NEURO 232 Epilepsy Flashcards
What is an epileptic seizure?
A transient event experienced by a subject as a result of synchronous and excessive discharge of cerebral neurones
What type of generalised seizures are there?
Tonic clonic
Absence
Myoclonic
Describe generalised tonic clonic seizures
Stereoyped, sudden onset LOC with limb stiffening and synchronous muscle jerking
Often also: cyanosis, tongue biting, incontinence and post-ictal confusion
Describe absence seizures
Begins in childhood, patient stares and pales slightly for a few seconds, maybe mild jerking - they will continue where they left off
Describe myoclonic seizures
Isolated muscle jerking
What are partial seizures
Seizures with a focal onset with features referable to one part of a hemisphere
What can partial seizures be classified into
Complex or simple
Describe complex partial seizures
impairment of awareness, may have aura, post ictal confusion, include automatisms
Describe simple partial seizures
No impairment of awareness, may have focal motor, sensory, autonomic is psychic symptoms - nothing post-ictal
What are common presentations with temporal complex partial seizures?
Aura - rising epigastric sensation, smells and tastes and fear. Motor and speech arrest, automatism with no recollection
What are non-epileptic attacks?
Psychogenic seizures
Describe non-epileptic attacks
retention of awareness, gradual onset, prolonged and frequent, no response to AED’s
asynchronous movements such as back arching, biting tip of tongue
Aura - autonomic arousal
Common with traumatic childhod experiences and a history of MUS
What investigations must be done in suspected seizure?
ECG, EEG and Imaging
What is heterotopic grey matter?
A developmental malformation resulting in island of grey matter that have failed to migrate towards the gyrae leaving a rim of grey matter around the ventricles
Very eliptogenic but normal intelligence
What is idiopathic generalised epilepsy?
A group of generalised seizures with normal imaging but abnormal EEG triggered by alcohol excess and lack of sleep - usually presents in childhood or adolescence
Describe juvenile myoclonic epilepsy
an IGE
upper limb jerking with seizures on waking
photosensitivity
good response to aed’s
What other genetic disease may cause epilepsy and is why you should check the skin?
tuberous sclerosis
What are some causes of epilepsy in adulthood?
IGE’s, head injury, alcohol, vascular malformations, hippocampal sclerosis
What is hippocampal sclerosis?
Scarring of the hippocampus which acts as an eliptogenic focus in partial complex seizures - difficult to control and associated with febrile seizures in infancy
What is usually the 1st sign of a brain tumour in adulthood?
Seizures
What is the commonest cause of epilepsy worldwide?
neurocysticercosis - eggs of pork tapeworm migrate to the brain
What are the principles of treating epilepsy?
Aim for one drug at the lowest dose and make increases over long periods of time
What is the main treatment for generalised epilepsy?
Sodium valproate, or lamotrigine, levitiracetam (women)
What is the main treatment for partial epilepsy?
carbamaxepine, lamotrigin and leviterecetam
When would you consider drug withdrawal?
2 years seizure free
What is status epilepticus?
Seizures/series of lasting 30 minutes without regaining consciousness = a medical emergency
What are some causes of status epilepticus?
encephalitis, tumours, trauma or missed dose/infection in those with epilepsy
What do you give immediately/early in status epilepticus?
iv lorazepam 4mg and repeat once after 10 minutes
What do you give in established status epilepticus?
iv phenytoin 15mg/kg given 50mg in 1 minute
What is the management in refractory status epilepticus?
ITU, GA, IV propofol/thiopental/midazolam
What is SUDEP?
Sudden unexpected death in epilepsy - non traumatic unwitness
What are the risk factors for SUDEP?
high seizure frequencym polytherapy, medication changes, young onset, poor compliance
How long must you be seizure free for to have a group 1 license?
1 year
6 months if single seizure and normal investigations
only in sleep - 1 year
What is the cingulate cortex involved in?
learning memory and emotion
What is the septal area in the brain?
The relay between the hippocampus and the hypothalamus with medial and ventral nuclei
What is the hippocampus important for?
all types of memory and is one of the most active sites for neurogenesis
post/dorsal = place cells - spatial memory/learning
What is the amygdala involved in?
fear and aggression
What personality changes can occur in temporal lobe epilepsy and why?
Due to the effect on the amygdala, hippocampal etc
hypergraphia, hypo-sexuality, emotional viscosity, mood swings, excessive religion
