Epilepsy Symposia Flashcards
What is epilepsy
Recurring, unprovoked, spontaneous seizures
What does a generalised onset mean?
Electrical discharges appear to start over the whole brain at the same time
What does partial/facial onset mean?
Electrical discharges appear to start in one cortical region and then may remain localised or spread over the whole brain
Describe frontal lobe seizures
Forced head and eye deviation to contralateral side
Difficulty speaking, unresponsiveness
Repetitive movements
Pt can be fully aware whilst it is happening
Epileptogenesis
Process where parts of normal brain converted to hyperexcitable brain
Epileptic seizure
Explosion of synchronous activity
Rhythmic firing of AP by neurons
What are febrile convulsions/seziures
Fever-induced
Can be due to point mutation in Na+ channel causing abnormally slow inactivation
Describe temporal lobe seizures
- physical
- cognitive
- affective
Preceded by warnings of deja vu, rising epigastric sensation, followed by lip-smacking and speech arrest Hallucinations Pallor/flushing Can mimic panic attacks Changes in smell
Parietal lobe seizures
Positive sensory symptoms
Tingling, pain
Distortion of body shape
Sensory Jacksonian March
Describe the tonic phase in a tonic clonic seizure
Continuous muscle spasms Will fall May have cyanosis due to thorax muscle contracting Tongue biting Incontinence
Describe the clonic phase in a tonic clonic seizure
Rhythmic jerking slows & gets larger in amplitude as the seizure ends
Describe the postictal phase in a tonic-clonic seizure
Coma Drowsiness Headache Confusion Muscle aching
Jacksonian march
Simple, partial seizures
Patient aware- localised discharge
Symptoms
- Lip smacking
- sudden muscle contraction
- sudden head and eye deviation
- lasts very briefly
Describe occipital lobe seizures
Visual hallucinations
Amaurosis on onset
-blackout
perampanel
AMPA receptor antagonist
non-competitive inhibitor
reduce spread / generalisation of seizure
well tolerated with improved alertness
Carbamazepine, oxcarbazepine and eslicarbazepine
Anticonvulsant
competitively inhibit the voltage gated sodium channel by binding with the receptor in its inactive state, prolonging the period between successive firings (prevents burst firing)
First line treatment for primary generalized epilepsy
sodium valproate
lamotrigine
First line treatment for partial (focal onset) epilepsy
carbamezapine
lamotrigine
Name drugs that can exacerbate generalized seizure types such as myoclonus and absences
- phenytoin
- carbamazepine
- gabapentin/pregabalin
Benzodiazepines
-side effects
acute/long term
Acute: Drowsiness Ataxia Hyperactivity Personality Change Cognitive impairment
Long Term:
tolerance/dependence
Phenytoin
-side effects
acute/long term
Acute:
Ataxia, Diplopia, Nystagmus
Long Term:
Gingival hyperplasia
Osteomalacia
Cerebellar atrophy
Sodium Valproate
-side effects
acute/long term
Acute:
sedation
nausea and vomiting
tremor
Long Term:
Hair thinning
Weight gain
Menstrual irregularities
Encephalopathy
difference between provoked seizures versus epilepsy
provoked caused by acute insults such as metabolic disturbance, withdrawal, stroke, alcohol
Causes of epilepsy
CVS Alcohol Tumour Post-traumatic Idiopathic
Idiopathic (Primary) Generalized Seizures
- tonic clonic
- absences
- myoclonic
> onset in childhood or adolescence
usually no focal symptoms/signs
often a number of seizure types cluster
a polygenic cause is presumed with no identifiable structural lesion on imaging
generalized (all leads) spike and wave discharges on EEG, photosensitivity may be present
Juvenile Myoclonic Epilepsy
>commonest form of primary generalized epilepsy >3-12% all epilepsy >juvenile onset, probably lifelong >early morning myoclonic jerks (ask) >photosensitive, sleep deprivation triggers >+/- absences >generalized tonic clonic seizures – >occur without warning
Tonic clonic seizures “grand mal”
-occurs without warning –risk of injury
-tonic phase
continuous muscle spasm, fall, cyanosis, tongue biting, incontinence
-clonic phase
rhythmic jerking slows and gets larger in amplitude as attack ends
-post-ictal (post-seizure) phase
coma, drowsiness, confusion, headache
muscle aching
Absences - “petit mal”
- abrupt
- short, 5-20 seconds
- multiple times/day, can lead to learning difficulties
- unresponsive, amnesia for the gap, rapid recovery
- tone preserved (or mildly reduced)
- eyelid flickering
- absences only, tend to remit in adulthood (childhood absence epilepsy)
simple partial seizure (SPS)
patient aware - aura
complex partial seizure (CPS)
aura/warning with a level of reduced awareness
Secondary Generalized Tonic Clonic Seizures – (GTCS)
warning/aura –eg epigastric rising sensation, altered smell, déjà vu, fear
cannot abort attack
onset sudden
duration 1-3 minutes
then falls , loses consciousness as seizure generalizes
rigidity/ convulsive jerks/ excess salivation
incontinence/tongue bite common
red/blue, wakes in ambulance/A&E
First line treatment for absent seizures
Ethosuximide
