Epilepsy (First Seizure) Flashcards
How do you differentiate between epilepsy with syncope with regards to: [6]
* Clinical presentation
* Onset
* Post-event symptoms
* Triggers
* Associated movements
* Investigations
Clinical Presentation:
- Syncope often presents with a sudden loss of consciousness due to transient global cerebral hypoperfusion. Patients may experience prodromal symptoms such as lightheadedness, palpitations, or visual disturbances.
Onset:
- Typically, syncope has a rapid onset and short duration, usually less than one minute.
Post-event Symptoms:
- Patients usually recover quickly and do not experience post-ictal confusion or prolonged drowsiness, unlike epilepsy.
Triggers:
- Common triggers include standing up quickly, emotional stress, or pain. Positional changes often play a significant role.
Associated Movements:
- Jerky movements can occur during syncope, but they are usually brief and less pronounced compared to epileptic seizures.
Investigations:
- Cardiovascular examination, tilt-table testing, and ECG are essential for identifying underlying cardiac causes.
How do you differentiate between epilepsy with PNES with regards to: [6]
* Clinical presentation
* Onset
* Post-event symptoms
* Triggers
* Associated movements
* Investigations
Clinical Presentation:
- PNES are events resembling epileptic seizures but are of psychological origin. Patients may display a variety of motor, sensory, or behavioural phenomena.
Onset:
- often gradual, with a duration that can be longer than typical epileptic seizures.
Post-event Symptoms:
- Post-ictal confusion is uncommon. Patients may exhibit emotional distress or recall the events during the episode.
Triggers:
- PNES can be triggered by stress, emotional trauma, or psychological conflict.
- They often occur in the presence of an audience.
Associated Movements:
- Movements are typically more variable and may include side-to-side head movements, asynchronous thrashing, or pelvic thrusting, which are uncommon in epileptic seizures.
Investigations:
- Video-EEG monitoring is crucial for differentiating PNES from epilepsy by capturing typical episodes and correlating them with EEG findings.
How do you differentiate between epilepsy with alcohol withdrawal seizures with regards to: [6]
* Clinical presentation
* Onset
* Post-event symptoms
* Triggers
* Associated movements
* Investigations
Clinical Presentation:
- Alcohol withdrawal seizures occur in individuals with a history of chronic alcohol use who abruptly reduce or stop their alcohol intake. They usually present with generalised tonic-clonic seizures.
Onset:
- These seizures typically occur within 6 to 48 hours after the last drink.
Post-event Symptoms: Post-ictal confusion and drowsiness can occur, similar to epileptic seizures.
Triggers:
- The primary trigger is the cessation or significant reduction of alcohol consumption.
Associated Movements:
- Movements are generally typical of tonic-clonic seizures, with no distinguishing features from other generalised seizures.
Investigations:
- Detailed history of alcohol use is crucial. Blood tests may reveal signs of chronic alcohol use, such as elevated liver enzymes and macrocytosis.
How do you differentiate between epilepsy with seizures secondary to Metabolic/Toxic Disturbance
with regards to: [6]
* Clinical presentation
* Onset
* Post-event symptoms
* Triggers
* Associated movements
* Investigations
Clinical Presentation:
- Seizures secondary to metabolic or toxic disturbances can present similarly to epileptic seizures, including generalised tonic-clonic seizures or focal seizures with secondary generalisation.
Onset
- The onset is usually acute and linked to the underlying metabolic or toxic cause.
Post-event Symptoms:
- Post-ictal symptoms may include confusion and drowsiness, depending on the severity and duration of the seizure.
Triggers: Common triggers include electrolyte imbalances (e.g., hyponatraemia, hypoglycaemia), renal or hepatic failure, drug toxicity, and withdrawal from certain medications or substances.
Associated Movements:
- Seizure movements do not differ significantly from those of primary epileptic seizures.
Investigations:
- Comprehensive metabolic panel, toxicology screen, and assessment of renal and hepatic function are critical for identifying the underlying cause.
When do you start antiepileptic drugs? [1]
Most neurologists now start antiepileptics following a second epileptic seizure.
Most neurologists now start antiepileptics following a second epileptic seizure. NICE guidelines suggest starting antiepileptics after the first seizure if any of the following are present ? [4]
- the patient has a neurological deficit
- brain imaging shows a structural abnormality
- the EEG shows unequivocal epileptic activity
- the patient or their family or carers consider the risk of having a further seizure unacceptable
It is useful when thinking about the management of epilepsy to consider certain groups of patients.
Which patients are have special considerations and how do you manage these? [3]
patients who drive:
- generally patients cannot drive for 6 months following a seizure.
- For patients with established epilepsy they must be fit free for 12 months before being able to drive
patients taking other medications:
- antiepileptics can induce/inhibit the P450 system resulting in varied metabolism of other medications, for example warfarin
women wishing to get pregnant:
- antiepileptics are generally teratogenic, particularly sodium valproate.
- It is important that women take advice from a neurologist prior to becoming pregnant, to ensure they are on the most suitable antiepileptic medication.
- Breastfeeding is generally considered safe for mothers taking antiepileptics with the possible exception of the barbiturates
women taking contraception:
- both the effect of the contraceptive on the effectiveness of the anti-epileptic medication and the effect of the anti-epileptic on the effectiveness of the contraceptive need to be considered
[] is considered the first line treatment for patients with generalised seizures with [] used for focal seizures.
Sodium valproate is considered the first line treatment for patients with generalised seizures with carbamazepine used for focal seizures.
Carbamazepine may exacerbate [2] seizures
Carbamazepine may exacerbate absence seizures and myoclonic seizures
