Non-Epileptic Attacks and Status Epilepticus Flashcards
Why do symptoms of a non-epileptic attack occur?
The subconscious part of the brain takes over from the conscious part of the brain which causes functional behaviours
What is the one marker that shows generally that people will not improve from non-epileptic attacks?
When they go on benefits
Can non-epileptic attacks be seen in people with pre-existing epilepsy?
Yes, frequently in the context of significant stress
Are non-epileptic attacks consciously mediated?
No, so the patient has no control over them
What are some causes for non-epileptic attacks?
Traumatic events, abuse, stress, anxiety or depression
How will a person who has had a non-epileptic attack present that may be different from an epileptic seizure?
They will know exactly what happened and what it felt like
How can you confirm a non-epileptic attack?
EEG - can either talk them into having an attack or can use long term video monitoring
What effect does anti-epileptic medication have on non-epileptic attacks?
It can make them worse
What are some treatment options for non-epileptic attacks?
Remove any diagnosis of epilepsy, gradually stop AEDs, find the underlying cause and give support, treat any co-morbid anxiety/depression, CBT (coping strategies and self-awareness techniques)
What are some movements favouring a non-epileptic attack?
Pelvic thrusting, side to side head or body movements
Describe the duration of a non-epileptic attack?
Normally longer than an epileptic seizure (mins-hours) and may be fluctuating
What are some triggers for a non-epileptic attack?
Anxiety or traumatic life events
What may happen after a non-epileptic attack?
The individual may be tearful
Do people get confusion following a non-epileptic attack?
Sometimes, but this doesn’t last for very long compared to an epileptic seizure
What happens to a persons eyes during a non-epileptic attack?
They are tightly closed (in epilepsy, they will be open and deviated)
Describe status epilepticus?
Recurrent seizures without gaining consciousness in between for > 30 minutes or a single seizure lasting > 30 minutes
What is convulsive status?
When there are generalised seizures without cessation
What defines non-convulsive status?
Conscious, but in an altered state
What is epilepsia partialis continua?
Continual focal seizures with preserved consciousness
What are some metabolic disorders that can precipitate status?
Hyponatraemia or pyridoxine (B6) deficiency
What are some precipitants of status?
Infection, head trauma, SAH, withdrawal of or impaired absorption of anti-convulsants
Why does status epilepticus cause hyperthermia?
Continued tonicity increases metabolic rate
Why does status epilepticus cause hypotension?
Massive vasodilation occurs to try to get rid of the excess heat
How many hours down the line in status epilepticus can there be cerebral damage?
8-10
What is the first line management of status epilepticus?
ABCDE
What must always be investigated if a patient presents with status epilepticus? What are some ways this can be done?
What is the underlying cause - collateral history, bloods, CT
What is the first medication that should be used in the manangement of status epilepticus?
Benzodiazepines
How can benzodiazepines be given in status epilepticus?
4mg lorazepam IV or 10mg midazolam buccal
Can a second dose of benzodiazepines be given in status epilepticus if the patient was unresponsive to the first?
Yes, they can have a repeated dose after 5 minutes of no response if they have not had a previous dose in the last 12 hours
You should never give more than how many doses of benzodiazepines in status epilepticus?
2
Benzodiazepines can only be given within how long of the start of status?
30 mins
Apart from benzodiazepines, what are some other medications you can deliver in the first 30 minutes of status epilepticus?
IV phenytoin with ECG monitoring or IV sodium valproate
Treatment for status epilepticus should be started when?
After 10 minutes
What should you do if there are no signs of improvement after 30 minutes of status?
Get ITU involved to administer general anaesthesia
If status is persistent, patients should be transferred to ITU within how long since their admission?
1 hour
How should you monitor patients in ITU with status epilepticus?
EEG
The possibility of partial status epilepticus should be considered in anyone presenting with what?
An acute confusional state
How can a diagnosis of partial status epilepticus be made and how should it be managed?
With an EEG, manage as for status epilepticus (with the exception of general anaesthesia and ITU admission)
