FN: Epilespy Flashcards
Definition
Recurrent tendancy to spontaneous, intermittant, abnormal electrical activity in part of the brain manifest as seizures
Causes
2/3 are idiopathic (often familial)
- Congenital
- Acquired
- Non-epileptic/provoked seizures
Congenital causes
NG
Tuberous sclerosis
TORCH
Perintal anoxia
Acquired
Vascular: CVA
Cortical scarring: trauma infection
SOL
Other: SLE, PAN, MS, sarcoidosis
Non epileptic/ provoked seizures
- Withdrawal: EtOH, opiates, benzos
- Metabolic: glucose, Na, Ca, urea, Nh3
- Raised ICP: trauma, haemorhage, cortical venous thrombosis
- Infection: meningitis, encephalitis, cycticerosis HIV
- Eclampsia
- Pseudoseizures
Prodrome defintion
Patient or others may notice change in mood or behaviour lasting hours - days
Not part of seizure
Aura
A simple partial seizure (usually temporal) which may precede other manisfestations Experienced as a strange feeling: 1. Epigastric rising 2. Deja/jamais vu 3. Automatism 4. Smells, lights, sound
PArtial (focal)
Features referable to part of one hemisphere
Primary Generalised
No warning/aura
Discharge throughout cortex w/o localising features
simple
awareness unimpaired
Complex
Awareness impaired
Secondary generalised
Focal seizure - generalised
e.g. aura - tonic-clonic
Diagnostic pointers
Aura Specific trigger e.g. flashing lights Lateral tongue biting (>incontinence) Typical movements e.g. tonic-clonic Cyanosis Post-ictal phase
Simple partial presenting features
Focal motor, sensory, autonomic or psychic symptoms
Complex partial : 5As
Aura
Autonomic change in skin colour, temperature, palps
Awareness lost: motor arrest, motionless stare
automatism:lip-smacking, fumbling, chewing, swallowing
Amnesia
Complex partial seizures usually arise form
Temporal lobe
Abscences (Petit mal)
Abrupt onset and offset
Short
Tonic-clonic (Grand mal)
LOC Tonic: limbs stiffen Clonic: rhythmic jerking of limbs ± cyanosis, incontinence, tongue biting (lateral) Post-ictal confusion and drowsiness
Myoclonic seizure
Sudden jerk of limb, face or trunk
Atonic (akinetic seizures)
Sudden loss of muscle tone – fall
No LOC
West syndrome/ Infantile Spasms
Clusters of head nodding and arm jerks
EEG shows hypsarrhythmia
Temporal localising features
Automations: lip smacking, chewing, fumbling
Deja/jamais vu
Delusional behaviour
Abdominal: rising, n/v
Emotional disturbance: terror, panic, anger, elation
Tastes, smells
Frontal localising features
Motor features: arrest, jacksonian march, Todds palsy
Parietal localising features
Sensory disturbance: tingling, numbness
Occipital localising features
Visual phenomena: spots, lines, flashes
