Initial Presentation of Seizures Flashcards
What is the chief characteristic of seizures?
They are stereotyped, recurrent events (i.e. each episode is the same)
Is there usually a trigger or prodrome associated with a seizure?
No (this is more a sign of syncope)
If, after a collapse, a patient is not aware of what happened - does this suggest a seizure or syncope?
Seizure (in syncope, the patient will generally know what has happened)
If, after a collapse, there is rapid recovery - does this suggest a seizure or syncope?
Syncope (in a seizure, the patient will be drowsy for a long time after)
When dealing with a possible seizure history, it is really important to get information from who? What can you ask them to do?
A witness (i.e. take a collateral history), ask them to take a video if it happens again
What are some important questions to ask about the onset of a collapse?
What was the person doing at the time? Were there any triggers? What was the environment like? What did they look like before? Were there any preceding symptoms?
What is a syncopal seizure?
When a person faints but doesn’t lie flat which results in small jerks
If there is a description of someone collapsing, being stiff and rigid followed by jerky movements, what does this suggest?
Generalised tonic clonic seizure
What are two things which may occur during a collapse which (despite belief) are not specific for epilepsy?
Tongue biting and urinary incontinence
What should you ask about the duration of a collapse?
How long the whole episode was, and how long any particular components lasted for i.e. tonic phase/clonic phase
What are some important things to ask about regarding the aftermath of the collapse?
Speed of recovery? Drowsiness/disorientation? Any residual deficits?
What are some risk factors for epilepsy that you may want to ask about when taking a history from a person with collapse?
Premature or very late birth/any time in special care, seizures in the past, head injury, family history, drugs/alcohol
What are some important things to ask about in the social history of a person possibly presenting with epilepsy?
Driving and occupation
When taking a collateral history for a possible seizure, what should you ask the person to do?
Describe the episode in simple terms, and ask for a demonstration of movements if possible
What is important to remember about nocturnal seizures?
The same thing will happen every time (this is a good question to ask a bed partner)
What are some drugs which may precipitate an epileptic seizure?
Aminophylline/thiophylline, analgesics e.g. tramadol, antibiotics, anti-emetics, opioids (and loads more)
Obviously it is impossible to remember every drug that can cause a seizure, but what is one important thing you should check for?
Has there been any recent changes to drugs taken (medically and recreationally)
If a patient comes to an epilepsy clinic for the first time, are they usually examined?
No (the history is much more important)
If a patient presents to A+E with collapse, what examination should be done?
Neurological
If a collapse turns out to be syncope, what examinations should be done? Who should they be referred to?
Cardiovascular, including a lying to standing BP measurement. Refer to cardiology
If anyone presents with a seizure, what is the most important investigation to perform?
ECG
Why is it so important to perform and ECG in patients presenting with a seizure?
Because seizures can be caused by arrhythmias which can be fatal (e.g. long QT)
Should brain imaging always be performed on someone presenting with a seizure?
No
When is most imaging for a seizure done?
After the patient has been seen in clinic
