Seizures Flashcards
What are the characteristics of primary generalised epilepsies?
No warning <25 History of absences, generalised tonic clonic seizures and myoclonic jerks Generalised abnormality on EEG May have family history
What are the characteristics of focal or partial epilepsies?
May get an “aura” Any age Partial seizures can become secondary generalised Focal abnormality on EEG MRI may show cause
How would a patient describe a generalised tonic clonic seizure?
Patient account:
- History preceding events (unpredictable, tend to cluster)
- Past medical history (complications at birth, febrile convulsions, trauma, meningitis or brain injuries)
- History of event itself (may have vague warning, irritability before them)
- Afterwards (severe tongue biting, incontinence, first recollection in ambulance or hospital, muscle pain)
How would a witness describe a generalised tonic clonic seizure?
Witness account:
- Groaning sound
- Tonic (rigid phase) then jerking in all limbs
- Eyes open (staring or rolling upwards)
- Foaming at the mouth
- Jerking for a few minutes and then groggy gor 15-30 mins
- May be agitated afterwards
What are the characteristics of absence seizures?
Often in children, who are unaware of them
May be provoked by hyperventilation or photic stimulation
Sudden arrest of activity for a few seconds- brief staring, eye-lid fluttering
Re-start what they were doing
What are the characteristics of juvenile myoclonic epilepsy?
Adolescence or early adulthood
Often provoked by alcohol or sleep deprivation
Can have absence and GTC seizures
Often has early morning myoclonus- drop things in morning, brief jerk in limbs
How would a patient describe a complex partial seizure/temporal lobe seizure?
Patient account:
- History preceding events (rising feeling in stomach, funny smell or taste, de ja vu)
- History of event itself (no recollection)
- Afterwards disorientated for a spell
How would a witness describe a complex partial seizure/temporal lobe seizure?
Witness account:
- Sudden arrest in activity
- Staring blankly into space
- Automatisms (lip smacking, repetitive picking at clothes)
What are the initial clinical assessment steps in seizures?
Refer to first seizure clinic
Do an ECG and routine bloods including glucose
A&E will often arrange a CT
What investigations can be done for epilepsy?
EEG for primary generalised epilepsies
MRI for patients under 50 with possible focal onset seizures
CT for patients over 50 with possible focal onset seizures
Video-telemtry if uncertain about diagnosis
What factors influence seizure risk in individuals diagnosed with epilepsy?
Missed medications (most common) Sleep disturbance or fatigue Hormonal changes Drug/alcohol use Stress/anxiety Photosensitivity in small number of patients
What is the first and second line treatment of primary generalised epilepsies?
First line- sodium valproate, lamotrigine or levetiracetam
Second line- topiramate, zonisamide, clobazam
What is the first and second line treatment of secondary generalised epilepsies?
First line- lamotrigine, carbamazepine or levetiracetam
Second line- topiramate, zonisamide, clobazam
What is the first line treatment of absence seizures?
Ethosuximide
What is the second line treatment of partial seizures?
Sodium valproate
Topiramate
Gabapentin
