Epilepsy + Seizures Flashcards
management of unprovoked generalised tonic-clonic seizures
- FIRST LINE : Sodium valporate
2. SECOND LINE : Carbamazepine / Iamtrigine
4 major types of seizures called
- Partial/focal seizures
- generalised
- unknown onset
- focal to bilateral seizures
status epilepticus
- patient continues to fit despite medication being administered
- further benzos medication
- infusions of anti epileptic medication or general anaesthetic agents
nature of movements in epileptic seizures
- Stiff/ Rigid/Shaking
- Synchronous movements
- No resistance to eye opening
acute management of seizures
most seizures terminate spontaneously but if the seizure doesn’t terminate after 5 - 10 minutes
if not;
1. ABC A - anaesthetist to secure the airway B - check sats and put patient on high flow oxygen C - IV access + Cannula - Check; * Blood glucose levels *Alcohol + Cocaine *Electrolyte imbalances - Low levels of magnesium/calcium/sodium can cause seizures
focal seizures
first line : carbamazepine or lamotrigine
second line: levetiracetam, oxcarbazepine or sodium valproate
Absence seizures/Petit mal
- sodium valproate or ethosuximide
2. sodium valproate particularly effective if co-existent tonic-clonic seizures in primary generalised epilepsy
Acute medical management of seziures
-2. FIRST LINE - Benzodiazepines :
Lorazepam ( IV) / Diazepam (rectal) are used
- admin : rectally or intranasally under the tongue
-3. Admin Benzodiazepines again - further lorazepam if seizure persists
- Iv infusion of antiepileptic
- phenytoin - Status epilepticus - if patient continues to fit despite administeration of medication
- General anaesthetic - Profolol/Modazelan to sedate patient and stop physical manifestation of the seizure
associated symptoms with epileptic seizures
- Postictal period - tired and drowsy ( may not remember ambulance coming or period straight after )
- Todd’s Paresis - seziure in the motor cortex causes temporary muscle weakness and paralysis
- Bowel incontinence is more likely in epilepsy
- Tongue biting - specific areas of the tongue bitten such as side of tongue or inside of cheek indicate epileptic seizure
- Auras
myoclonic seizures
- short muscle twitches
nature of movements in non epileptic seizures
- contorted movements
- backarching
- pelvic thrusting movements
- resistance to eye opening
Psychogenic non-epileptic seizures
- previously termed pseudoseizures, this term describes patients who present with epileptic-like seizures but do not have characteristic electrical discharges
- patients may have a history of mental health problems or a personality disorder
focal to bilateral seziure
- starts on one side of the brain in a specific area before spreading to both lobes
- previously termed secondary generalized seizures
tonic seizures
- a type of generalised seizure
2. all muscles become stiff and flexed
pathophysiology of epilepsy
- Excess excitation
- Excess levels of glutamate released to bind onto NMDA receptor channels resulting in long term activation - Too little inhibition
- too little of GABA neurotransmitter binds to GABA receptor and causes opening of CL- ion channels
Temporal lobe seizure symptoms
- Hallucinations (auditory/gustatory/olfactory),
- Epigastric rising/Emotional - refers to stomach sensation that starts in the stomach and rises in waves up the chest to throat or head - Automatisms (lip smacking/grabbing),
- Deja vu/Dysphasia post-ictal)
duration of epileptic seizure
- shorter
2. less than 5 minutes
definition of epilepsy
a common neurological condition characterised by recurrent seizures.
Febrile convulsions
- typically occur in children between the ages of 6 months and 5 years
- around 3% of children will have at least one febrile convulsion
- usually occur early in a viral infection as the temperature rises rapidly
seizures are typically brief and generalised tonic/tonic-clonic in nature
conditions associated with epilepsy
- cerebral palsy: around 30% have epilepsy
- tuberous sclerosis - rare genetic condition that causes non cancerous, benign tumors to develop in different parts of the boody
- mitochondrial diseases
atonic seizures
- all muscles suddenly relax and become floppy
myoclonic seizures
FIRST LINE - sodium valproate
SECOND LINE: clonazepam, lamotrigine
management
following the patients first seizure, patients have an;
- EEG
- Neuroimaging - MRI
- Most neurologists start anti epileptics following a second epileptic seizure
other common causes of recurrent seizures apart from epilepsy;
- febrile convulsions
- alcohol withdrawl seizures
- psychogenic non epileptic seizures
tonic - clonic seizures
- tonic phase is when muscles tense up followed by clonic phase where muscles contract and relax
basic classification of seizures
. Where seizures begin in the brain
- Level of awareness during a seizure (important as can affect safety during seizure)
- Other features of seizures
colour changes in non epileptic seizures
- flushed
colour changes in epileptic seizures
- Cyanosed
Generalised sezuires
- engage both sides of the brain on onset
- can be further divided into
- motor :
* tonic/clonic
* atonic
* clonic
* myoclonic
- non motor : absence sezuire
clonic seziures
- violent muscle contractions known as convulsions
focal/ partial seizures
- start in a specific site of the brain
- level of awareness can vary;
- focal awareness/simple partial - no lack of awareness
- focal impaired awareness/complex partial - complete lack of awareness
- awareness unknown - Can be further classified into motor/non motor
- motor : Jacksonian march
- non motor : deja vu, jamais vu, or aura
signs and symptoms
patients who have had a generalised seizure also
- bite their tongue
- experience incontinenece of urine
- following a seizure have ‘postictal phase’ where they feel tired and drowsy for 15 mins
frontal lobe seizure symptoms
- head and leg movements
- posturing
3 post
duration of non epileptic seizure
- longer
2. waxes and wanes
Alcohol withdrawl seizures
- occur in patients with a history of alcohol excess who suddenly stop drinking, for example following admission to hospital
- chronic alcohol consumption enhances GABA mediated inhibition in the CNS (similar to benzodiazepines) and inhibits NMDA-type glutamate receptors.
- Alcohol withdrawal is thought to be lead to the opposite (decreased inhibitory GABA and increased NMDA glutamate transmission)
- the peak incidence of seizures is at around 36 hours following cessation of drinking
- patients are often given benzodiazepines following cessation of drinking to reduce the risk
