Fits/ Epilepsy Flashcards
What is epilepsy?
Neuro condition characterised by 2 or more seizures
What conditions are associated with epilepsy?
Cerebral palsy
Tuberous sclerosis
Mitochondrial diseases
How can you classify epileptic seizures?
Primary generalised
Secondary generalised
Focal
What is a primary generalised seizures?
Idiopathic juvenile epilepsy- whole brain is being affected
Underlying genetic basis, otherwise pts are normal with no structural brain abnormalities
Usually manifest in childhood and adolescence
What is secondary generalised seizures?
Due to irritation/infection/inflammation of the cortex, or cortex needs something e.g oxygen, glucose, space
A focal seizure can progress to affect the whole brain–> secondary generalised seizure
What are some types of generalised seizures?
Tonic clonic
Tonic
Clonic
Typical absence
Myoclonic
Atonic
Describe a tonic clonic seizure
Loss of consciousness–> tonic phase: muscle tensing- whole body is rigid with jaw clenched
Clonic phase–> repetitive rhythmic jerking movements
Features of tonic-clonic seizures?
Jaw clenched
lateral tongue biting
cyanosis
foaming at the mouth (may be blood stained)
Irregular breathing
may make a loud sound
confused, drowsy post-ictally
Incontinence
Features of absence seizure?
typically happen in children
Blank stare into space, then abruptly returns to normal.
During the episode, won’t respond
Unaware they’ve had the seizure
Lasts around 10-20s
Features of atonic seizure?
Known as ‘drop attacks’
Brief lapse in muscle tone
Usually last up to 3 mins
Features of myoclonic seizure?
Sudden brief muscle contraction
Pt usually awake
Like a jerk
Typically occur in Juvenile myoclonic epilepsy
What is Juvenile myoclonic epilepsy?
Typical onset in the teens, more common in girls
1. Infrequent generalized seizures, often in morning
2. Daytime absences
3. Sudden, shock like myoclonic seizure
usually good response to sodium valproate
What is a focal seizure?
Usually arises from the temporal lobe and can affect M.E.S.H
M = memory
E = emotion
S = speech
H = hearing
IT DOES NOT INVOLVE THE WHOLE BRAIN
How can a focal seizure present?
Deja vu
lip smacking
jamais vu
doing things on autopilot
What is the post-ictal phase?
When a pt has just had a seizure, feels drowsy/unwell/tired 15-30mins
Investigations post first seizure?
EEG and MRI
What advice would you give to patients who have just had a/ first seizure?
Need to inform the DVLA- stop driving
Inform occupational health at their work place
No swimming, no heights
GP if they have further seizures
Call an ambulance if a further seizure lasts more than 5 mins
Triggers for seizures in idiopathic juvenile epilepsy?
Binge drinking alcohol
Sleep deprivation
Management for generalised seizures?
Sodium valporate or lamotrigine / levetiracetam in women of childbearing age
Management for focal seizures?
1st line = Carbamazepine or lamotrigine
2nd line = sodium valproate or levetiracetam
Update: 1st line = lamotrigine or levetiracetam
2nd line = sod val or carbamazepine.
Side effects of sodium valproate?
From Z2F - teratogenic, liver damage and hepatitis, hair loss, tremor
From BNf
increased appetite and weight gain
alopecia: regrowth may be curly
P450 enzyme inhibitor
ataxia
tremor
hepatitis
pancreatitis
thrombocytopaenia
teratogenic (neural tube defects)
From QM: Anaemia, confusion, gastric irritation, haemorrhage, hyponatraemia, tremor, weight gain
Side effects of carbamazepine?
From Z2F - agranulocytosis, aplastic anaemia and induces P450
From lec and BNF:
P450 enzyme inducer
dizziness and ataxia
drowsiness
leucopenia and agranulocytosis
syndrome of inappropriate ADH secretion
visual disturbances (especially diplopia
What blood monitoring needs to be done for Sodium valproate?
Vit D levels regularly
FBC - thrombocytopenia
LFTs - liver failure
Pregnancy
What blood monitoring needs to be done for carbamazepine?
Blood counts
Plasma conc
Renal and hepatic monitoring
Side effects of Lamotrigine?
Stevens johnson syndrome or toxic epidermal necrolysis (often 1st 8 weeks) warn to see dr if rash or flu symptoms
diplopia
blurred vision
photosensitivity
tremor
agitation
aplastic crisis
Quesmed: blurred vision, arthralgia, ataxia, diarrhoea, dizziness, headache, insomnia, rash, tremor.
What is status epilepticus?
When > 5mins continuous or 2+ seizures without full recovery within 30 mins
How do you manage status epilepticus?
A-E assessment–> IV lorazepam 4mg–> after 10- 15mins if seizure has not stopped IV lorazepam 4mg–> once established status (this means ongoing) Phenytoin infusion 20mg/kg- max rate 50mg/min–> call ITU–> rapid sequence induction- thiopental etc.
What can you give in status epilepticus if there is no access?
IM midazolam 10mg
PR diazepam 10mg
What are febrile convulsions?
Children between 6mnths- 5years
Usually occur early in viral infection as temp rises rapidly
Brief and generalised tonic/tonic- clonic
What are alcohol withdrawal seizures?
Pts with hx of alcohol excess if suddenly stop drinking
Peak incidence is around 36 hours following cessation of drinking
Pts give benzodiazpines following cessation to reduce the risk
Psycho-genic non-epileptic seizures
pt presents with epileptic type seizures but does not have the characteristic electrical discharge
Pts may have hx of mental health problems or a personality disorder
Lactate levels in pt who has had generalised tonic clonic seizure?
How doe this differ to syncopal pt?
T-C seizure: Raised lactate ! (this is due to local muscle hypoxia during seizure)
Syncopal: normal lactate
What is idiopathic generalised epilepsy?
A group of epileptic disorders that are believed to have strong underlying genetic basis and strong FHx
Pts are otherwise normal with no structural brain abnormalities
Starts early childhood - adolescence
Seizure types include absence, myoclonus and primary generalised T-C
Why are vitamin D levels monitored in patients taking sodium valproate?
Sodium valproate induces metabolism of vitamin D so need to routinely measure levels
Management of atonic seizures?
Tonic or atonic seizures:
- males: sodium valproate
- females: lamotrigine
