Neurology - Seizures Flashcards by Jack Hogg

Causes of NEAD

Childhood abuse
Neglect
Psych conditions - Depression, schizophrenia

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Presentation of NEAD

Gradual onset 
Long duration > 2 minutes
Pelvic thrusting 
Post-ictal crying/upset 
Violent thrashing 
Don't occur when alone

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NEAD investigations

Prolactin - Normal

Video telemetry

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What is NEAD

Disorder of movement, sensation or experience that resembles epileptic seizure without cerebral ictal damage

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What is a seizure

Clinical manifestation of abnormal and excessive neuronal discharge

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What is epilepsy

A tendency to have seizures

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What is syncope

Transient global cerebral hypoperfusion

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Causes of epilepsy

Cerebral palsy 
Tuberous sclerosis 
Downs 
Mitochondrial disease
SLE 
Cerebral vascular disease
Tumours

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Focal seizures

Simple partial
Complex partial
Jacksonian
Todd’s paralysis

Can spread to bilateral

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Generalised seizures

Tonic-clonic 
Myoclonic 
Tonic 
Atonic 
Absense

Both sides of the brain - Always LOC

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Simple partial presentation

No LOC
No memory loss
No post-ictal symptoms

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Complex partial presentation

LOC
Memory loss
Post-ictal confusion

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What does Jacksonian mean

Spreads from distal to proximal - E.g. in an arm

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What is Todd’s paralysis

Paralysis after a seizure

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Temporal seizures presentation

Hallucinations
Automatisms - Lip smacking, grabbing, pulling
Deja vu
Post-ictal dysphasia

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Frontal seizure presentation

Movements
Post-ictal weakness
Jacksonian march

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Parietal seizure presentation

Paraesthesia

Occipital seizure presentation

Floaters/flashers

Absence seizure presentation

Cease activity

Blank stare

What happens in a tonic-clonic seizure

Rigid

Followed by convulsions

What happens in a tonic seizure

Rigid

What happens in a myoclonic seizure

Rapid jerk movements

What is an atonic seizure

Sudden loss of muscle tone causing a fall

Pre-ictal symptoms

Prodrome - Change in mood or behaviour

Aura

Strange feeling in gut
Deja vu
Change in smell
Flashing lights

Post-ictal symptoms

``` Headache Confusion Myalgia Sore tongue Temporary weakness - FRONTAL Dysphasia - TEMPORAL ```

Other causes of seizure

VITAMIN D ``` Vascular - Stroke, SAH, haematoma Infection - Meningitis, abscess Trauma - Head injury AI - SLE Metabolic - Hypoglycaemia, hypoxia, alcohol withdrawal, fever Iatrogenic - TCA, BDZ, tramadol Neoplasm - Primary and secondary mets Degenerative ```

Epilepsy diagnostic criteria

2 or more unprovoked seizures occurring > 24 hours apart

Epilepsy investigations

EEG | MRI

Epilepsy management indications

Start after second seizure Start in first seizure if... - FND - Structural abnormality on imaging

Focal epilepsy management

Carbamazepine | Lamotrigine

Absence epilepsy management

Valproate Ethosuximide NOT CARBAMAZEPINE

Tonic clonic epilepsy management

Valproate Lamotrigine Carbamazepine

Myoclonic epilepsy management

Valproate Lamotrigine Clonazepam NOT CARBAMAZEPINE

Valproate side effects

VALPROATE ``` Vomiting Anorexia/ataxia Liver toxicity Pancreatitis Retention of weight Oedema Alopecia Teratogenic - NTD, tremor, thrombocytopenia Enzyme inhibitor - P450 ```

Driving with epilepsy

No structural defect and no epilepsy on EEG - Cannot drive for 6 months after first unprovoked seizure If epilepsy - Must be seizure free for 12 months

Epilepsy in pregnancy

Require specialist care | NO VALPROATE

Status epilepticus definition

Seizure lasting > 5 minutes > 2 seizures in 5 minutes NEAD IS DDx

Causes of status epilepticus

Stopping anti-epileptic drugs | Alcohol withdrawal

Status epilepticus management

``` ABC + O2 Buccal midazolam Rectal diazepam IV lorazepam Phenytoin Known epilepsy - Phenobarbital Intubate ```

Complications of status epilepticus

Renal - AKI from rhabdomyolysis Metabolic - Lactic acidosis and hypercapnia Autonomic - Vomiting, incontinence Cardio/resp - Hypoxia, aspiration pneumonia