Neurology - Seizures Flashcards
Causes of NEAD
Childhood abuse
Neglect
Psych conditions - Depression, schizophrenia
Presentation of NEAD
Gradual onset Long duration > 2 minutes Pelvic thrusting Post-ictal crying/upset Violent thrashing Don't occur when alone
NEAD investigations
Prolactin - Normal
Video telemetry
What is NEAD
Disorder of movement, sensation or experience that resembles epileptic seizure without cerebral ictal damage
What is a seizure
Clinical manifestation of abnormal and excessive neuronal discharge
What is epilepsy
A tendency to have seizures
What is syncope
Transient global cerebral hypoperfusion
Causes of epilepsy
Cerebral palsy Tuberous sclerosis Downs Mitochondrial disease SLE Cerebral vascular disease Tumours
Focal seizures
Simple partial
Complex partial
Jacksonian
Todd’s paralysis
Can spread to bilateral
Generalised seizures
Tonic-clonic Myoclonic Tonic Atonic Absense
Both sides of the brain - Always LOC
Simple partial presentation
No LOC
No memory loss
No post-ictal symptoms
Complex partial presentation
LOC
Memory loss
Post-ictal confusion
What does Jacksonian mean
Spreads from distal to proximal - E.g. in an arm
What is Todd’s paralysis
Paralysis after a seizure
Temporal seizures presentation
Hallucinations
Automatisms - Lip smacking, grabbing, pulling
Deja vu
Post-ictal dysphasia
Frontal seizure presentation
Movements
Post-ictal weakness
Jacksonian march
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
