
  • NO loss of consciousness or memory
  • Isolated limb jerking
  • Head turning (away from side of the seizure)
  • Isolated paresthesia
  • Todd’s paralysis – temporary paralysis/weakness
25
Q

Describe complex partial seizures

A
  • Most commonly from temporal lobe
  • Can have LOC
  • Can affect awareness/memory before, during or after
  • Visual/auditory hallucinations
  • Lip smacking
  • Automatism
  • Post ictal confusion/drowsiness is common
  • Symptoms depend on lobe involved
26
Q

Describe secondary generalised seizures

A
  • Partial seizures that spread to lower brain areas, which initiates a generalised seizures
  • Usually tonic-clonic
27
Q

What are symptoms of seizures that suggests temporal lobe?

A

Aura, dysphasia, post ictal period

28
Q

What are symptoms of seizures that suggests frontal lobe?

A

Jacksonian march + Todd’s palsy

29
Q

What are symptoms of seizures that suggests parietal lobe?

A

Paraesthesia

30
Q

What are symptoms of seizures that suggests occipital lobe?

A

Vision changes

31
Q

How do you diagnose epilepsy?

A

Must have 2 or more that are 24+hrs apart

32
Q

What investigations do you do for epilepsy?

A
  • EEG
  • MRI/CT
  • Bloods – FBC, U&Es, LFTs, BM (to look for a potential cause, infection)
33
Q

What is seen on EEG for epilepsy?

A
  • 3H2 wave in absence seizures
  • Not diagnostic
  • Support diagnosis, can determine type of epilepsy
  • May be falsely negative
34
Q

What is seen on CT/MRI for epilepsy?

A
  • examine hippocampus
  • can show focal lesions to identify cause
35
Q

What is the treatment for epilepsy?

A
  • Sodium valproate to all types
    EXCEPT females of childbearing age (15-45) as it’s teratogenic
  • Instead give lamotrigine
36
Q

What is a complication of epilepsy?

A

Status epilepticus
NEURO EMERGENCY

37
Q

What is status epilepticus?

A
  • Seizure which lasts longer than 5 minutes or more than one seizure within 5 minutes (without returning to normal consciousness between) - Can lead to permanent brain damage and death
38
Q

How do you treat status epilepticus?

A

Benzodiazepines –> LORAZEPAM 4mgIV
If doesn’t work phenobarbital then phenytoin

2a neuro (33 decks)

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