Non-Epileptic Attacks Flashcards
What are some examples of functional attacks?
Dissociative seizures Non-epileptic attack disorder Pseudoseizures Psychogenic non-epileptic seizures Hysterical seizures
What are functional attacks related to?
Traumatic events Physical/sexual abuse Other stress Anxiety or depression Other
How are functional attacks diagnosed?
History
Linguistic analysis
Outpatient EEG and video with provocation
Longterm video EEG monitoring
Where do seizures result from?
Abnormal electrical discharge in part of brain- not all of the brain is active at once
Can mimic area of brain function
This is how seizure semiology is used
What will be felt in somatosensory auras?
Numbness Tingling Electric shocks Thermal sensations Pain
Where are somatosensory auras from?
Somatosensory cortext (parietal lobe) Occasional insular cortex
What can be seen in visual auras?
Simple shapes Static Flashing Moving lights Colours
Where are visual auras from?
Occipital love
Occasionally temporal
Where are vertiginous auras from?
Temporal-parietal lobe, near visual and auditory association areas
Where are autonomic auras from?
Temporal lobe (insula, amygdala, etc)
What are some features of functional attacks?
Attacks with prominent motor activity
Episodes of collapse with no movement
Abreactive attacks- fear, gasping, hyperventilation
Duration often prolonged eg 10-20mins
How are functional attacks treated?
Removal of any diagnosis of epilepsy
Withdrawal of antiepileptic drugs
Explanation of the nature of the attacks
Positive support
Appropriate counseling for any previous traumatic events
Treatment of any associated anxiety or depression
CBT
What is status epilepticus?
Recurrent epileptic seizures without full recovery of consciousness
Continuous seizure activity lasting more than ?30 minutes
What are the types of status epilepticus?
Generalized convulsive status epilepticus
Non convulsive status- conscious but in “altered state”
Epilepsia partialis continua- continual focal seizures, consciousness preserved
What are some precipitants of status epilepticus?
Severe metabolic disorders- hyponatraemia, pyridoxine deficiency Infection Head trauma Sub-arachnoid haemorrhage Abrupt withdrawl of anti-convulsants Treating absence seizures with CBZ
What is convulsive status epilepticus?
Generalised convulsions without cessation
Why can convulsive status epilepticus cause lasting damage?
Due to the excess cerebral energy demand and poor substrate delivery
What can convulsive status epilepticus cause?
Respiratory insufficiency and hypoxia
Hypotension
Hyperthermia
Rhabdomolysis
What can occur in uncontrolled status epilepticus?
Glutamate release
Excitotoxicity
Neuronal death
How is status epilepticus managed?
ABCDE
Identify cause- emergency bloods +- CT
Anti-convulsants- phenytoin (check levels), keppra, valproate, benzos
How should prolonged and serial seizures be treated by carers at home?
Diazepam 10-20mg rectal
Midazolam 10-20mg buccal
What immediate antiepileptic drug treatment can be given in status epilepticus?
Lorazepam 4mg IV (preferred as long duration of action)
Diazepam 10-20mg IV(respiratory depression, hypotension)
If there is a delay in gaining IV access, what antiepileptic drug treatment can be given for immediate control of status epilepticus?
Diazepam 10-20mg rectal
Midazolam 5-10mg IM
What should be given in status epilepticus if there is any suggestion of hypoglycaemia?
50ml 50% glucose
What should be given in status epilepticus if there is any suggestion of alcoholism or impaired nutritional status?
IV Thiamine
What antiepileptic drug treatment should be given for sustained control of status to epilepticus in patients with established epilepsy?
Re-establish usual AED treatment by NG tube/orally/(IV for phenytoin)
What antiepileptic drug treatment should be given for sustained control of status to epilepticus in patients without established epilepsy or if seizures are continuing?
Fosphenytoin 18mg(PE)/kg IV, 100-150mg/min with ECG monitoring
Phenytoin 18mg/kg IV, <50mg/min with ECG monitoring
Phenobarbital 15mg/kg IV 100mg/min (fosphenytoin or phenobarbital preferable as can be given more rapidly)
Maintain phenobarbital/phenytoin levels by NG tube/IV/orally
If status epilepticus persists beyond drug treatment, what should be done?
ITU transfer within 1hr of admission
Control status with GA with thiopentone or propofol
Monitor control with full EEGs or cerebral function monitor
What should be considered in any patient presenting with an acute confusional state?
Possibility of partial status epilepticus
How is partial status epilepticus confirmed?
EEG recording
How is partial status epilepticus treated?
As for convulsive status epilepticus short of GA and ITU admission
