epilepsy (see DM) Flashcards
what is an epileptic seizure
a transient episode of abnormal neurological function caused by sudden excessive or hypersynchronous cortical neuronal activity
6 types of generalised seizure
- absence;
- myoclonic;
- tonic;
- atonic;
- clonic;
- tonic clonic;
syncope (6) vs seizure (9)
syncope:
1. prodromal symptoms (light headedness etc.);
2. pallor;
3. fall;
4. hypotonia;
5. brief duration;
6. no post-ictal confusion
seizure:
1. variable warning;
2. fall
3. initial tonic phase;
4. cyanosis;
5. clonic jerking;
6. duration (minutes);
7. tongue biting;
8. incontinence;
9. post-ictal confusion
what is status epilepticus
a dangerous condition in which epileptic fits follow one another without recovery of consciousness between them- medical emergency
status epilepticus Mgx
- ABCDE
- benzodiazepine given e.g. buccal midazolam, PR diazepam or IV lorazepam
what is SUDEP
sudden unexplained death in epilepsy
absence (6) vs complex partial (6) seizure
absence:
- brief
- no warning
- EEG generalised 3Hz spike wave
- abrupt onset
- abrupt cessation
- specific drug treatment
complex partial:
- prolonged
- may have warning
- EEG focal abnormalities
- post-ictal period
- automatisms
- most AED used for treatment
what is an epilepsy syndrome?
a syndrome defines by non-random clustering of clinical features which occur consistently together
what hormone can be used to distinguish between a seizure and pseudoseizure
prolactin (raise in seizure)
if a pt has one seizure and normal brain scan what is the chance of recurrance
40% chance and increases in risk as number of seizures increases
7 epilepsy syndromes
- childhood absence epilepsy;
- juvenile myoclonic epilepsy;
- autosomal dominant nocturnal frontal lobe epilepsy;
- benign childhood focal epilepsy;
- west syndrome;
- lennox-gastaut syndrome;
- temporal lobe epilepsy due to mesial temporal scelrosis;
how might benign childhood focal epilepsy present
mouth abnormalities - mouth area of the homonculous is affected
west syndrome presentation
Violent flexor spasms of the head, trunk and limb followed by extension of the arms; severe brain impairment
what drugs does childhood absence epilepsy respond well to
- ethosuximide
- sodium valporate
how does childhood absence epilepsy present
frequent absence seizures (up to 100/day) seen in children -> onset is usually 5-8 and more common in girls
when does childhood absence epilepsy usually remit at
puberty
what is juvenile myoclonic epilepsy
myoclonic seizures that arise in teenage years -> these are usually preceded by absence seizures (may even be up to 10 years prior); generalised tonic-clonic seizures may also arise at the same time as myoclonus
4 precipitating factors of juvenile myoclonic epilepsy
- sleep deprivation
- fatigue
- alcohol
- emotional stress/excitement
juvenile myoclonic epilepsy EEG (3)
- irregular 3-6Hz spike/poly spike and slow way discharge;
- photoparoxysmal responses;
- focal abnormalities
juvenile myoclonic epilepsy prognosis
lifelong seizures though generally well controlled with medication
juvenile myoclonic epilepsy Mgx
- lifestyle advice
- sodium valporate
- lamotrigine
- clonazepam
- levetiractem
what drugs should be avoided in juvenile myoclonic epilepsy
vigabatrin, tiagabine, carbamezapine (may exacerbate myoclonus)
what is temporal lobe epilepsy
the most common form of focal epilepsy - seizures arise in the temporal lobe
what are the two types of temporal lobe epilepsy
- mesial temporal lobe (limbic);
- lateral temporal lobe (neocortical)
mesial temporal lobe epilepsy presentation examples
- olfactory/gustatory hallucinations
- fear
- deja vu/jamais vu
- epigastric sensation
- behavioural arrest
- altered awareness/consciousness
- contralateral dystonic arm posturing
- lip smacking, swallowing etc. automatisms
mesial temporal lobe seizure duration/post-ictal
duration of minutes, followed by post-ictal confusion, dysphagia and gradual recovery
what will MRI show of someone with mesial temporal lobe epilepsy
hippocampal atrophy/sclerosis
what facial abnormality might be seen in someone with mesial temporal lobe epilepsy
facial asymmetry - flattening of the contralateral naso-labial fold
mesial temporal lobe epilepsy mgx
seizures usually still occur with medication -> surgery my be the only option
what may cause SUPED to occur (4)
- breathing - A seizure typically may cause a person to briefly stop breathing -> can result in hypoxia if last too long;
- heart rhythm - Rarely, a seizure may cause a dangerous heart rhythm or cardiac arrest;
- brain function - Seizures may suppress or interfere with the function of vital areas in the brainstem;
- other (unknown)
causes of excess mortality in epilepsy (7)
- underlying disease
- suicide
- seizure related accidents
- status epilepticus
- drug reactions
- aspiration pneumonia
- SUDEP
risk factors for SUDEP (6)
- young;
- generalised tonic-clonic seizures;
- uncontrolled epilepsy
- learning diability
- seizures occuring during sleep
- poor adherence to antiepileptic drug regimens
causes of depression in epilepsy (4)
- underlying cause of seizure;
- physiological effects of recurrent seizures;
- iatrogenic factors (AEDs, post operative, force normalisation);
- psychosocial consequences of epilepsy
treatment pathway for epilepsy (basic)
first monotherapy AED -> second monotherapy AED trial -> polytherapy AED trial -> epilepsy surgery evaluation
what type of epilepsy is most suitable to surgery
lesional temporal lobe epilepsy
why are areas of the brain temporarily lesioned in the epilepsy surgery work up
to see what the side effects of this lesion are prior to permanent resection
contraindications for epilepsy surgery (4)
- multi focal epileptogenic regions
- non-localisable epileptogenic zone
- epileptogenic region in eloquent cortex
- patient reluctance
4 ways of neuromodulation in epilepsy (if surgery and AED not sutiable)
- vagal nerve stimulation
- responsive neurostimulation
- deep brain stimulation
- trigeminal nerve stimulation
side effects of vagal nerve stimulation (4)
- hoarsness/voice alteration
- coughing
- dyspnoea
- parasethesia
i.e. effects of CN X stimulation
