Seizures Flashcards
What kind of questions would be important to ask someone who has had a seizure/ someone who witnessed it?
What were they doing before?
Did they feel dizzy, faint or unwell?
What did it look like?
Were they aware throughout?
How did they come around, were they sleepy?
How does a faint typically present?
Preceded by light headedness, sweating and pale complexion
Collapse and loss of consciousness, not confused after
Give some examples of drugs which are known to precipitate seizures
Antibiotics
Tramadol
Anti-emetics
Opioids
What are the definitions of seizures Vs epilepsy?
A seizure describes abnormal discharge of electrical activity in the brain
Epilepsy is the tendency to recurrent epileptic seizures
What does SUDEP stand for?
Sudden unexplained death in epilepsy
What are some of the risk factors for death in epilepsy?
Nocturnal seizures
Aspiration
Alcohol and drug use
Poor compliance with medication
What are focal seizures?
A seizure which occurs due to a part of the brain being structurally abnormal
E.g motor, sensory, olfactory seizures e.t.c
Who gets focal seizures?
Older patients - they are more likely to have an abnormality in the brain
What defines a seizure as being simple or complex?
Simple focal seizures are without impaired consciousness
Complex focal seizures are with impaired consciousness
What is a generalised seizure?
A seizure which occurs due to more than one part of the brain being affected
It is not due to a structural abnormality but due to a problem with the pathways
What are secondary generalised seizures?
When a focal seizure connects to a cortical pathway and spread across the brain to cause a generalised seizure
What abnormalities are classically seen on EEG with generalised seizures?
Spike-wave abnormalities on ECG
Who has generalised seizures?
Younger patients
*It is hardly ever diagnosed in patients aged 30+
What are the typical clinical features of juvenile myoclonic epilepsy?
Early morning jerks
Generalised seizures
Risk factors; sleep deprivation and flashing lights
What are the 5 main types of generalised seizures?
Absence
Myoclonic
Atonic
Tonic
Tonic-clonic
Describe absence seizures and the 1st line managemend
Brief pauses
Occurs in children
Ethusuxamide is 1st line (blocks calcium channels)
Describe a myoclonic seizure
Sudden jerks of the limb, face or trunk
Describe an atonic seizure
Sudden loss of muscle tone causes collapse
no loss of consciousness
Describe a tonic-clonic seizure
Patient goes rigid first (tonic) and then jerks (clonic)
Post-ictal confusion and drowsiness
In tonic clonic seizures, why do patients flex their arms into their chest?
Because flexor muscles are stronger than extensor muscles
What are the ways in which a focal seizure affecting the temporal lobe of the brain might present?
Motor features
Olfactory hallucinations (uncle involvement)
Auditory hallucinations (auditory cortex involved)
Emotional disturbance e.g sudden terror (hippocampal involvement)
What are the ways in which a focal seizure affecting the frontal lobe of the brain might present?
Motor features
Dysphagia and speech arrest
Post ictal Todd’s palsy
What are the ways in which a focal seizure affecting the parietal lobe of the brain might present?
Motor disturbances
Sensory disturbances (e.g tingling numbness and pain)
What are they ways in which a focal seizure affecting the occipital lobe of the brain might present?
Visual phenomena (e.g spots, lines and flashes)
What investigations should be done for a patient presenting with seizures?
CVS exam and lying and standing BP (syncope)
ECG
CT
EEG
What is the typical ECG sign which might be present in a patient presenting with seizures?
Prolonged QT syndrome
Imaging, such as CT is not routine for first seizures. In what situations would it be considered?
Skull fractures
Deteriorating GCS
Head injury
Suspected SAH
EEG is not the best test to do and is only really done to confirm non-convulsive attacks. T/F?
True
E.g spike wave abnormality in absence seizures
When do you treat seizures?
If a patient has epilepsy and is at high risk of seizure recurrence
When the patient wants to be treated
What is the first-line medication for focal epilepsy?
Carbamazepine
2nd line = lamotrigine
What is the first-line medication for generalised epilepsy?
Sodium valproate
2nd line = lamotrigine or clonazepam
Which two anticonvulsants should not be given together?
Sodium valproate and lamotrigine
Which drug should never be given in generalised epilepsy?
Carbamazepine
What are the side effects of sodium valproate?
WEIGHT GAIN
Hair loss
TERATOGENIC
What are the side effects of carbamazepine?
Ataxia
Blurred vision
Vertigo
Hyponatraemia
What are the side effects of lamotrigine?
Steven Johnson Syndrome
Which drugs used in the treatment of epilepsy are liver enzyme inducing?
Carbamazepine, phenytoin and barbiturates
Which side effects of sodium valproate (not including the fact it is teratogenic) are often considered less acceptable in women?
Weight gain and hair loss
most men get fat and bald anyway
Which form of contraception is particularly badly affected by anticonvulsants and therefore should not be used in these patients?
The progesterone only pill
A higher dose of the morning after pill is required in patients who are taking anticonvulsants. Can this be given out by a pharmacist?
No - it needs to be given by a doctor
Women of child-bearing age should be taking which supplement?
Folic acid
Lamotrigine is NOT harmful to infants and is therefore appropriate for breastfeeding mothers. T/F?
TRUE
What is status epilepticus?
Recurrent epileptic seizures without full recovery of consciousness
Seizure activity is continuous for 30 minutes +
What are the 3 types of status epilepticus?
Generalised convulsive status epilepticus
Non convulsive status
Epilepsia partialis continua
What happens in generalised convulsive status epilepticus?
Generalised convulsions without cessation
What happens in non-convulsive status?
Conscious but in an altered state
*more common in older patients
What happens in epilepsia partialis continua?
Continual focal seizures with consciousness preserved
What consequences can generalised convulsive status epilepticus have?
Respiratory insufficiency
Rhabdomyolysis
What are some of the possible precipitants of status epilepticus.?
Severe metabolic disorders
Infection
Head trauma
Abrupt withdrawal of anticonvulsants
Treating absence seizures with carbamazapine
What are functional attacks?
Aka Non epileptic attack disorder (NEAD), pseudo seizures and psychogenic seizures.
Seizures which relate to traumatic events, abuse or stress
How can functional attacks be managed?
Explain the nature of the attacks to the patient
Treat underlying mental health problems
*patient needs to be psychologically ready to talk about/ be re-exposed to trauma
NOT treated with anticonvulsants
What characteristic movements does non epileptic attack disorder (NEAD) present with?
Pelvic thrusting
Head turning
How long must a person wait before they can drive an HGV after their first seizure assuming they have no more?
5 years
How long must a person wait before they can drive a car after their first seizure assuming they have no more?
6 months
