Seizures Flashcards
Where are focal seizures originating from?
Specific area on one side of brain
Awareness types in focal seizures and types
Focal aware
Focal impaired awareness
Awareness known
Motor, non motor or auras
Types of general seizure
Tonic-clonic
Tonic
Clonic absence
Atonic
When do yuo start antiepileptics after one seizure?
Patient has a neurological deficit
brainimaging -> structural abnormality
EEG - unequivocal epileptic acitivty
Patient/family/carers = unacceptable risk of another seizure
How long off driving after first unprovoked seizure?
6 months - if no relevant EEG activity or structural abnormality(then 12 months)
How long can’t drive after seizure if established epilepsy or multiple seizures?
12 months
When is surgeyr an option for epilepsy?
Focal - specific part of brain can be resected
What is an epileptic seizure?
Sudden transient attack of symptoms and signs due to abnormal electrical activity in the brain, leading to a disturbance in consciousness, beahviour, emotion, motor function or snesation
when does a seizure occur in the brain?
Imbalance between excitatory and inhibitory forces within network of cortical neurones in favour of sudden onset excitation, from alteration of brain function, genes, subcellular signalling to widespread neuronal circuits
Causes
Idiopathic
Cerbrovascular disease
What casues of cerebrovascular disease can cause seizures?
- cerebral infrction, haemorrhage, venous thrombosis
What drugs canc cause seizures?
Phenothiazines, isonia\is, TCAs, benzodiazepines, binge drinking, alcohol
Which metabolic disorders can cause seizures?
Uraemia
Hypoglycaemia
Hypo/ernatremia
Hyper/ocalcemia
What types of encephalitits can cause seizures?
Viral
Autoimmune eg anti-NMDA receptor
anti-LG11
Complciations of epilepsy
Injuries during seizures eg tongue biting
Social stigmatism, occupational issues
Anxiety/depression
Status epilepticus
Sudden unexplained death in epilepsy
Increased mortality rate
What can precede seizures?
Aura - dependent on part of brain effected eg visual, deja vu etc
Triggers for seizures
Sleep deprivation, stress, light sensitivity, alcohol use
What happens in a tonic seizure?
Short lived, abrupt, generalised muscle stiffening - may cause a fall - with rapid recovery
What happens in generalised tonic clonic seizure?
Generalised stiffening and subsequent rhythmic jerking of limbs, urinary incontinence and tongue biting
When do absence seizures occur?
Childhood
Atonic seizure
Sudden onset of loss of muscle tone causing falls
Mycolonic seizure
Brief, ‘shock-like’ involuntary single or multiple jerks
What post ictal phenomena can happen after a seizure?
Drowsiness, headaches, amnesia or confusion (usually occur only after gneralised tonic and/or clonic seiures)
What post ictal phenomena can happen after a seizure?
Drowsiness, headaches, amnesia or confusion (usually occur only after gneralised tonic and/or clonic seiures)
Investigations
Bloods
EEG
ECG
Neuroimaging - MRI brain, CT brain
Polysomnography
Handheld video recordngs
Why is an ambulatory EEG often used?
EEG can often be normal when a seizure is not occuring - have to wait for a seizure to occur to pick up on abnoormal activity
What is investgiation of choice fro seizures?
MRI brain
When is an MRI most useful?
Don;t respond to 1st line meds
Focal onset history
What is status epilepticus?
Seizure over 5 minutes or multiple with no break between them
1st line management of status epilepticus
IV lorezapam up to 4mg
Buccal midazolam 10mg or rectal diazepam 10-20mg if no IV access
2nd line in status epilepticus
IV phenobarbital or pheyntoin
What give if no IV access 1st line
What to take measurements from in status epilepticus
VBG, ECG, oxygen saturations, temp, pulse rate + BP
How to treat hypoglycaemia, alcohol/malnourishment in status epilepticus?
IV dextrose if hypoglycaemia
IV thiamine if alcoholism/malnourishment suspected
