Introduction to epilepsy Flashcards
Epilepsy
Defined as recurring, unprovoked (spontaneous) seizures
Causes of acute symptomatic seizures
Acute insults such as stroke, alcohol withdrawal, metabolic disturbances
Causes of epilespy
Traumatic brain injury
Tumour
Stroke
Idiopathic
Alcohol
Generalised onset
Electrical discharges appear to start over the whole brain at the same time
Partial/ focal onset
Electrical discharge appears to start in one cortical region and then may remain localised or spread over the whole brain- secondary generalised
Types of Idiopathic generalised seizures
Limited repertoire of seizures
Tonic clonic seizures (grand mal)
Absences (petit mal)
Tonic seizures
Atonic seizures
Myoclonic seizures
Idiopathic generalised seizures
Onset in childhood or adolescence
Usually no focal symptoms/ signs
Often a number of seizure types cluster
Polygenic cause preseumed
Generalised spike and wave discharges on EEG
Photosensitivity may be present
Juvenile myoclonic epilepsy
Commonest form of primary generalised epilepsy
3-12% all epilepsy
Juvenile onset, probably lifelong
Early morning myoclonic jerks
Photosensitive, sleep deprivation triggers
Generalised tonic clonic seizures
Occur without warning
Tonic clonic seizures ‘grand mal’
Occurs without warning- risk of injury
Tonic phase
Clonic phase
Post-ictal phase
Tonic phase
Continuous muscle spasm
Fall
Cyanosis
Tongue biting
Incontinence
Clonic phase
Rhythmic jerking slows and gets larger in amplitude as attack ends
Post ical (post seizure) phase
Coma
Drowsiness
Confusion
Headache
Muscle aching
Absences ‘petit mal’
Abrupt
Short 5-20 seconds
Multiple times/ day- can lead to learning difficulties
Unresponsive, amnesia for the gap
Tone preserved
Eyelid flickering
Absences only, tend to remit in adulthood
Partial seizures- focal onset seizures
Simple partial seizure- patient aware- aura
Complex partial seizure- aura/ warning with a level of reduced awareness
Can be secondary generalised- patient may experience a prior warning
Secondary generalised tonic clonic seizures
Warning/ aura- epigastric rising sensation, altered smell, deja vu, fear
Cannot abort attack
Onset sudden
Duration 1-3 minutes
Fall, lose consciousness as seizure generalises
Rigidity/ convulsive jerks/ excess salivation/ excess salivation/ incontinence/ tongue bite
Temporal lobe epilepsy symtoms
Hallucinations of taste/ speech/ smell/visual
Epigastric rising sensation
Pallor/ flushing/ heart rate changes
Oral lip smacking/ chewing movements
Dystonic posturing
Deja vu
Speech arrest
Fear, elation, depression, anger
Frontal lobe seizures
10-30 seconds
Rapid recovery
Predominantly nocturnal
Forced head/ eye deviation
Motor activity often bizarre, thrashing
Often misdiagnosed as non-epileptic
Parietal lobe epilepsy symptoms
Positive sensory symptoms
Tingling, pain
Distortion of body shape/ image
Jacksonian march of positive sensory symptoms
Occipital lobe epilepsy symptoms
Typically simple visual hallucinations- balls of coloured or flashing lights
Amaurosis (blackout or whiteout) at onset
Which patients to scan
Jacksonian motor or sensory seizures
Patients with focal neurological deficit
Alcohol withdrawal seizure; only scan if subdural haematoma suspected
