seizure disorder

Question 1

Status epilepticus- what is it + mx in hosp and community

Answer 1

Medical emergency. It is defined as seizures lasting >5mins or >3 seizures in one hour.

Mx: ABCDE

(1. ) IV lorazepam 4mg, repeat after 10mins if seizure continues
(2. ) If seizures persist: IV phenytoin
(3. ) Ix:
- bedside obs, BM, urine dip
- bloods: FBC, glucose, UE, ABG,
- other tests: ECG, EEG, CT

In community

(1. ) General protective measures e.g. head + neck protected, away from dangerous position
(2. ) Resuscitation as required, secure airways and assess resp and cardiac function
(3. ) Buccal midazolam (1st line)
- PR diazepam (2nd line)
(4. ) Call ambulance
- if seizure >5mins after med administrated
- first episode
- concerns or difficulties monitoring ABC

Question 2

what are the 6 types of epileptic seizures

Answer 2

Generalised tonic-clonic seizures
- rhythmic jerking or limbs, urinary incontinence, tongue biting

Tonic

• short lived <1min, muscle becomes stiff and pt often falls backwards
• abrupt generalised muscle stiffness with rapid recovery

Atonic

• ‘drop attacks’
• loss of muscle tone, suddenly relax + floppy, often falls forwards

Myoclonic

• ‘sudden jump’ ‘muscle jerk’
• brief, ‘shock like’, involuntary single or multiple jerks

Focal seizures

• Starts in temporal lobes, affects hearing, speech, memory, emotions:
• Hallucinations
• memory flashbacks
• déjà vu
• doing strange things on autopilot

Absence Seizure

• Typically in children.
• Pt becomes blank, stares into space and then abruptly returns to normal.
• During this episode pt is unaware of their surroundings + wont’ respond
• Lasts 10-20s

Question 3

Epilepsy clinical features + Ix

Answer 3

(1.) Prodromal: confusion, irritability or mood disturbances.

(2. ) Early-ictal
- aura: sensory, cognitive, emotional or behaviour changes.
- not all experience aura, usually suggestive of focal epilepsy

(3. ) Ictal: depending on type: LOC, tongue biting, urinary incontinence
(4. ) Post-ictal: drowsiness, headache, amnesia, confusion

Ix

• Collateral hx
• Ex: cardio, neuro, examine oral mucosa, any injuries
• bloods inc glucose
• ECG r/o cardiac
• EEG
• MRI

Question 4

Mx of epilepsy

Answer 4

(1. ) Urgent first fit clinical referral if 1st seizure
(2. ) Inform DVLA
- 1st unprovoked seizure = not drive for 6m
- Epileptic pt should be seizure free for at least a year to drive
- Should not drive during medication change or withdrawal

AED

(1. ) Sodium valproate - 1st line for generalised tonic-clonic, absent, atonic, myoclonic seizures
- lamotrigine or carbamazepine (2nd line) for women bearing age

(2. ) Lamotrigine or Carbamazepine - 1st line for focal seizures
(3. ) Vagal nerve stimulator if medical Rx fails