Non-Epileptic Attacks and Status Epilepticus

Question 1

Why do symptoms of a non-epileptic attack occur?

Answer 1

The subconscious part of the brain takes over from the conscious part of the brain which causes functional behaviours

Question 2

What is the one marker that shows generally that people will not improve from non-epileptic attacks?

Answer 2

When they go on benefits

Question 3

Can non-epileptic attacks be seen in people with pre-existing epilepsy?

Answer 3

Yes, frequently in the context of significant stress

Question 4

Are non-epileptic attacks consciously mediated?

Answer 4

No, so the patient has no control over them

Question 5

What are some causes for non-epileptic attacks?

Answer 5

Traumatic events, abuse, stress, anxiety or depression

Question 6

How will a person who has had a non-epileptic attack present that may be different from an epileptic seizure?

Answer 6

They will know exactly what happened and what it felt like

Question 7

How can you confirm a non-epileptic attack?

Answer 7

EEG - can either talk them into having an attack or can use long term video monitoring

Question 8

What effect does anti-epileptic medication have on non-epileptic attacks?

Answer 8

It can make them worse

Question 9

What are some treatment options for non-epileptic attacks?

Answer 9

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)

Question 10

What are some movements favouring a non-epileptic attack?

Answer 10

Pelvic thrusting, side to side head or body movements

Question 11

Describe the duration of a non-epileptic attack?

Answer 11

Normally longer than an epileptic seizure (mins-hours) and may be fluctuating

Question 12

What are some triggers for a non-epileptic attack?

Answer 12

Anxiety or traumatic life events

Question 13

What may happen after a non-epileptic attack?

Answer 13

The individual may be tearful

Question 14

Do people get confusion following a non-epileptic attack?

Answer 14

Sometimes, but this doesn’t last for very long compared to an epileptic seizure

Question 15

What happens to a persons eyes during a non-epileptic attack?

Answer 15

They are tightly closed (in epilepsy, they will be open and deviated)

Question 16

Describe status epilepticus?

Answer 16

Recurrent seizures without gaining consciousness in between for > 30 minutes or a single seizure lasting > 30 minutes

Question 17

What is convulsive status?

Answer 17

When there are generalised seizures without cessation

Question 18

What defines non-convulsive status?

Answer 18

Conscious, but in an altered state

Question 19

What is epilepsia partialis continua?

Answer 19

Continual focal seizures with preserved consciousness

Question 20

What are some metabolic disorders that can precipitate status?

Answer 20

Hyponatraemia or pyridoxine (B6) deficiency

Question 21

What are some precipitants of status?

Answer 21

Infection, head trauma, SAH, withdrawal of or impaired absorption of anti-convulsants

Question 22

Why does status epilepticus cause hyperthermia?

Answer 22

Continued tonicity increases metabolic rate

Question 23

Why does status epilepticus cause hypotension?

Answer 23

Massive vasodilation occurs to try to get rid of the excess heat

Question 24

How many hours down the line in status epilepticus can there be cerebral damage?

Answer 24

8-10

Question 25

What is the first line management of status epilepticus?

Answer 25

ABCDE

Question 26

What must always be investigated if a patient presents with status epilepticus? What are some ways this can be done?

Answer 26

What is the underlying cause - collateral history, bloods, CT

Question 27

What is the first medication that should be used in the manangement of status epilepticus?

Answer 27

Benzodiazepines

Question 28

How can benzodiazepines be given in status epilepticus?

Answer 28

4mg lorazepam IV or 10mg midazolam buccal

Question 29

Can a second dose of benzodiazepines be given in status epilepticus if the patient was unresponsive to the first?

Answer 29

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

Question 30

You should never give more than how many doses of benzodiazepines in status epilepticus?

Answer 30

2

Question 31

Benzodiazepines can only be given within how long of the start of status?

Answer 31

30 mins

Question 32

Apart from benzodiazepines, what are some other medications you can deliver in the first 30 minutes of status epilepticus?

Answer 32

IV phenytoin with ECG monitoring or IV sodium valproate

Question 33

Treatment for status epilepticus should be started when?

Answer 33

After 10 minutes

Question 34

What should you do if there are no signs of improvement after 30 minutes of status?

Answer 34

Get ITU involved to administer general anaesthesia

Question 35

If status is persistent, patients should be transferred to ITU within how long since their admission?

Answer 35

1 hour

Question 36

How should you monitor patients in ITU with status epilepticus?

Answer 36

EEG

Question 37

The possibility of partial status epilepticus should be considered in anyone presenting with what?

Answer 37

An acute confusional state

Question 38

How can a diagnosis of partial status epilepticus be made and how should it be managed?

Answer 38

With an EEG, manage as for status epilepticus (with the exception of general anaesthesia and ITU admission)