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
When should an acute CT scan be done for someone presenting with a seizure?
In any case where there is a chance that the person may require neurosurgical intervention in the next few days
Give some specific examples of reasons why a person presenting with a seizure may require an acute CT scan?
Clinical skull fracture, deteriorating GCS or failure to be GCS 15/15 4 hours after presentation, focal signs, head injury with seizure, suggestion of other pathology
What investigation should never be done to establish the cause of a seizure?
EEG
When are the only times that an EEG should be done?
To classify epilepsy, confirmation of non-epileptic attacks, surgical evaluation for severe epilepsy and confirmation of non-convulsive status
What are some conditions which are commonly confused differentials of epilepsy?
Syncope, non-epileptic attack, panic attacks/hyperventilation, sleep phenomena
How should you manage patients who have had a one off seizure?
Counsel the patient and explain what has happened, explain that one seizure doesn’t necessarily mean epilepsy. Explain the risk of recurrence of future seizures and driving rules.
What are the DVLA rules for a one-off seizure in someone who drives a car?
You can reapply for your license after 6 seizure free months if medical advisors decide there isn’t high risk of you having another seizure
What are the DVLA rules for a one-off seizure in someone who drives an HGV?
You can reapply for your license if you haven’t had a seizure in 5 years and you haven’t taken any anti-epilepsy medication in 5 years
What are the DVLA rules for epilepsy in someone who drives a car, who gets seizures while awake and loses consciousness?
You can reapply for your license if you have been seizure free for 1 year
What are the DVLA rules for epilepsy in someone who drives a car, who gets all their seizures at night?
You may still qualify for a license if it has been more than 12 months since your last attack
What are the DVLA rules for epilepsy in someone who drives an HGV?
You can reapply for your license if you haven’t had an epileptic attack in 10 years and haven’t taken any anti-epileptic medication for 10 years
