Epilepsy/seizure Flashcards
What is a jacksonian march?
Attacks start in one part of body and gradually spread to others
What is Todds palsy?
A paresis of affected limb lasting hours after partial seizure - stroke mimic
What is epilepsy? and criteria?
Neurological disorder marked by sudden, recurrent episodes of sensory disturbance, LOC or convulsions ass with abnormal electrical activtiy in the brain
-At least two unprovoked seizures more than 24 hours apart
What genetic disorders are more likely to have epilepsy?
Downs syndrome - 10%
Angelmans = 80%
Prader-Willi - 20%
Who gets epilepsy?
Children or over 60s
More common in learning disability
Genetic disorders
First degree relatives with condition
What drugs can cause epilepsy?
Isonazid, tricyclic antidepressants
Binge alcohol drinking
Drug - benzodiazapenes or alcohol withdrawal
What metabolic disorders can cause epilepsy?
Hyponatremia/hyper, hyper/ocalcemia
Uraemia, hypoglycaemia
Causes of epilepys - list
Idiopathic
Genetic/congenita
Drugs
Metabolic/electrolyte disorders
CNS infections eg meningitis
Autoimmune disease
Brain neoplasm
Head injury/cranial surgery
Neurodegenerative diseases
1/3 - anatomical/sy,ptomatic eg cerbrocascualr disease, tumour, head injury
What is Sodium valproate used ofr? contraindications?
generalised seizures
- Teratogenic, lvier damage
What is Carbamazepine used for + contraindications?
focal seizures
- Teratogenic, myelosurpession, ataxia, diplopia
What is phenytoiin used for? Containdications?
- Phenytoin
- Teratogenic, gum hypertrophy, hirstutism, ataxia, diplopia
What is phenytoiin Containdications?
- Teratogenic, gum hypertrophy, hirstutism, ataxia, diplopia
What drug is used fro absence seizures?
Ethosuximide
What syndrome is a contraindication for lamotrigine?
Steven-Johnson syndrome
Driving advice in epilepsy
Driving advice in epilepsy –
Car/ Bike:
Epileptic seizure – no driving for 1 year without seizure
One off seizure – no driving for 6 months without seizure
Bus/ coach:
More than one seizure – no driving for 10 years without seizure and not on AEDs
One off seizure – no driving for 5 years without seizure and not on AEDs
Treatment of status epilepticus
1st line = benzodiazapine
- IV lorazepam 4mg
- Repeat after 10 mins
- Consider PR diazepma or buccal midazolam if no IV access
2nd line = AED-20 mins
- eg Phenytoin, Levetriacetam, valproate
- Loading dose then infusion
3rd line = anaesthetise + ventialte - 30 mins
- ITU e/EEG monitoring
First line treatment of myoclonic seizures in males
Sodium valproate
What do myoclonic seizures NOT display?
LOC
Incontinence
Tongue biting
Post ictal period of fatigue
What seizures is ethosuximide used for?
Absence
When is lamotrigine/topirimate used in men?
3rd line for myoclonic seizures after sodium valproate and levetriacetam have failed
What is first line for women with myoclonic seizures?
Levetiracetam
Why is sodium valproate not offered to women of child bearing age?
It is severely teratogenic - neurodevelopmental delay
When do you treat epilepsy?
After the second seizure unless meet crtieria for after first one
Criteria for epilepsy treatment after first seizure
Neurological deficit
Structural abnormality on scan
EEG - unequivocal epileptic activity
Patient or faimly - furture risk of seizure is unacceptable
Generalised tonic clonic, tonic or atonic, myclonic first line, absence seizures second line medication?
Men - sodium valproate
Women - Lamotrigine (not in myoclonic) or levetiracetam (not in tonic or atonic)
Focal seizures treatment 1st line and second line
1st - lamotrigine or levetiracetam
2nd - carbamazepine, oxcarbexapine or zonisamide
What medication may exacerbate absence seizures?
Carbamazepine
Differentials for seizures
Syncope
Migraine
Transient ischaemic attack
Cardiac arrhythmias
Paroxysmal vertigo
Acute encephalopathy
Sleep disorders e.g. narcolepsy, parasomnias
Transient global amnesia
Involuntary movement disorder
Panic attacks
Non-epileptic seizures
Where is a UMN lesion?
Above anterior horn cell in spinal cord or motor nuclei in cranial nerves
Function of the cerebellum
- Co-ordinates movement
- Maintains equilibrium + muscle tone
- complex regulatory + feedback system with many neural cnnections
What is myasthenia gravis? What is antibodies test for it’
Disorder of neuromuscular transmission
anti-ACHR antibodies
What is a non convulsive seizure
Non-Convulsive Status Epilepticus (NCSE) is a persistent change in the level of consciousness, behaviour, autonomic function, and sensorium from baseline associated with continuous epileptiform EEG changes, but without major motor signs
Features of temporal lobe seizure
Lip smacking
Post-ictal dysphasia
With or without consciousness impairment
Aura:
psychic/deja vu
Hallucinations
Rising epigastric snesation
Frontal lobe vs occipital vs pariteal lobe features of sezirue s
Frontal lobe (motor) Head/leg movements, posturing, post-ictal weakness, Jacksonian march
Parietal lobe (sensory) - Paraesthesia
Occipital lobe (visual) - Floaters/flashes
What is epilepsy
Epilepsy - disorder of the brain due to tendency to seizures manifested as at least two unprovoked seizures occuring >24 hours apart
OR one unprovoked seizure and a high probability of more occuring due to predisposing factors eg brain lesion
OR diagnosis of epilepsy syndrome
What is a partial/focal seziure
Simple motor seizure
Often tempiral and frontal lobe
Remain conscious
What is simple partial vs complex partial seizure
Complex - altered consciousness
No memeory or awareness but can still interact
Features of temporal lobe seizure onset and pathology
Focal onset 2/3
Deja vu, unfamiliarity, brink of revelation
Medial or hippocampal scarring from childhood febrile convulsions
Clinical features of focal sezirue
Chewing, bite tongue, work face
Heat, foosebumps, fear
Odd smell often unpleasant eg burning, plastic petrol etc
Frontal lobe seizure featres
Bizarre, bilateral
Cycling of lef, pelvic thrusting
Brief and frequent
Nocturnal
Head cersions - away from origin
Defnecers postion - one flexed arm other extended
What is defencers position in frontal lobe seizure
ONe arm flexed one extended
Features of occipital lobe seizures
Eye symptoms, movements, eyelid flickering, crude visual manifestations often lights
Metabolic conditions and stroke can cause
What stroke often causes perception distortion
Parietal lobe eg size of hands vs self etc
Questions to ask about prodromal symptoms epilepsy
Aura
Syncopal
Head injuroes
Drugs - anitHPTN, recreational
Investgiations psot seizure
Cranial imaging -CT/MRI
EEG
Management of epilepsy
A-E
AIRWAY
Antiepielptic drug
Which antiepileptic is safest in pregnancy
Lamotrigine
Appearnace of epileptic seizure
Pre - deja vu, focal SM
Stiffens - TONIC phase
Red/blue face, eyes open. Sustained convulsion
UL flexed, LL extended
Tonic cry, grunting then stertor post ictal
Prolonged recovery, amnestic phase
Mat have no recollection hours after event
