Epilepsy: Seizures and Syndromes Flashcards
important features of fall history?
onset (what were they doing? where? symptoms before? what did they look like?) event itself (any movements? responsiveness/consciousness throughout?) afterwards (speed of recovery, sleepiness/disorientation, deficits)
how do you take a history of a seizure?
ask eye witness to demonstrate the movements
general features of vasovagal syncope?
feeling unwell and unsteady
go pale and grey
hit the ground then BP restored very quickly and back to normal
tongue biting and urination are features of seizure?
no
not specifically
can be caused by lots of things
name 7 risk factors for epilepsy?
birth problems delayed development seizures in past (including febrile fits) head injury family history drugs alcohol
how is examination used in seizures?
often no examination in 1st seizure as little benefit
if syncope is diagnosed then do cardio exam and L+SBP
always do an ECG
examples of drugs which can cause seizures
analgesics (tramadol, opioids)
antibiotics (penicillins, cephlasporins, quinolones)
antiemetics (prochlormezapine)
important ECG sign to look out for after a fall or seizure?
long QT syndrome
who requires an urgent CT scan after a seizure?
clinical or radiological skull fracture deteriorating GCS focal signs head injury with seizure failure to be GCS 15/14 4 hrs after arrival suggestion of other pathology
how useful is an EEG in epilepsy?
not useful so not used
many people have abnormal EEG with no epilepsy
30% of epilepsy patients have normal EEG
indications for EEG?
classification of epilepsy
confirmation of non-epileptic attacks
surgical evaluation
confirmation of non-convulsive status
differential diagnoses for seizures?
syncope non-epileptic attack TIA migraine hypoglycaemia parasomnias paroxysmal movement disorders MS tonic spasms
first step after a fall diagnosis?
counselling
- explain diagnosis (seizure vs syncope vs epilepsy etc)
- explain seizure doesn’t mean epilepsy
- discuss risk of recurrence
- discuss driving and safety
rules for driving and seizures?
single seizure = cant drive car for 6 months, cant drive HGV for 5 years
epilepsy diagnosis = 1 year seizure free, 3 years of only nocturnal seizures, 10 years off medication to drive an HGV
what is epilepsy?
tendency to recurrent, usually spontaneous, epileptic seizures
what are epileptic seizures?
abnormal discharge of electricity in the brain
abnormal synchronisation of neuronal activity (usually excitatory with high frequency APs, sometimes predominantly inhibitory)
interruption of normal brain activity (general or focal)
why do people have epileptic seizures?
too much excitation or too little inhibition
can be due to changes in
- cell number/types
- connectivity
- synaptic function
- voltage gated ion channel function
genetic, acquired brain, metabolic, toxic and environmental factors
how common is epilepsy?
most common in infancy and old age but can be at any age
50-80 per 100,000
epilepsy mortality?
1 in 400 chance of death in a year
what is SUDEP?
sudden unexpected death from epilepsy
most common cause of death in epilepsy?
can often be a consequence of the underlying cause of the epilepsy (brain tumour, stroke etc)
suicide in younger patients (<50)
2 main classifications of epileptic seizures?
focal/partial = (abnormality in a part of the brain which irritates surrounding area of brain causing abnormal discharge of electricity = focal seizure, can hit a pathway causing it to spread causing a secondary generalised seizure generalised = discharge immediately hits pathways causing whole brain to "light up"
features of generalized?
most have genetic predisposition
present in childhood and adolescence, generalised spike-wave abnormalities on EEG
types of partial seizure?
simple = without impaired consciousness complex = with impaired consciousness
