Seizure disorders Flashcards
Case 1: 19 year old, felt strange
Ask- How they were day before, day of? What were you doing during that day
Generalized seizure questions? What do we need to ask
Take a history for a patient with likely seizure/syncope
What questions to ask ? What other clinical features are important to ask about?
Time to full recovery?
Reliving factors?
DDx for collapse with convulsions?
What is syncope? What causes syncope?
What is convulsive syncope
Terminology to understand - syncope is
Case 2: History different - tonic clonic
What other features will support a seizure?
1) Risk factors for seizures?
2) Trigger factors?
Risk factors
- Family history
- Antenatal factors (immature birth, complications at birth)
- febrile seizures
- Head injuries
- Infections as a child (meningitis)
- Car accidents/head injuries
- Illicit drug use
- Etoh use
What are important risk factors and trigger factors for seizures?
What investigations are important immediately?
1) ECG
2) ABG
3) EEG
4) CT head/MRI
MS SG: Is it a seizure?
only 1/3 of EEGs will show seziure activity - seizures are mostly diagnosed from history!
EEG Showing generalized - next
64 y old male, after MVA poor historian
MRI- only has 25%
32 y/o with AV malformations- (dilated veins) seen
45 y/o First seizure
25 year old with refactory seizures
Hippocampus sclerosis
What type of seizure?
How do we differentiate them?
Generalized seizures: Have bilaeral networks of the brain having rapid fire AP, when it
What is a focal seizure? (one area of the brain - depends on area of the brain affected)
What is an Absent seizure (a form of generalized seizure)
Absence seizure Hx and exam?
What is a focal impaired Awareness seizure?
Classifying seizures
How do we classify seizures?
If you have a seizure whats your chances of having another seizure?
Whats your chances of having epilepsy?
When are patients most at risk after their first seizure?
Does the patient have epilepsy? How do we answer this question?
What important things do you have to discuss with a patient with first seizure?
(counselling) (driving?)
- Safety- driving liscense
- Employment - are they safe at work?
- cannot work in high risk settings e.g roofer, scuba diving instructor; armed forces, police, ambulance
- Cannot swim by yourself!!!!!! (need someone), cannot be fishing by yourself
- DRIVING
- Medications? (should we begin them or not?) giving a medication will reduce risk of second and third seizure- (important especially if in career that cannot have seizure)
- WHAT to avoid - sleeping good, and drugs +
Case continuation:
- Looks like a focal seizure - temporal sharp waves
- what anticonvulsants? (they only
Need to know anticonvulsants:
Management of patient - Driving with first episode seizure (australia)
How long after first seziure +medication can a patient not drive?
What are key diagnostic feature of Focal seizures?
What are risk factors for this condition?
What is your DDx for focal seizure?
What is the criteria for Generalized tonic clonic seizure?
What makes this epilepsy? ( Frequency + timing)
