Seizure Disorders Flashcards
define epilepsy
recurrent tendency to spontaneous abnormal electrical activity in the brain causing convulsions and abnormal behaviour
what are the underlying causes of epilepsy
idiopathic
structural abnormalities
childhood febrile convulsions
what structural abnormalities can predispose to epilepsy
SOL
developmental abnormalities
head injury
what is a prodrome
the period before a seizure occurs where specific symptoms occur
what features occur during a prodrome
deja vu
flashing lights
funny taste/smell
strange feeling in gut
describe the period of a seizure
period in which the patient loses awareness/becomes unresponsive
generally lasts less than 5 minutes
associated with tongue biting and incontinence
what features occur during the post-ictal state following a seizure
confusion
headache
muscle ache and weakness
Todd’s palsy
what is Todd’s palsy
temporary weakness following a seizure
what are the two different types of seizures that occur
focal
generalised
what is the difference between focal and generalised seizures
focal - occurs in one area of the brain
generalised - abnormal activity in multiple area of the brain
who is most likely to have partial seizures
older people
those with an underlying structural abnormality
what is the difference between simple and complex partial seizures
simple - no loss of awareness or post octal symptoms
complex - loss of awareness, aura and post-ictal symptoms
list some features of a partial seizure in the temporal lobe
dysphasia emotional disturbance visual/auditory hallucinations lip smacking/grabbing odd taste/smell flashbacks
list some features of a partial seizures in the frontal lobe
dysphasia
posturing movements
behavioural symptoms
Jacksonian seizures
sensory disturbance is most likely a partial seizure in which lobe of the brain
parietal lobe
who is most likely to develop generalised seizures
young people
list some triggers for bringing on generalised seizures
flashing lights
sleep deprivation
describe the tonic phase of a tonic clonic seizure
patient falls to the ground, becomes rigid and cyanosed as they stop breathing
tongue biting and urinary incontinence
usually lasts 1 minute
describe the clonic phase of a tonic clonic seizure
asymmetrical convulsive jerks
eyes roll to the back of the head and breathing starts again
can last several minutes
describe an absence seizure
brief lapse in awareness in which the patient stops what they are doing and stares blankly
EEG spike and wave at 4Hz
describe myoclonic seizures
seizures that manifest as clonic like jerks without the tonic contractions
give an example of a myoclonic seizure
juvenile myoclonic epilepsy
describe the presentation of myoclonic epilepsy
presents in puberty
associated with early morning seizures
brought on by lack of sleep, bright lights and alcohol
describe an atonic seizure
seizure that manifests as sudden loss of muscle tone with the maintenance of consciousness
when is imaging indicated in epilepsy
to identify a structural abnormality
what are the indications for an EEG
to classify epilepsy
confirm non epileptic attacks
evaluate patients being considered for surgery
to confirm non-convulsive status epilepticus
what is the first line management for generalised seizures
sodium valproate
lamotrigine
levetiracetram
what is the first line management for focal seizures
carbamazepine
which anti-convulsant is contraindicated in generalised seizures and why
carbamazepine makes generalised seizures worse
when is sodium valproate not a first line drug for generalised seizures
for young women due to teratogenicity
what are the side effects of sodium valproate
nausea tremor oedema ataxia weight gain liver failure/pancreatitis thrombocytopenia irreversible hair loss
what are the side effects of lamotrigine
maculo-papular rash Steven-Johnson syndrome DIC tremor diplopia
most epilepsy patients are on how many drugs
just one, usually increase dose to be suitable
what is SUDEP
sudden unexplained death in epilepsy
increased risk if epilepsy is poorly controlled, patient smokes, drinks or takes drugs
if a patient with epilepsy has a seizure, how long can they not drive for
car - 1 year
HGV - 10 years
what are the issues that can occur with AEDs and contraception
most AEDs are liver enzyme inducers which reduce the efficacy of COCP and progesterone only contraceptives
what must be discussed with pregnancy and epilepsy
pre-pregnancy counselling about risk of congenital anomalies with AEDs - take high dose folic acid
drugs can also be passed through breast milk
define status epilepticus
seizure that lasts more than 5 minutes
multiple seizures within 30 minutes
second seizure that occurs before the first is completely done
what are the triggers for status epilepticus
stopping AEDs suddently infection head injury metabolic upset eclampsia
how is status epilepticus managed
IV lorazepam, if no improvement after 10 minutes try another dose
phenytoin second line
if IV access cannot be established, how can status epilepticus be managed
rectal diazepam
buccal midazolam
what is non-epileptic attack disorder
functional seizures at subconscious level
associated with past trauma
describe the features of non-epileptic attack disorder
long seizures lasting 10-20 minutes
symmetrical florid convulsions with large movements
no improvement with anticonvulsants
