Epilepsy / siezures Flashcards
What is epilepsy?
Recurrent tendency to spontaneous , intermittent, abnormal electrical activity in part of the brain leading to seizures
What are seizures?
Most seizures last from 30s to 2mins.
however it is emergency if seizure lasts longer than 5mins. Or if a person doesn’t wake up between a series of seizure.
Symptoms vary. not all siezures lead to convulsion.
- trance like state
- odd feeling
- loss of consciousness
What are some non epileptic causes of seizures?
VITAMIN CDE
VASCULAR:
- haemorrhagic stroke
- ischaemic stroke
- haemorrhage
INFECTIOUS:
- meningitis
- encephalitis
- abscess
TRAUMA
AUTOIMMUNE:
-Vasculitis
METABOLIC:
- Na+ imbalance
- Hyper/hypoglycaemia
- HypoCa2+
- Liver failure (hepatic encephalopathy)
Iatrogenic:
Neoplasms:
tumour
Congenital:
-cortical dysplasia
Degenerative:
-Alzheimer’s
Environment:
-withdrawal of alcohol / drugs
RAISED ICP
What is the prevalence of epilepsy?
1% of population
What is the peak age of onset?
early childhood or in elderly
What are 2 common siezure mimics?
- syncope
- migraine
What are the differential diagnoses for blackouts?
- vasovagal syncope (onset over seconds, preceded by nausea, pallor, sweating)
- Epilepsy
- Stokes-adams attacks (transient arrhythmias causes fall in cardiac output)
- Drop attacks (sudden weakness of legs, usually in old women)
What is the difference between generalised vs focal siezure?
1) generalized seizure affects both sides of the brain and the consciousness
2) focal siezures are localised to specific cortical regions and can result in impaired consciousness or not.
What are 2 elements of a “fit” are suggestive of a siezure?
- tongue biting
- slow recovery
What are the 3 questions to consider before diagnosis of epilepsy?
1) Are these real siezures (tongue biting / slow recovery are suggestive)
2) What type of seizure is it ? (focal or generalised_
3) Are there any triggers? e.g. alcohol, stress, fevers, flickering lights.
What are some triggers of epileptic siezures?
- alcohol
- stress
- fevers
- certain sounds
- flickering lights
Describe the events before , during and after a siezure
1) Prodrome - (may notice change in mood or behaviour)
2) Aura (part of siezure when pt is aware, may have strange feeling in gut, dejavu)
3) Post ictally (headache, confusion, myalgia and sore tongue)
What invx can be done after a patient’s first ever siezure?
1) admission
2) 24hr bloods (FBC, U+Es, LFT’s, Glucose, Ca2+, Mg2+, ABG)
3) drugs screen
4) Lumbar puncture
5) Electroencephalogram (EEG)
6) CT / MRI (structural, space occupying lesions)
what is a pseudosiezure?
pseudosiezures can mimic epileptic siezures however are emotional and stress related.
The EEG is normal.
When are drugs appropriate for the treatment of siezures?
1) if there is a high risk of reecurance after 1st siezure (e.g. structural brain lesion)
2) more than 2 unprovoked siezures
