Epilepsy/Status Epilepticus/Functional Neurological Disorder Flashcards
Define Seizure
A seizure is the transient occurrence of signs or symptoms due to abnormal excessive or synchronous neuronal activity in the brain
Seizures can manifest as a disturbance of consciousness, behaviour, cognition, emotion, motor function, or sensation.
An isolated seizure can be caused by toxic, metabolic, structural, and infectious factors and should not be confused with epilepsy
Difference in focal and generalised seizures, and what are their classification based on
Focal seizures — originate in networks limited to one hemisphere, and may be localised or more widely distributed (generally divided into those with retained awareness or impaired awareness)
Generalised seizures — originate in bilaterally distributed networks, and can include cortical and subcortical structures (but not necessarily the whole cortex). Generally divided into motor and non-motor (absence) seizures.
Define epilepsy and the criteria for a diagnosis
Epilepsy is a neurological disorder in which a person experiences recurring unprovoked seizures.
ILAE description - a disease of the brain defined by any of the following conditions:
- At least two unprovoked seizures occurring more than 24 hours apart.
- One unprovoked seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years.
- Diagnosis of an epilepsy syndrome. (usually based on patterns of seizure, age of onset, EEG, imaging, etc)
How is epilepsy different from seizure?
A key element is that epileptic seizures are unprovoked and considered recurrent. Provoked seizures would not be considered as epilepsy.
Define convulsive status epilepticus
Convulsive status epilepticus is a prolonged convulsive seizure lasting for 5 minutes or longer, or recurrent seizures one after the other without recovery in between.
Non-convulsive status epilepticus and management
Similar to Convulsive SE
* first-line using lorazapam and monitoring with EEG
* However, general anaesthesia with refractory episode is usually not needed
A short summary of primary generalised epilepsy
- Often presents in childhood/teens
- Early morning jerks
- Generalised seizures
- Risk factors - sleep deprivation, flashing lights
A short summary of focal-onset epilepsy
- Underlying structural cause
- Focal onset, can then generalise
- Onset at any age
- Hippocampal sclerosis can occur
- Frequently involves complex partial seizures (ie partial seizures with altered consciousness)
Types of generalised seizures
Tonic-clonic
Absence
Atonic
Myoclonic
Describe tonic-clonic seizures
- Loss of consciousness andtonic (muscle tensing) andclonic (muscle jerking) episodes
- May be associated tongue biting, incontinence, groaning and irregular breathing
- After the seizure there is a prolongedpost-ictal period where the person is confused, drowsy and feels irritable or depressed
Describe absence seizures
- Typically happen in children, 90% stop as they get older
- The patient becomes blank, stares into space and then abruptly returns to normal
- During the episode they are unaware of their surroundings and won’t respond
- These typically only lasts 10-20 seconds
Describe atonic seizures
- Characterised by brief lapses in muscle tone, causing the patient to fall
- These don’t usually last more than 3 minutes
- Consciousness retained
Describe myoclonic seizures
Present as sudden brief muscle jerks of a limb, trunk, or face
With focal-onset seizures, how does onset location typically relate to presentation?
Focal-onset seizures with impaired consciousness are most commonly temporal-onset, these commonly have post-ictal symptoms like confusion.
In those where consciousness is not impaired, post-ictal symptoms are usually absent
What is the most likely type of seizure in secondary generalised seizure developed from focal-onset seizures?
Tonic-clonic
What kind of signs and symptoms should be picked up when asking “what happened before, during and after the attack”
- Any subjective symptoms at the start of the seizure (aura) — suggestive of focal epilepsy; these may provide information on where the seizure might arise.
- Any potential triggers, for example sleep deprivation, stress, light sensitivity, or alcohol use.
- Specific features of the seizure, for example:
*Short-lived (less than 1 minute), abrupt, generalised muscle stiffening (may cause a fall) with rapid recovery — suggestive of tonic seizure.
*Generalised stiffening and subsequent rhythmic jerking of the limbs, urinary incontinence, tongue biting —suggestive of a generalised tonic-clonic seizure.
*Behavioural arrest — indicative of absence seizure.
*Sudden onset of loss of muscle tone — suggestive of atonic seizure.
*Brief, ‘shock-like’ involuntary single or multiple jerks —suggestive of myoclonic seizure. - Residual symptoms after the attack (post-ictal phenomena), such as drowsiness, headaches, amnesia, or confusion (usually occur only after generalised tonic and/or clonic seizures).
12-lead ECG is routinely requested in a patient with suspected seizure, what specifically is this looking at?
Prolonged QT syndrome and cardiac arrhythmias that can mimic a seizure
General rules in medical management of seizures
- Drug therapy should be only started after a minimum of two fits
- Only use one drug at a time,and begin with a small dose, and gradually increase it, until control is achieved, toxic affects occur, or the maximum dose is reached
Describe the clinical use and side effects of five main medications used for seizures
What are the implications of epilepsy/seizure on driving?
- If a driver has a seizure (of any type) they must stop driving immediately and inform the DVLA
- Patients who have had a first unprovoked epileptic seizure or a single isolated seizure must not drive for 6 months
- Patients with established epilepsy must be seizure free for at least one year and must not have a history of unprovoked seizures
