neurology Flashcards
A 7-year-old boy is seen by his general practitioner after his teacher has been noticing that the young boy often stares blankly at the wall for a few seconds. During these episodes, he is usually unresponsive and unable to speak.
What is the most likely diagnosis?
absence seizure
what are the factors used to classify seizures
basic seizure classification is based on 3 key features:
1. Where seizures begin in the brain
2. Level of awareness during a seizure (important as can affect safety during seizure)
3. Other features of seizures
how are seizures classified
focal
generalised
unknown onset
focal to bilateral seizure
what are the features of focal seizures
previously termed partial seizures
these start in a specific area, on one side of the brain
the level of awareness can vary in focal seizures.
The terms focal aware (previously termed ‘simple partial’), focal impaired awareness (previously termed ‘complex partial’) and awareness unknown are used to further describe focal seizures
focal seizures can be classified as being motor (e.g. Jacksonian march), non-motor (e.g. déjà vu, jamais vu; ) or having other features such as aura
what are the motor features of focal seizures
e.g. Jacksonian march
what are the non-motor features of focal seizures
(e.g. déjà vu, jamais vu; ) or having other features such as aura
what are the features of generalised seizures
these engage or involve networks on both sides of the brain at the onset
consciousness lost immediately.
The level of awareness in the above classification is therefore not needed, as all patients lose consciousness
generalised seizures can be further subdivided into motor (e.g. tonic-clonic) and non-motor (e.g. absence)
what are the specific examples of generalised seizures
generalised seizures can be further subdivided into motor (e.g. tonic-clonic) and non-motor (e.g. absence)
tonic-clonic (grand mal)
tonic
clonic
typical absence (petit mal)
atonic
what are seizures of unknown onset
this termed is reserved for when the origin of the seizure is unknown
what is focal to bilateral seizures
starts on one side of the brain in a specific area before spreading to both lobes
previously termed secondary generalized seizures
what is epilepsy
neurological condition characterised by recurrent seizures
what diseases is epilepsy associated with
cerebral palsy: around 30% have epilepsy
tuberous sclerosis
mitochondrial diseases -
what are the causes of seizures?
can develop one-off seizures following any insult to the brain, for example, infection, trauma or metabolic disturbance.
- febrile convulsions
- alcohol withdrawal seizures
- psychogenic non- epileptic seizures
what are febrile convulsions
typically occur in children between the ages of 6 months and 5 years
around 3% of children will have at least one febrile convulsion
usually occur early in a viral infection as the temperature rises rapidly
seizures are typically brief and generalised tonic/tonic-clonic in nature
what are alcohol withdrawal seizures, what is the peak incidence of these seizures
ccur in patients with a history of alcohol excess who suddenly stop drinking, for example following admission to hospital
the peak incidence of seizures is at around 36 hours following cessation of drinking
what can patients be given to reduce risk of alcohol withdrawal seizures
benzodiazepines following cessation of drinking to reduce the risk
what are psychogenic non-epileptic seizures
previously termed pseudoseizures
describes patients who present with epileptic-like seizures but do not have characteristic electrical discharges
patients may have a history of mental health problems or a personality disorder
what are the signs and sx of epilepsy
loss of consciousness - ‘blackout’ or ‘collapse’.
bite their tongue
experience incontinence of urine
motor jerks
what is the postictal phase in epilepsy
where they feel drowsy and tired for around 15 minutes following seizure
investigations in patient presenting with blackout/ suspected seizure
electroencephalogram (EEG) and neuroimaging (usually a MRI).
describe management of seizures
meds started after the second seizure
As a general rule:
sodium valproate is used first-line for patients with generalised seizures
carbamazepine is used first-line for patients with focal seizures
what is status epilectus and how is it managed
If a patient continues to fit benzodiazepine medication
a medical emergency requiring hospital treatment.
Management options include further benzodiazepine medication, infusions of antiepileptics or even the use of general anaesthetic agents.
describe the acute management of epilepsy
seizures can resolve spontaneously
when seizures don’t terminate after 5-10 minutes then it is often appropriate to administer medication to terminate the seizure. Patients are often prescribed these so family members may administer them in this eventuality
‘rescue medication’ = Benzodiazepines such as diazepam are typically used are may be administered rectally or intranasally/under the tongue.
which groups of patients should be considered when prescribing anti epileptics
- pt who drive
- pt taking other meds
- women wishing to get pregnant
- women on contraception
advice to patients who drive on ant epileptics
generally patients cannot drive for 6 months following a seizure. For patients with established epilepsy they must be fit free for 12 months before being able to drive
advice to patients who drive on ant epileptics
generally patients cannot drive for 6 months following a seizure. For patients with established epilepsy they must be fit free for 12 months before being able to drive
advice to patients who on other meds on antiepileptics
antiepileptics can induce/inhibit the P450 system resulting in varied metabolism of other medications, for example warfarin
advice to patients who wishing to get pregnant antiepileptics
antiepileptics are generally teratogenic, particularly sodium valproate. It is important that women take advice from a neurologist prior to becoming pregnant, to ensure they are on the most suitable antiepileptic medication. Breastfeeding is generally considered safe for mothers taking antiepileptics with the possible exception of the barbiturates
advice to patients who are on contraception and on antiepileptics
both the effect of the contraceptive on the effectiveness of the anti-epileptic medication and the effect of the anti-epileptic on the effectiveness of the contraceptive need to be considered
drugs used in epilepsy
sodium valporate
carbamepezine
Lamotrigine
phenytoin
