Patho- Epilepsy Flashcards
What is epilepsy?
A group of CNS disorders in which recurrent seizures occur, due to chronic underlying processes
What are the two main pathologies of epilepsy?
Primary/idiopathic
Secondary/symptomatic
What is primary epilepsy?
No causative event behind it
What is secondary epilepsy?
Epilepsy caused by something else
What can cause secondary epilepsy?
Trauma Neoplasm Hydrocephalus Infection Developmental abnormalities Cerebrovascular disease
What are the two main categories of epilepsy?
Generalised
Focal
Which part of the brain does generalised epilepsy affect?
All of it
Name some forms of generalised seizures
Grand mal/generalised tonic-clonic Petit mal/absence Myoclonic Tonic Atonic Akinetic Infantile spasms/febrile convulsions Functional
What is a differential for generalised seizures?
Vasovagal
What is vasovagal reaction?
Loss of consciousness due to reacting to trigger (blood etc).
Quick recovery
Describe grand mal/generalised tonic-clonic
Tonic rigidity followed by a tremor.
What is the tonic phase?
Body rigidity
What can happen in the tonic phase?
Incontinence
Tongue biting
How long does a tonic episode tend to last?
Seconds to a minute
What is a clonic phase?
Convulsions
What can happen in a clonic phase?
Mouth frothing
Jerking
How long can a clonic phase last?
Minutes
What follows a generalised tonic-clonic seizure?
Drowsiness, confusion or coma
IS it possible to be conscious during a seizure?
No- if conscious then cannot be epilepsy!!!
How do you treat a generalised tonic-clonic seizure?
Leave generally and will resolve
Diazepam or phenytoin
How do you prevent generalised tonic-clonic seizures?
Sodium valproate
Lamotrigine in women of childbearing age
Carbamazepine
What causes an absence seizure?
Developmental abnormalities of neuronal control.
What are the symptoms of an absence seizure?
10-45 s (maybe 100/day) with consciousness altered- blank out.
3 Hz spike-and-wave EEG activity
Mild clonic spasms may occur
Who develops absence seizures?
Children
How do you prevent absence seizures?
Ethosxumide
Valproate
What must you NOT give to those with absence seizures?
Carbamazepine
Phenytoin
What is myoclonic seizure?
Isolated clonic jerks
How does myoclonic seizure present on EEG?
3Hz spike and wave
WHat are the symptoms of a myoclonic seizure?
Rhythmic series of clonic seizures
Isolated clonic jerks
How do you prevent a myoclonic seizure?
Sodium valproate
Clonazepam
Lamotrigine
What should you not give to someone with myoclonic seizures?
Carbamazepine
What is a tonic seizure?
Intense stiffening of body without jerks
What is an atonic seizure?
Sudden loss of posture leading to collapse
What is an akinetic seizure?
Cessation of movement, falling and loss of consciousness
What is an Infantile spasms/febrile convulsions?
A syndrome with bilateral attacks of brief recurrent myoclonic jerks.
What causes Infantile spasms/febrile convulsions?
Fever
How do you treat an Infantile spasms/febrile convulsions?
Leave if under 15m
Diazepam >15m
What is a functional seizure?
Trigger will cause the person to trash when they see or hear something
What is a functional seizure often a sign of?
Abuse
What are partial seizures?
Seizure affecting only one part of the brain
Give some examples of partial seizures
Simple partial
Complex partial
Temporal lobe
Partial seizures secondarily generalized
What is a Partial seizures secondarily generalized?
Partial seizure immediately preceding a GTC seizure
What is a simple partial seizure?
Just motor clonic restricted to one or a few muscles
Where does a simple partial seizure originate?
Motor cortex
What is The March of the Seizures?
In simple partial the clonic movement starts at the edge of the mouth and moves elsewhere
How is consciousness impaired in a simple partial seizure?
No concious loss
What is complex partial seizure?
SImilar to simple but with consciousness impairment/confusion/falling and Automatisms
What are Automatisms?
Unconscious movement that may resemble simple repetitive tics
What are some symptoms of a temporal lobe seizure?
Feeling of unreality or undue familiarity with the surroundings
Blank episodes of staring, vertigo, visual hallucinations
Auditory and balance affected
“Reality is unreal”
What is the buzzword for a temporal lobe seizure?
Lipsmacking
How do you treat partial seizures?
Carbamazepine or lamotrigine
What is status epilepticus?
A life-threatening neurological condition defined as 5 or more minutes of either continuous seizure activity or repetitive seizures without regaining consciousness.
Used to be 30 minutes
How serious is status epilepticus?
Medical emergency!
What is the pathophysiology of epilepsy?
High frequency AP bursts
Hypersynchronization
Failure of synaptic inhibition
What is the seizure threshold?
The minimum threshold at which seizures will occur
How do you diagnose epilepsy?
EEG
History
Rule out syncope- BP and ECG
How do you rule out syncope?
BP and ECG
How does a seizure appear on EEG?
High voltage spike-and-wave activity
Normal between attacks
When should you CT in epilepsy?
Clinical or radiological skull fracture Deteriorating GCS Focal signs Head injury with seizure Failure to be GCS 15/15 4 hours after arrival Suggestion of other pathology (e.g. SAH)
How do you actually treat epilepsy?
Leave Diazepam Midazolam Phenytoin Treat underlying cause (hypoglycemia etc)
What are some side effects of phenytoin?
Gum hypertrophy
Hirtuism
How often should phenytoin be given?
Once a day MAX!
How should epilepsy prophylaxis be given?
Start low and go slow
Name four main antiepileptic drugs for prophylaxis
Clonazepam
Sodium valproate
Carbamazepine
Lamotrigine
What are the side effects of Lamotrigine?
Rash
Headache
What is clonazepam mainly used for?
Myotonic seizures
What are some side effects of clonazepam?
Sleep
What group should sodium valproate not be given to?
WOmen of child bearing age
What are some side effects of sodium valproate?
Weight gain/appetite stim Teratogenic Hair loss Thrombocytopenia Fatigue Tremor
What are some side effects of Carbamazepine?
Presyncope Nausea Headache Hyponatremia Rash
What can Carbamazepine interfere with?
Morning after pill
