Epilepsy and Seizures Flashcards
what is syncope?
temporary loss of consciousness caused by a fall in blood pressure.
- a simple faint
what is a hypoxic seizure?
when the brain is deprived of oxygen and causes the person to lose consciousness
what is a concussive seizure ?
when someone experiences trauma to their head
- for example, RTA and contact sports
give some examples of differential diagnoses for a blackout?
syncope first seizure hypoxic seizure concussive seizure cardiac arrhythmia non-epileptic attack
in what age range are cardiac arrhythmias more common?
more common in older people
whats two important things to do to get a good idea of whats happened during the seizure ?
detailed history from patient
detailed history from witnesses
what questions would you ask the patient about their seizure ?
- did you have any warning signs?
- what happened before the incident?
- did you have any injuries?
- what were you doing at the time ?
- has anything like this happened in the past?
- how did you feel afterwards
what sort of questions would you ask the witness about the seizure?
- what were the patterns of movements ?
- what was the colour of the person?
- what was the person doing before hand
- how fast did the seizure last?
- how long until the person came back around and start speaking
what other information about the patient who has had a seizure ?
age sex PMH past psychiatric history alcohol and drug abuse family history
what gender are black outs more common in?
females
what is the most common cause of fainting?
vasovagal syncope
what are the warning symptoms of syncope?
- light headed
- nausea
- hot
- sweating
- ringing in ears
- tunnel vision
what are some causes of vasovagal syncope?
prolonged standing standing up quickly trauma watching/experiencing medical procedures eg. venipuncture micturition coughing
what posture is the person when they have a syncope attack ?
upright posture
- as less blood is getting to the brain
what posture is the person when they have a seizure?
any posture
does a person turn pale when they have a syncope attack ?
yes
are there warning signs with syncope?
yes
are there warning signs with a seizure?
no
- usually sudden onset
do people who have seizures turn pale?
no
is injury common with syncope?
no
- usually rare to be injured
is the recovery time for syncope faster compared to a seizure ?
yes
- usually recover fast unless they stand up quickly
do people who have seizures recover fast?
no
- they have a slow recovery
is incontinence common with people who have syncope attack?
incontinence is rare
what position should someone who has had a syncope attack be placed in to recover?
lie down with their legs up
where are common places for people to have hypoxic seizures ?
air planes
dentist
what can occur if the person who has had a hypoxic seizure stands up too quick?
they can have another seizure as not enough blood can get to the brain
state a functional cardiac problem which can cause black outs?
long QT syndrome
what is the appearance of non-epileptic attacks?
May look bizarre
Can be prolonged
what can a cause of non-epileptic seizures be?
history of abuse
- domestic
- sexual
are non-epileptic attacks more common in females or males?
females
describe what a generalised tonic-clonic seizure looks like
when the person goes stiff (tonic) then jerks (clonic)
the jerks are synchronise
are non-epileptic attack patients given anti-epileptics?
no
state some bizarre movements people with non-epileptic attacks may do?
- thrust their hips in a history of sexual abuse
- wipe the work top surface in a kitchen
- touch the cooker
- walk about
what investigations should be done if someone has their first seizure ? (4)
Blood sugar
ECG
Alcohol/drug in body
CT head (if someone isn’t waking up)
when the patient is about to be discharged after their first seizure what advice should be given to them? (4)
- safety information sheets
- check if their employment is affected
- check if they are still allowed to drive
- explain the driving regulations
if someone has their first seizure and their test results are normal. Are they allowed to drive?
no
- they can’t drive for 6 months
if someone has their first seizure and their test results are abnormal or due to alcohol. Are they allowed to drive?
no
- they can’t drive for a year
if someone who drives a HGV or PSV has their first seizure and their test results are normal. Are they allowed to drive?
no
- they can’t drive for 5 years and can’t be on anti-epileptic medication
if a child has minor jerks then when they turn 11yrs they have a seizure. Is it likely they have epilepsy?
yes
what are the two main types of epilepsy?
primary generalised epilepsy
focal onset epilepsy
describe some characteristics of primary generalised epilepsy
History of myoclonic jerks, especially first thing in the morning
Absences or feeling strange with flickering lights
give an example of myoclonic jerks?
hypnic jerks
state some characteristics of focal onset epilepsy
History of “deja vu”
Rising sensation from abdomen
Episodes of looking blank with lip-smacking
Fiddling with clothes
define epilepsy
Epilepsy is a condition in which seizures recur, usually spontaneously
define epileptic seizure
epileptic seizure is an intermittant stereotyped disturbance of consciousness, behaviour, emotion, motor function or sensation which, on clinical grounds, is believed to result from abnormal neuronal discharges
what is the incidence of epilepsy per 100,000?
50-120
who are most affected by epilepsy?
children and older people (cardiac problems)
what percentage of people with learning difficulties will have epilepsy?
22%
what organisation have classified epileptic seizures into different groups?
International League Against Epilepsy (ILAE)
what are absence seizures ?
day dreaming almost
what are atonic seizures ?
losing all muscle tone and falling to the ground like a puppet
what are tonic jerks ?
stiffening
comparing focal onset and generalised seizures. which seizures do you loose consciousness?
generalised seizures
what age is most affected by primary generalised epilepsy?
<25 yrs, usually diagnosed earlier as they are due to brain function
what age is most affected by focal epilepsy?
any age, the cause can be any focal brain abnormality such as stroke, brain tumour
what abnormality will the EEG have for primary generalised and focal epilepsy?
primary generalised = generalised abnormality
focal = focal abnormality
which type of epilepsy will show warning signs?
focal epilepsy
why can epilepsy in people with learning difficulties be difficult?
they can have behavioural repetitive movements which can be stereotypical of epilepsy
when testing for epilepsy, what there things can be done to the patient to try stimulate epilepsy?
- hyperventilation
- photic stimulation
- sleep deprivation
what drug is used for absence seizures ?
ethosuximide
what drugs are used for primary generalised epilepsies ?
Lamotrigine
Levetiracetam
what epileptic drug is very effective but can cause learning problems in babies ?
sodium valproate
what drugs are used for focal seizures?
Lamotrigine
Carbamazepine
what two drugs can be used first line for status epilepticus?
Lorazepam
Midazolam
what are the side effects of sodium valproate ?
tremor weight gain ataxia nausea drowsiness transient hair loss pancreatitis hepatitis
what are the side effects of carbamazepine
ataxia drowsiness nystagmus blurred vision skin rash low serum sodium level
what are the side effects of lamotrigine
skin rash
difficulty sleeping
what are the side effects of levetiracetam
irritability
depression
what are the side effects of topiramate
weight loss
nearly aphasic
tingling hands and feet
what are the side effects of zonisamide
bowel upset
cognitive problems
what are the side effects of lacosamide
dizziness
what are the side effects of pregabilin
weight gain
what are the side effects of vigabatrin
behavioural problems
visual field defects
when can epileptic patients have a driving license ?
- seizure free for a year
- established pattern of sleep only related attacks for a year
when can an epileptic patient hold a HGV or PSV license ?
seizure free for 10 years and not be on anti epileptic drugs
what is status epilepticus?
Prolonged or recurrent tonic-clonic seizures persisting for more than 30 minutes with no recovery period between seizures
is epilepsy a risk factor for status epilepticus ?
no
what is the mortality rate for status epilepticus ?
5-10%
what three drugs can be used first line to treat recurrent tonic-clonic seizures (TCSE)?
midazolam
lorazepam
diazepam
what three drugs can be used second line to treat recurrent tonic-clonic seizures (TCSE)?
phenytoin
valproate
what three drugs can be used third line to treat recurrent tonic-clonic seizures (TCSE)?
anaesthesia
what is the main cause of death following TCSE?
from the underlying cause of the TCSE
- metabolic problem
- congenital malformations
what age ranges have the highest mortality following TCSE ?
very young and very old
