Seizures Flashcards
What are the 3 categories of causes of syncope?
Reflex - bloods being taken, cough
Orthostatic - hypotension, dehydration, medication related (anti hypertensive), endocrine, ANS
Cardiogenic - arrhythmia, aortic stenosis
What are the typical things a patient will tell you of an account of syncope?
They will have a very brief episode and will recover quickly - usually whilst still on the floor Felt light headed, clammy, blacking out Fully orientated quickly Urinary incontinence Aborted by sitting
What is epilepsy?
Tendency to have recurrent unprovoked seizures
Neurones have a background activity and if this is disrupted then we can have a seizure
When is epilepsy diagnosed after 1 seizure?
A scan which shows high risk of recurrence i.e. stroke or tumour in part of the brain
Or an EEG which shows a tendency to seizures
What are the 2 main groupings of epilepsy and what are the differences between the 2?
Generalised seizures - electrical activity occurs across the whole brain
Focal seizures - electrical disturbance just happens in one part of the brain
In what age of patients is primary generalised mostly found in?
<20
What can put someone at risk of having generalised tonic clinic seizures early on in life?
Meningitis
Birth complications
Brain injuries
Trauma
What are the symptoms signs of juvenile myoclonus epilepsy?
Can have Absence and generalised tonic clonic seizures
Will have early morning myoclonus (brief jerks in limbs, drop things in the morning)
What investigations will the neurology clinic carry out to investigate referrals?
EEG
MRI
CT
Video telemetry
What is the first line treatment for primary generalised epileptics?
Sodium valproate
Lamotrigine
Levetiracetam
What is the acute treatment for a seizure?
Lorazepam / diazepam
Phenytoin / valporate
What anti epileptic drug shouldn’t be used in pregnancy?
Sodium valproate
What is the first line treatment for focal and secondary generalised seizures?
Lamotrigine
Carbamezapine
Levetiracetam
If someone has a single seizure when can they drive agin?
After 6 months if they have no further seizures and investigations are normal
What is status epilepticus?
Prolonged or recurrent tonic clonic seizures persisting for more than 30 mins with no recovery period between seizures
What is the first line treatment for status epilepticus?
Midazolam
Lorazepam
Diazepam
What is non-convulsive status epilepticus?
Prolonged unresponsiveness following a seizure
What is the typical history of a cardiogenic syncopal episode?
Syncope on exertion May have chest pain, palpitations, SOB Comes round fairly quickly May be sweaty/clammy Unable to feel pulse May have few brief jerks Rapid recovery
What things provoke seizures?
Alcohol withdrawal Drug withdrawal Few days after head injury Within 24hrs stroke Within 24hrs brain surgery Severe electrolyte disturbance Eclampsia
Describe an absence seizure?
Often in children and are unaware of them
May be provoked by hypoventillation / photic stimulation
Sudden arrest of activity for a few seconds - staring, may have eye fluttering
What are the types of generalised seizures?
Generalised tonic clonic seizure
Absence seizure
Myoclonic seizures
Atonic seizures
What are juvenile myoclonic seizures provoked by?
Alcohol
Sleep deprivation
What type of seizures does a patient with juvenile myoclonic epilepsy have?
Absence seizures
Generalised tonic clonic seizures
What is a typical feature of juvenile myoclonic epilepsy?
Early morning myoclonus
What are the types of focal seizures?
Secondary generalised
Simple partial
Complex partial
What might a patient feel before a complex partial seizure?
Rising feeling in their stomach
Funny smell/taste
De ja vu
What is the presentation of a complex partial seizure?
Sudden arrest in activity
Staring into space
Automatisms i.e. limp smacking, repetitive picking at clothes
What is the first line treatment for secondary generalised eizures?
Carbamezapine
Lamotrigine
Levetiracem
What is the first line treatment for status epilepticus?
Midazolan
Lorazepam
Diazepam
Mortality is highest in status epilepticus if it occurs after….
Stroke
Encephalitis
Mass lesion
Trauma
What is the percentage of mortality in status epilepticus?
5-10%
What is a pseudoseizure?
Non epileptic attack
Psychological attack
No abnormal brain activity
What is a pseudoseizure like?
Psychological attack, may occur at times of stress or rest
Patients will give lots of details of what’s going on around them but little of themselves
May describe dissociation
Patient retains awareness - tracking eye movements
Movements not typical of a seizure i.e. pelvic thrusts, asynchronous movements, tremor
How would you diagnose a seizure as a pseudoseizure?
Clinical features of the attack
Try and catch typical episode on EEG as it will show no abnormal brain activity
What factors influence seizure risk?
Alcohol / drug use Drug interactions Hormonal changes Sleep disturbance, fatigue Photic stimulation (other rare triggers include noise & patterns) Stress/anxiety
State 3 side effects of the drug phenytoin.
Arrhythmias
Hepatitis
Medication interactions (releases liver enzymes so make other drugs ineffective)
State the side effects of sodium valproate.
Tremor Weight gain Ataxia Nausea Drowsiness Hepatitis Teratogenic
State side effects of carbamezapine.
Low serum Na Nystagmus Blurred vision Ataxia Drowsiness Skin rash
State the side effects of lamotrigine.
Skin rash
Difficulty sleeping
State the side effects of levetiracetam.
Irritability
Depression
What anti-epileptic drugs can cause hepatitis?
Sodium valproate
Phenytoin
What anti-epileptic drugs can cause drowsiness?
Carbamezapine
Sodium valproate
What anti-epileptic drug can cause other drugs to become ineffective and why?
Phenytoin
Because it releases liver enzymes
What anti-epileptic drugs cause ataxia?
Sodium valproate
Carbamezapine
in the event of status epileptics, why may midazolam be the first line treatment of choice before diazepam?
because of the route of administration;
midazolam can be given buccal or nasal whereas diazepam has to be IV or rectal therefore more uncomfortable for the patient
