Neurology - Epilepsy Flashcards
What are seizures?
transient episodes of abnormal electrical activity in the brain
Investigations
EEG
MRI brain
ECG
what do tonic and clonic mean?
tonic - muscle tensing
clonic - muscle jerking
what comes first tonic or clonic phase?
tonic
associated features of generalised tonic-clonic seizures
tongue biting incontinence groaning irregular breathing post-ictal period
post-ictal period - tonic clonic
prolonged
confused, drowsy and irritable
managing tonic-clonic seizures
sodium valproate
lamotrigine/carbamazepine
where do focal seizures start?
temporal lobe
what do focal seizures affect?
hearing, speech, memory and emotions
how can focal seizures present?
hallucinations
memory flashbacks
deja vu
treatment for focal seizures - 1st line
carbamazepine or lamotrigine
second line treatment focal seizures
sodium valproate
levetiracetam
who do absence seizures typically occur in?
children
describe an absence seizure
blank, stares into space and abruptly return to normal
treating absence seizures
sodium valproate or ethosuximide
atonic seizures
lapses in muscle tone
what can atonic seizures be indicative of?
lennox-gastaut syndrome
managing atonic seizures
sodium valproate
2nd - lamotrigine
what do myoclonic seizures typically occur as part of?
juvenile myoclonic epilepsy
describe myoclonic seizure
sudden jump
patient usually awake
treating myoclonic seizures
sodium valproate
lamotrigine, topiramate
infantile spasms
rare starts at 6 months
clusters of full body spasms
infantile spasms prognosis
1/3 die by 25 but 1/3 are seizure free
treating infantile spasms
prednisolone
vigabatrin
what is first line for most types of epilepsy? what is the exception?
sodium valproate
focal epilepsy
how does valproate work?
increase GABA activity
relaxing effect on the brain
sodium valproate side effects
teratogenic
liver damage and hepatitis
hair loss
tremor
side effects of carbamazepine
agranulocytosis
aplastic anaemia
induces p450 - interactions
phenytoin side effects
folate and vit D deficiency
osteomalacia
ethosuximide side effects
night terrors
rashes
lamotrigine side effects
SJS or DRESS
leuokopenia
define status epilepticus
seizures lasting >5 minutes or more than 3 seizures in 1 hour
non-pharmacological treatment status epilepticus
secure airway
high concentration oxygen
ABCDE - check glucose, IV access
medical treatment status epilepticus community
10-20mg rectal diazepam
10mg buccal midazolam
medical treatment status epilepticus hospital
IV lorazepam 4mg repeat after 10 mins
IV phenytoin or phenobarbital
final diagnosis for people presenting with first seizure
25% epilepsy
syncope, single seizure, psychiatry, narcolepsy etc
important history from patient
preceding seizure warning symptoms level of awareness first recollection seizure markers - tongue biting, incontinence
3rd party history - seizure
very important how were they before seizure eyes open or closed describe movements pallor, breathing, pulses duration time to recover
3 categories of syncope
reflex (neurocardiogenic)
orthostatic
cardiogenic - arrhythmia
provoked seizures
alcohol/drug withdrawal
24hrs after head injury
eclampsia
name some generalised seizures
tonic-clonic
myoclonic
absence
atonic
name some focal seizures
simple partial
complex partial
temporal lobe
generalised vs focal seizures
generalised = no warning, under 25, absences, EEG general abnormality, FH focal = aura, any age, MRI
automatisms
lip smacking
repetitive picking at clothing
invesigations
ECG, bloods (glucose)
MRI, EEG
DVLA rules
single seizure - 6 month ban if investigations normal and no further events
seizure free for a year
