neuro epilsepsy Flashcards
what is epilsepy
recurrent tendency to spontanous intermittent abnormal electriacl activity in the btrain - manifests in seizures
types of seizures x2
generalised - both hemispheres
focal / partial - one cerebral hemisphere involved at onset
what is required to be classed a s chronic disease in epilspsy
need at least 2 seizures over 24hrs apart to be epileptic
ecg normal between
what is an aura
part f a seisure patient is unaware of
types of generalised seizures
tonic clonic tonic clonic atonic absence myoclonic
types of focal seizures
simple
complex
partial seizure w secondary generalised - spread to other hemisphere
what is partial seizure w secondary generalised
starts in one hemisphere, electrical activity then spreads to other hemisphere
jerkin
epidem
pre 20 post 60
1% prevalence
dx of epilsepsy
2+ unprovokedn seizures over 24hrs apart
ecg normal in between
mri to ideniftu any strctural abnormalities i.e tumour
ddx of epilsepsy
hypoglycaemia
tia
syncope
non epilieptic attacks
diff between epileptic it and non epileptic attacks
non epileptic - eyes closed and longer
diff between epileptic fit and syncope
syncope eyes closed and no tongue biting
incontinence rarer than vs epilepsy
can avoid by changing posture
what is conceiuousness levels in each partial seizure
simple - remain concsious
complex - impaired conciousness
causes of epilepsy
2/3 - idiopathic cerebal tumours viral enceph meningitis alcohol withdrawal cocaine sle stroke ms
pahtophysicological basis behind epilsepys
too much excitation - glutamate - Ca IN
too little inhibition - GABA - Cl in is inhib - dysfunctional gaba receptor
what is status epilepticus
continuous seizure over 30 mins
increased duration increased cerebral ddmaage
without recovery between
Mx of status epilepticus
IV lorazepram (= a benzodiazepine like in huntingtons chorea)
rectal diazepam
2- phenytoin loading
3 - o2 and anaesthetic
effects of partial seizures if affecting frontal lobe
MOTOR AND THOUGHT
JACKSONIAN MARCH, where they are fully aware of what they are doing but have no control. - up n down motor homunculus starts face/thumb –> entire side
TODDS PARALYSIS = hemiparalysis - 2 days - post ictal
TODD the marching Frog - playing drums - F for frog and frontal
effect of seizures affecting temporal lobe partial seizure
MEM EMOTION RECEPTIVE SPEECH
aura – de ja vu., jamais fu, olfactory hallucinations
automatisms - lipsmacking
can devel into secondary generalised seizure
effect of parietal lobe partial seizure
SENS DISTURBANCES
tingling
numbness
effect of occipital lobe seizure
visual phenomena - zig zag lines
what is clin features of a simple partial seizure
remains consious - awareness unimplaired - no postictal symptoms
Length of seizures,
30 seconds -120 seconds. generally under 3 minutes
examination a=of a seizure, things you can ask witness
How long did the seizure last
what was the character of the seizure, how did it change, phases of the seizure. the speed of convulsions.
if incontinence.
Sequence of events of seizure.
any post ictal signs they have noticed like dysphasia
Examination of a seizure, what would you ask the patient
what were you doing before seizure
did you notice any preictal symptoms, deja vu jamais vu, auras, general feeling.
did you retain consciousness during the seizure. do you have monory of what happened
post ictal features, dysphasia, todd’s Palsy.
does their tongue hurt, indication of tongue biting.
incontinence during seizure
commonest cause of seizures
2/3. Idiopathic generalised epilepsy, usually familial.
Management of seizures
conservative
education on potential triggers, alcohol, substance, stress. medications
education on maintaining safety, driving. avoid baths, locking doors.
Pharmacological management of seizures
antiepileptic drugs- carbamazepine - for tonic clonic, and partial seizures
sodium valproate- for all other kinds
What is a seizure?
The clinical manifestation of dyssynchronous neuronal discharge
What are the tonic and clonic phases of a grand mal seizure?
Tonic - rigid stiff limbs
Clonic - generalised, bilateral, rhythmic jerking
What are the characteristics of a simple partial seizure?
Awareness unimpaired
Focal motor/sensory/autonomic symptoms
No post-ictal symptoms
What is the treatment of primary generalised seizures?
sodium Valproate or lamotrigine
What is the treatment of absence seizures?
sodium Valproate or ethosuximide
What is the treatment of partial seizures?
Carbamazepine or lamotrigine
Surgical management of seizures
Vagus nerve stimulation,
When can a patient drive with epilepsy?
Free of daytime seizures for at least one year
must inform DVLA
hwo does carbamezapine treat partial seizures
inhibits Na channels SE=drowsy
how does iamotrigine treat partial seizures
inhibits glutamate relase - less excitory
SE - blurred vision
