Seizure Disorders Flashcards
List risk factors for epilepsy
Birth and abnormal development Past seizures (inc. febrile fits) Head injury (LOC) Family history Drugs Alcohol
List drugs that are common precipitants of epilepsy
Antibiotics Tramadol Anti-emetics Opioids Aminophylline
What is the mandatory first investigation in all patients presenting with a seizure?
ECG
Which seizure patients usually qualify for MRI/CT?
Intracranial pathology
Trauma
Focal signs
Low GCS
What is the rule regarding driving after your first seizure?
Can’t drive until seizure-free for:car: 6 months
hgv: 5 years
What is the rule regarding driving with epilepsy?
Can’t drive until seizure-free for:car: 1 year
hgv: 10 years
Define “seizure”
Abnormal discharge of electrical activity in the brain
Define “epilepsy”
A tendency for repeat epileptic seizures
Define “epileptic seizure”
Abnormal synchronisation of neural activity, usually excitatory, causing interruption of brain activity
What are the 2 classifications of epileptic seizure?
Focal
Generalised
What is the difference between focal and generalised epileptic seizure?
Focal: part of brain structurally abnormal causing focal symptoms e.g. stroke
Generalised: neural cortical pathways conduct seizure to different brain areas
Which is more common in children and young people - focal or generalised epileptic seizures?
Generalised seizures (typically genetic predisposition) Focal seizure can have onset at any age, more common in adults
What is the treatment of choice for focal seizures?
Carbamazepine or Lamotrigine
Sodium valproate is an alternative
What is the treatment of choice for primary generalised epilepsy?
Sodium valproate
Lamotrigine as an alternatives
Which patient group in particular should not be given sodium valproate and why? What are the other side effects?
Young girls
Teratogenic
Weight gain, hair loss, fatigue
Which epileptic drug can make generalised seizures worse?
Carbamazepine
List clinical features of functional non-epileptic attack
Prominent motor activity
Collapse
Fear, gasping, hyperventilation
Prolonged duration (up to 20mins)
What is status epilepticus?
Recurrent epileptic seizures without full recovery of consciousness, lasting more than 30 minutes
List some precipitants of status epilepticus
Infection Trauma Metabolic disorders Withdrawal of anti-convulsants Sub-arachnoid haemorrhage Treating abscence seizures with carbamazepine
Which drug is preferred over diazepam for immediate control of acute seizure?
Phenytoin
What are some common differential diagnoses for epilepsy?
Syncope Non-epileptic attack disorder (pseudoseizures) Panic attacks Hyperventilation Sleep phenomenon TIA/Migraine/ Hypoglycaemia
Which investigation should be performed if primary generalised epilepsy is suspected? What would be the results?
EEG
Spike-wave abnormality
List the six types of generalised epilepsy. Which is the most common?
Tonic-clonic (most common) Abscence Myoclonic Clonic Tonic Atonic
What does an abscence seizure look like?
Blank out or stare into space for few seconds ‘drop attacks’
What does a myoclonic seizure look like?
QUICK jerky contraction and relaxation of muscles
What does a clonic seizure look like?
Rhythmic twitching/jerking of one or several muscles
What does a tonic seizure look like?
Sudden stiffening and contraction of muscles
What does an atonic seizure look like?
(loss of muscle tone and strength suddenly)
What are the two main types of focal epilepsy?
SIMPLE: without impaired consciousness
COMPLEX: With impaired consciousness
What are the features of juvenile myoclonic epilepsy?
Early morning jerks/clumsiness
Generalised seizure
What are the risk factors for juvenile myoclonic epilepsy?
Sleep deprivation
‘Flashing lights’
In generalised epilepsy there is no apparent cause. True/False?
True
In focal epilepsy there is no apparent cause. True/False?
False
Underlying structural abnormality
What is the mechanism of action for most anti-epileptic drugs - phenytoin, carbamazepine, lamotrigine?
Inhibit voltage-gated sodium channels (reduce excitability and APs)
What is the mechanism of action of sodium valproate?
GABA synthesis
What class of drug are the majority of anti-epileptics?
Anticonvulsants
What is the main side effect of levetiracetam?
Mood swings
What are the main side effects of topiramate?
Sedation
Dysphasia
Weight loss
Gabapentin/pregabilin are more commonly used for…
Neuropathic pain
Which medications must you be aware will have reduced efficacy in females when taken with anti-epileptic drugs?
CAN INDUCE HEPATIC ENZYMES
Combined oral contraceptive pill
Progesterone only pill
Morning after pill
What are the main types of status epilepticus?
Generalised convulsive status epilepticus (generlasised convulsions without cessation)
Non-convulsive status (conscious but in altered state)
Epilepsia partialis continua (continual focal seizures, consciousness preserved)
What is the main type of acute seizure?
Status epilepticus
How should status epilepticus be managed?
Stabilize patient - ABC
Identify cause - emergency bloods +/- CT
Quick administration of anticonvulsants
Which anticonvulsants are used in status epilepticus?
Phenytoin
Keppra
Valproate
Benzodiazepines
What are the main complications of convulsive status epilepticus?
EXCESS CEREBRAL ENERGY DEMAND + POOR SUBSTRATE DELIVERY = LASTING DAMAGE Respiratory insufficiency and hypoxia Hypotension Hypothermia Rhabdomyolysis
What investigation results would you expect in non-epileptic attack disorder?
CNS exam, MRI and EEG normal
List some examples of triggers of non-epileptic attack disorders
Traumatic events
Physical/ sexual abuse
Stress
Anxiety/ depression
Outline the management of non-epileptic attack disorders
Stop epileptic treatment e.g. anticonvulsants
Find cause and treat e.g. counselling, CBT
What other terms can be used to describe non-epileptic attack disorders?
Pseudoseizures
Psychogenic non-epileptic seizures
Dissociated seizures
Functional attacks
List the main side effects of lamotrigine
Rash
Steven Johnson Syndrome
Which drug is used as the 1st line treatment of absence seizures?
Ethosuxamide
List the main side effects of carbamazepine
Blurred vision
Vertigo
Hyponatraemia
