seizures Flashcards
what is a focal seizure?
a seizure originating within networks linked to one hemisphere of the brain and often associated with underlying structural disease
what are the subclasses of a focal seizure?
without impairment of consciousness
with impairment of consciousness
evolving to bilateral convulsion seizure
what is a generalised seizure?
involves bilaterally disturbed neuronal networks that leads to simultaneous onset of widepread electrical discharge with no localising features related to a single hemisphere
what are the subclasses of generalised seizure?
absence seizures
tonic-clonic (limbs stiffen and jerk)
Myoclonic (sudden jerk of limb, face or trunk)
Atonic (sudden loss of muscle tone)
what features indicate focal temporal lobe seizure?
automatisms i.e lip smacking, chewing, swallowing, grabbing. patient unaware
Dysphasia
Deja Vu
Emotional disturbance
hallucinations and delusions
what features indicate a focal frontal lobe seizure?
motor features
Jacksonian march
motor arrest
post-ictal Todds palsy (transient paresis)
what features indicate a focal parietal lobe seizure?
sensory disturbance
motor symptoms (due to spread from pre-central gyrus)
what features indicate a focal occipital lobe seizure?
visual phenomena e.g spots, lines or flashes
what can cause seizures?
idiopathic
structural
- cortical scarring
- SOL
- stroke
Others
- Alcohol withdrawal
- electrolyte disturbances
- meningitis
- SLE
- Sarcoidosis
- liver failure
- drugs and toxins
what investigations should be done in seizure work up?
detailed Hx - pre, during, post
Glucose - rule out hypo/hyper FBC - CNS infection U&E's - electrolyte disturbance LP - CNS infection CT/MRI head - structural? Tox screen - drug cause?
EEG
- focal spikes or sharp waves associated with slowing electrical activity
Ambulatory EEG
what are the treatment options for focal epilepsy?
lamotrigine
carbamazepine
levetiracetam
what are the treatment options for generalised epilepst?
sodium valproate
levertiracetam
lamotrigine
what are the SE’s of carbamazepine?
leucopenia
diplopia
erythematous rash
what are the SE’s of lamotrigine?
maculopapular rash (SJS/TENS) diplopia
what are the SE’s of levetiracetam?
depression and anxiety
dyspepsia
