Epilepsy/ syncope Flashcards
Common causes of loss of consciousness
- epilepsy
- syncope
How to assess and episode of loss of consciousness
Before:
-events leading up
The episode itself: -Warning symptoms -Awareness -Things to note: Eyes open/close Abnormal movements Pallor Duration
After episode:
- how quickly they regain consciousness
- seizure marks
Categories of syncope
Reflex/ neuro-cognitive: -Taking blood -Cough Cardiogenic: arrythmia / aortic stenosis Orthostatic : -Dehydration -autonomic nervous system
Assessment
Examination:
- Look for palpitations
- Postural BP
ECG
- Heart block
- QT ratio
24hr ECG
Characteristics of cariogenic syncope?
-On exertion
-During episode:
palpitation, chest pain, SOB
Unable to feel pulse
-After episode:
chest pain/ palpitations
clammy/sweaty
Came around quickly
What is epilepsy
Disruption of the electrical activity of the neurones
When is a person said to have epilepsy
If they suffer from more than one episode of unprovoked seizure or if there is a high tendency of reoccurrence
What causes a provoked structured seizure?
- Alcohol withdrawal
- Drug withdrawal
- Within 24 hours of a stroke
- Within 24h of neurosurgery
- Eclampsia
- With severe electrolyte disturbance
Different types of epilepsy?
- Generalised
- Focal
Categorisation of general epilepsies?
- Absence
- Generalised tonic-clonic
- Myoclonic
- Juvenile myoclonic
- Atonic
Properties of general epilepsies
- No warning
- Younger than 25
- Generalised symptoms of EEG
- May have family history
- Previous episodes of absences/ myoclonic jerks/ general tonic-clonic episodes
Characters of absence seizures?
- Common in children
- Rarely remembered
- Can be triggered by hyperventilation/ photic stimulation (i.e. light through clouds)
- Stop all activity for a few seconds then regain consciousness
- Eyes fluttering
Generalised tonic clonic seizures: what happens before the even
- Uneventful
- PMH: trauma, meningitis, complications at birth
GTC: event itself
- Vague warning such as irritability before hand
- Groaning sound
- Tonic (rigid phase) followed by all 4 limb jerking movements
- Eyes open : staring or rolling upwards
- Foaming at mouth
- Jerking for about 15-30 mins
- Groggy for a while before they regain consciousness
GTC: what happens after the event
- Lateral tongue biting
- Muscle pain
- Does not recover for a while (e.g. in ambulance)
What triggers juvenile myoclonic epilepsy
-Sleep deprivation
-Stress
In adolescence
What happens during juvenile myoclonic epilepsy
- Absence
- GTC seizures
- Early morning myoclonus (likely to drop things in the morning)
- Jerky limb movements
What are the properties of focal seizures
- Get aura
- Any age
- Focal abnormality of EEG
- MRI may show cause
- Simple and complete partial can become secondary generalised
Types of focal seizure
- Simple partial
- Complex partial
- Secondary generalised
What happens before a complete partial seizure
- Weird feeling in the belly
- Feeling of De Ja Vu
What happens during a complete partial seizure
- Sudden stop of activity
- Stares blankly into space
- Automatisms: staring blankly into space/ smacking of lips
- no recollection
What happens after complete partial seizure
Does not recollect for a while
How to assess a seizure
- Refer to first seizure clinic
- EEG
- MRI for focal lesion
- anti-epileptic drugs
- epilepsy nurse
- Driving
Risk factors associated with seizures
- Hasnt taken medication
- sleep/disturbance/ fatigue
- Hormonal changes
- Drug/alcohol use
- Stress/ anxiety
- Photosensitivity
First line of treatment of epilepsy
- Sodium Valproate, Lamotrigine, Levetiracetam for primary generalised epilepsies
- Lamotrigine, Carbamazepine, Levetiracetam for focal and secondary generalised seizures
- Ethosuximide for absence seizures
Treatment for acute epilepsy
- Lorazepam, midazolam (diazepam) first line:
* Valproate or phenytoin second line for status epilepticus
Side effects of phenytoin
what’s the HAP?
Arrythmia
Hepatits
Side effects for carbamazepine
ABDN BLows
- Ataxia
- Drowsiness
- Nystagmus
- Blurry vision
- Skin rash
- Low serum sodium levels
Side effects for sodium Valproate
DAWN HAT
- Drowsiness
- Ataxia
- weight gain
- Nystagmus
Heptatitis
Avoid in pregnant
Tremor
Side effects for Lamotrigine
LaSS
- skin rash
- diffuclty sleeping
Side effects for leveracitam
LID
- irritability
- Depression
Driving regulations after a singles episode
- 6 months after episode if investigations are normal and they have had no further episodes
- They can drive HGV/ PSV (larger vehicles) after 5 years if same as above applies
Driving regulations if they are epileptic
- Can drive after 1 year if they have no further episode or only episodes which arise in their sleep
- They can drive an HGV/PSV- if they are seizure free for 10 years
What is status epileptics
A prolonged state of epilepsy lasting more than 30 mins with no interruption
First line and second line of treatment for status epileptics
First line: diazepam
Second line: Phenytoin
What the outcomes of status epilecticus
- High mortality rate especially in the young
- Avoid secondary injury
What is a pesudoseizure
Non-epileptic seizure
What happens leading up to pseudo seizure
- High stress
- Remember other people reactions
What happens during a pseudo seizure/after
Event itself:
- Prolonged period of waining
- May describe dissociation
After event:
-Remember other peoples reactions
How do epileptic drugs work?
Sodium channel blockers:
Lamotrigine
Carbapezamine
Calcium Channel blockers:
Phenytoin
GABA receptor enhancement
Benzodiazapenes: Lorezapam, midazolam
GABA release:
Valpronate
Gabapentine
