lecture 10 - epilepsy Flashcards
What is a seizure?
A convulsion or transient abnormal eventing resulting from a paroxysmal discharge of cerebral neurons
What is a common clinical definition of epilepsy?
At least 2 unprovoked seizures occurring more than 24 hours apart
What are the 3 types of onset of a seizure?
Focal onset, generalised onset, unknown onset
Which type of seizure will always alter consciousness?
Generalised - entire CNS is affected
What are the 3 different categories that epileptic seizures are classified under?
focal vs generalised,
aware vs unaware,
motor vs non-motor
What is the term for a non-motor generalised seizure?
Absence seizure
What is the alternate term for an absence seizure?
Petit mal
What is the alternate term for a tonic-clonic seizure?
Grand mal
What is an atonic seizure?
A seizure where there is partial or total loss of muscle tone
What is a myoclonic seizure?
A seizure characterised by arrhythmic, random muscle jerks
What is a tonic-clonic seizure?
A seizure characterised by extension/flexion (tonic) and then rhythmic jerking (clonus)
What investigation is used to diagnose seizures?
EEG (electroencephalogram)
What are the basic characteristics of an EEG during a generalised seizure?
Spikes/waves across all EEG leads, may be of varying height but all start at the same time
What are the basic characteristics of an EEG during a partial seizure?
Spikes/waves in some leads, though others may be affected later due to spread (focal to bilateral seizure)
What are some differential diagnoses for seizure?
syncope, migraine, TIA, hypoglycaemia, pseudoseizures
What are some causes of non-epileptic seizures?
Trauma, surgery, space occupying lesions, pyrexia, vascular issues, drugs/ drug withdrawal, encephalitis, metabolic abnormalities, degenerative neural disorders
What are the 2 main classes of drugs used in epilepsy/seizure management?
Anti-convulsants, benzodiazipines
What 2 drugs are most commonly used in focal seizures and most generalised seizures?
Valproate, levetiracetam
What drugs are most commonly used in focal seizures?
Phenytoin, carbamazepine, pregabalin
What anticonvulsant drug is only effective in treating absence seizures?
Ethosuximide
What is the clinical definition of status epilepticus?
Recurring seizure without recovery or a single seizure lasting for greater than 5 minutes
What is the first line treatment for status epilepticus?
benzodiazipines, followed by AEDs or barbiturates
Why is status epilepticus dangerous?
After 30 minutes, there is a high risk of long-term brain damage or death due to respiratory and airway dysfunction
What are the principles of bystander/paramedic management of a seizure in the community?
position patient on their side, remove dangers, put pillow under head, reassure bystanders, assess airway patency, nasopharyngeal airway, oxygen therapy after seizure, IM/IV benzos, gain history from family/patient, head-to-toe check, signs of stroke
What are the principles of a history taking following a seizure?
history of epilepsy, last known seizure, drug management, skipped doses, typical seizure pattern, recent injury/illness, seizure type (generalised/focal), alcohol/benzo use
