Epilepsy COPY Flashcards
What is epilepsy
neurological disorder characterised by recurrent seizures
What are seizures
A seizure is defined as a paroxysmal alteration of neurological function as a result of excessive, hypersynchronous discharge of neurons within the brain
What causes a seizure
imbalance between excitation and inhibition within the neurons of the brain.
What is the imbalance between
- GABA -VE
- GLUTAMATE +VE
Inherited risk factors of epilepsy
- premature birth
- brain development malformation
- fx
- av malformation
Acquired risk factors
- febrile convulsions
- brain tumor
- traumatic brain injury
What can trigger a seizure
- Non-adherence with anti-epileptic -drugs (AEDs)
- Fatigue
- Stress
- Alcohol or recreational drugs
- Flashing lights
How are seizures classified
1-Where the seizures began
2-Level of awareness during the seizure
3-Other features of the seizure e.g. motor
Pre - ictal phase features ?
- triggers such as alcohol
- aura - subjective feeling of warning pre- seizure
- mood changes
- anxiety
- difficulty sleeping
- feeling that your gonna have a seizure b4 you have it not everyone has it
what to investigate during the Ictal stage ? 6
- length of seizure
- appearance
- progression
- consciousness
- injury
- urinary incontinence
What would jerking suggest
tonic clonic
What occurs in a tonic clonic seizure
- no aura
- rigidity, fall to floor
- clonic phase , jerking phase
- eyes open
- incontinence
- tongue biting
What is myoclonic
Some or all of the body suddenly twitches. Usually lasts less than a second
Muscle twitching and spasming
What is a behavioural arrest seizure and what does it suggest?
A type of focal non-motor seizure characterized by an arrest or pause of activities, freezing, or immobilization as the predominant semiological feature throughout the seizure
Arrest seizure? IDK Maryam’s retarded
What is atonic
Sudden loss of muscle strength. Can cause a person to drop to the ground
What occurs during an abscence seizure
- childhood moments of staring blankly into space
- 3hz spike on ecg
what to investigate in the post - ictal symptoms 5
post ictal symptoms:
- drowsiness
- headaches
- amnesia
- dysphagia
- sore tongue
Where can seizures originate?
- Focal: originates within one side of the brain
- Generalised: involve both hemispheres of the brain at onset
- Focal to bilateral: previously termed ‘secondary generalised’, the seizure starts on one side of the brain and spreads to both sides
- Unknown: difficult to determine in some cases
What is the most common location of focal seizures
temporal lobe
Temporal lobe focal seizure features
- oral automatis , lip smacking, chewing
- manual automatism - picking, fumbling
- auras - deja vu, unpleasant smells
frontal lobe features of a focal seizure
- sexual automatism
- predominantly motor symptoms
- bizarre behavior
occipital focal seizure features
- vision loss
Initial investigations
Bedside
- Urinalysis: nitrites or leucocytes would suggest infection
- Capillary blood glucose: to exclude hypoglycaemia
- ECG: to exclude differentials such as cardiogenic syncope
Bloods
- FBC
- Inflammatory markers
- U&E,bone profile , mg2+
Imaging for a seizure
ct head - to exclude intracranial causes such as haemorrhage
Diagnosis for epilepsy must involve?
must have had 2 or more seizures withins 24hr periodq
Conservative management
- education
- stop driving
medical management ?
- anti epileptic drugs
- sodium valproate for general epilepsy
- lamotrogine for focal seizures
who cant have sodium valproate
except females of child bearing age
mechanism of sodium valproate
- increases conc of GABA
Acute complications
- Injury
- Tongue biting
- Shoulder dislocation: usually posterior
- Status epilepticus: state of prolonged seizure activity >5 minutes
Three types of focal seizures
- Complex- with impairment of consciousness
- Simple- no impairment of consciousness
- Secondary generalised - focal to bilateral
first line tx for focal seizures
Lamatrogine or levetiracetam
1st line for tonic clonic focal
What seizures have sodium valproate as first line tx
Abscence (No its ethosuximide for absence)
Generalised - tonic-clonic
myoclonic
Complications of epilepsy
- Status epilepticus - >5 minutes of continuous seizures
- Depression
- Suicide
- Sudden unexpected death in epilepsy (SUDEP)
what medication may worsen myoclonic seizures
carbamezepine
asynchronous limb movements, trunk movements and eyes being closed would suggest ?
dissociative seizure
Side effects of lamotrigine
- blurred vision
- agitation
- diplodopia
- rash
- tremor
’ crazy movements’ sudden jerking of a limb , trunk or face with preserved consciousness would indicate
Myoclonic seizure
jacksonian march ?
Seizure starts in one group but can then move to another
Classic to focal motor seizures
