Epilepsy and seizures Flashcards
what is a seizure?
short episode of symptoms caused by burst of abnormal electrical activity in the brain
what is epilepsy?
ongoing liability to recurrent seizures
focal cf generalised seizures?
focal: abnormal electrical activity in one part of brain only
generalised: affects both hemispheres, awareness always impaired
T/F: focal seizures can sometimes progress to secondary generalised seizures
true
some patients develop auras before a seizure which can take various forms including…
deja-vu, change in smell, vision or taste
why is it important to ask patients about auras
auras are regarded as focal aware seizures- would help you decide whether they’re fit to be driving
focal aware seizures are aka as __ __ seizures
simple focal seizures
in focal aware seizures, symptoms depend on the anatomical localisation
1) frontal lobe
2) parietal lobe
3) occipital lobe
4) temporal lobe
1) predominantly motor signs: stiffness, twitching, spasm. Jacksonian march: focal seizure spreads from distal part of limb towards ipsilateral face
2) sensory manifestations: tingling, numbness, pain
3) visual phenomena: flashing lights, colours, hallucinations
4) changes in mood or behaviour. Rising epigastric sensation common
focal impaired awareness seizures mainly arise from the ___ lobe
temporal
mesial temporal lobe epilepsy
1) most common cause?
2) typically associated with what type of seizures?
1) hippocampal sclerosis
2) complex focal seizures
In a complex focal seizure it may be possible to identify which three distinct components?
1) aura
2) absence (LOC)
3) automatism
T/F: following a complex focal seizure the patient is usually total amnesic for the events of the automatism
true
what is an automatism?
repetitive stereotyped movement e.g. lip smacking, chewing, fiddling, walking, whilsting
T/F: following a complex focal seizure some patients can develop postictal confusion
true
name 5 subtypes of generalised seizure
absence myoclonic clonic tonic tonic-clonic
describe absence seizures
abrupt LOC and cessation of all motor activity
T/F: absence seizures are typically associated with an episode of falling
false - tone is usually preserved and there is no fall
how long do absence seizures typically last?
= 10s
absence seizures usually develop when in life?
childhood/ adolescence
typical EEG appearance of absence seizures?
3Hz generalised spike-wave
describe myoclonic seizures
brief contraction of a muscle, muscle group of several muscle groups > small twitch/ severe jerk
juvenile myoclonic epilepsy
1) is a subtype of idiopathic ___ epilepsy
2) characteristic seizure?
3) develops between the ages of __ and __
4) in most cases what kind of seizures also occur?
5) good or poor response to treatment?
1) generalised
2) brief myoclnoic jerks, usually occurring in first hour or so after awakening. Sudden shock-like jerks affecting mainly the shoulders and arms
3) 12-18
4) generalised tonic-clonic (usually months or years after onset of myoclonus)
5) complete response to treatment in 80-90%, but lifelong therapy may be needed
describe a clonic seizure
muscle begin to jerk and spasm. Elbows, legs and head flex and relax rapidly
clonic seizures are most frequent in what age group?
neonates and infants
most common form of generalised seizures?
tonic-clonic
describe tonic-clonic seizures
tonic phase: quick LOC, skeletal muscles become stiff
clonic phase: rapid contraction-relaxation of muscles. Tongue may be bitten from strong jaw contractions. In some cases may have cyanosis and incontinence.
T/F: EEG is the diagnostic test of choice for epilepsy
false- Epilepsy is clinically diagnosed
EEG may be normal in some patients with epilepsy
EEG only used to support diagnosis and help determine seizure type/ epileptic syndrome
T/F: neuroimaging is not routinely requested to diagnose epilepsy
true
Principles of anti-epileptic drug treatment
1) first establish…
2) use MONOTHERAPY/ POLYTHERAPY
3) re titration of doses?
4) when is polytherapy generally used?
1) epilepsy diagnosis and subtype
2) monotherapy: one drug at a time
3) start low, go slow
4) if monotherapy with at least 3 first choice drugs has failed to control seizures
First line therapy in adults for
1) tonic clonic seizure
2) absence seizure
3) myoclonic seizure
4) focal seizures
5) unclassified
1) sodium valproate (lamotrigine if unsuitable)
2) ethosuximide (it SUX to miss out), sodium valproate
3) sodium valproate
4) lamotrigine, carbamazepine (have to FOCUS in a car)
5) sodium valproate
Second line therapy in adults for
1) tonic clonic seizure
2) myoclonic seizure
3) unclassified
1) levitiracetam, topiramate, clobazam
2) levitiracetam
3) lamotrigine, topiramate
which anti-epileptics are teratogenic?
sodium valproate (NTD)
phenytoin (clef palate)
carbamazepine
which anti-epileptic can cause a rash and Stevens-johnson syndrome?
lamotrigine
which anti-epileptic is used in pregnancy because its not teratogenic?
lamotrigine
which anti-epileptic may exacerbate myoclonic seizures?
lamotrigine
define status epilepticus
convulsive seizure which continues >5 minutes or occur one after the other with no recovery between
1st line treatment for status epilepticus
1) in the community?
2) in hospital?
3) what is 2nd line if seizures continue?
1) buccal/ rectal midazolam
2) IV lorazepam
3) IV phenytoin/ phenobarbital
DVLA regulations group 1 vehicles (car, motorcycle)
1) if seizure occurs when awake
2) if seizure occurs when asleep
3) if seizure occurs when awake but doesn’t affect consciousness
1) stop driving 1 year
2) can drive if no awake attack for 3 years
3) may drive if its the only type of attack you’ve ever had and the first one was 12 months ago
DVLA regulations group 2 vehicles (bus, lorry)
1) one off seizure
2) more than one seizure/ diagnosis of epilepsy
1) stop driving for 5 years
2) must be seizure and medication free for 10 years
describe a tonic seizure
brief LOC, patient falls to ground and often there is extension of the neck with upturning of the eyes and arching of the back
what neuroimaging is the modality of choice in some cases of epilepsy? when would this be indicated?
MRI is modality of choice when needed- particularly imp if epilepsy onset <2 y/o with any suggestion of focal onset and/or who don’t respond to 1st line treatments
