Epilepsy And Tremor Flashcards
Features of essential tremor
Fine tremor Symmetrical More prominent on voluntary movement Worse when tired, stressed or after caffeine Improved by alcohol Absent during sleep
Differentials for tremor
Parkinson’s disease Multiple sclerosis Huntington’s chorea Hyperthyroidism Fever Medication - antipsychotics Essential tremor
Management of essential tremor
Propranolol
Primidone - barbiturate anti - epileptic medication
Seizure definition
Transient episodes of abnormal electrical activity in the brain
Investigations for epilepsy
EEG
MRI brain - tumours
Haematinics
Types of seizures
Generalised tonic clinic seizures Focal seizures Absence seizures Atonic seizures Myoclonic seizures Infantile spasms
Generalised tonic clonic seizures
Loss of consciousness
Tonic - muscle tensing
Clonic - muscle jerking
Tongue biting Incontinence Groaning Irregular breathing Post-ictal period
Post ictal period
Time after the seizure where the person is confused, drowsy and feels irritable or depressed
History of seizure
Before, during after
SOCRATES - onset, character, relieving factors, aggravating factors, time and duration
Symptoms:
- tongue biting
- incontinence
- loss of consciousness
- fever
- de ja vu
- hallucinations
Management of tonic clonic seizures
First line - sodium valproate
Second line - lamotrigine or carbamazepine
Focal seizures
Start in the temporal lobe, affecting hearing, speech, memory and emotions
Focal seizure presentation
Hallucinations
De ja vu
Flashbacks
Auto pilot
Management of focal seizures
First line: carbamazepine or lamotrigine
Second line: sodium valproate or levetiracetam
Absence seizures features
Typically children
Patient becomes blank and stares into space then abruptly returns to normal
Unaware of surroundings and won’t respond
How to initiate an absence seizure
Get child to blow tissue paper repeatedly
Management of absence seizures
Sodium valproate
Or ethosuximide
Atonic seizures features
Drop attacks - brief lapses in muscle tone
Less than 3 minute episodes
Which condition is atonic seizures associated with?
Lennox- Gastaut syndrome
Management of atonic seizures
First line: sodium valproate
Second line: lamotrigine
Features of myoclonic seizures
Sudden brief muscle contractions like a sudden jump
Usually awake
Normally in children as juvenile myoclonic epilepsy
Treatment of myoclonic seizures
First line: sodium valproate
Second line: lamotrigine, levetiracetam or topiramate
Infantile spasm features
West syndrome - clusters of full body spasms
Poor prognosis
Treatment of West syndrome
Prednisolone
Vigabatrin
Sodium valproate
GABA agonist
Side effects of sodium valproate
Teratogenic
Liver damage and hepatitis
Hair loss
Tremor
Side effects of carbamazepine
Agranulocytosis
Aplastic anaemia
Induces P450
Phenytoin side effects
Folate and vitamin D deficiency
Megaloblastic anaemia
Osteomalacia
Ethosuximide side effects
Night terrors
Rashes
Lamotrigine side effects
Steven Johnson’s syndrome
Leukopenia
When to admit a seizure
Lasting more than 5 minutes ore more than 3 seizures in 1 hour
Status epilepticus
When seizure persists for > 5 mins
Medical emergency
Status Epilepticus management
A-E
- secure airway
- high concentration oxygen 15L
- check blood glucose levels
- IV lorazepam 4mg repeated after 10 minutes if seizure continues
- if persists - phenobarbital or phenytoin
Medications in the community for status epilepticus
Buccal Midazolam
Rectal diazepam
