Seizures, Blackouts And Epilepsy Flashcards
Remember to always ask about occupation and driving status.
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What is the definition of syncope?
Reflex bradycardia with or without peripheral vasodilatation.
Reflex anoxic is a type of syncope, what is it?
It is seen when young children hold their breath, causing them to fit and faint.
What is a stokes Adams attack?
Transient arrhythmias causing reduced cardiac output and loss of consciousness.
Pre-attack: palpitations.
Attack: fall to the ground with LOC, pallor and slow or absent pulses.
Recovery: within seconds and associated with flushing.
Who do drop attacks usually present in and what are the features?
Sudden weakness in the legs not associated with and warning. No associated confusion.
Most often seen in elderly women.
Definition of epilepsy?
Recurrent tendency to spontaneous,intermittent, abnormal electrical activity in the brain that manifests as convulsions or abnormal behaviour.
List a few examples of aura in epilepsy?
Deja vu
Flashing lights (visual changes)
Funny tastes and smell (gustatory and olfactory)
Strange feeling in the gut.
How long does a seizure usually last?
Usually lasts less than 5 minutes. Patient becomes unresponsive and commonly associated with tongue biting and urinary incontinence.
Temporary weakness in the post ictal phase is known as what?
Todd’s palsy. (Focal weakness)
Simple partial seizure?
Complex partial seizure?
Simple = without impaired consciousness Complex = with impaired consciousness
What is a Jacksonian seizure?
Usually frontal lobe, partial seizure in which there are twitching movements of the upper limb that spread to the face and lower limb.
Commonly associated with Todd’s palsy.
Typically cause no change in awareness or alertness.
What is an absence seizure and how does it appear on EEG?
Brief lapses of awareness in which patient stops what they are doing and stares blankly.
EEG: Spike and wave at 3Hz.
What is a myoclonic seizure and how does it show up on EEG?
Seizure than manifests and clonic like jerks without the tonic contraction.
e..g juvenile myoclonic epilepsy; usually seen around puberty and associated with early morning myoclonic seizures. Most patients go on to develop tonic clonic.
EEG: photosensitive poly spike and wave.
What is an atonic seizure?
Seizures that manifest as sudden loss of all muscle tone with maintenance of consciousness which differentiates it from narcolepsy.
Diagnosis of epilepsy?
Largely clinical diagnosis.
CT/MRI to identify potential structural abnormality.
EEG:
- To classify epilepsy
- Confirm non-epileptic attack’s
- Evaluate patients being considered for surgery.
- To confirm non convulsive status epileptics.
What is the management of focal epilepsy?
1) Carbamazepine
2) Lamtoragine, valproate, topiramate.
What is the first line drug used for generalised seizures?
Sodium valproate.
Not suitable for younger women because of teratogenicity.
Side effects of sodium valproate?
Nausea, tremor, ataxia, pancreatitis, thrombocytopenia, liver failure, encephalopathy.
Reversible hair loss.
Lamotrogine: Facts and side effects
Generally well tolerated and can be used in both generalised and focal seizures but main issue is it takes several months to titrate to effect.
Side effects: maculpaupular rash, Steven Johnson syndrome, Disseminated intravasuclar coagulation, Diplopoda and photosensitivity.
3 main side effects of topiramate?
Sedation
Dysphasia
Weight loss
Carbamazepine, when is it used and side effects?
Not use in generalised epilepsy as it may make seizures worse.
Leukopenia, drowsiness, double or blurred vision, impaired balance.
What is SUDEP?
Sudden unexplained death in epilepsy
Risk is increased if epilepsy is poor controlled, patient smokes, drinks and uses illicit drugs.
Driving and epilepsy:
1st seizure: cannot drive for 6 months or HGV for 5 years.
If have a seizure: no driving for 12 months.
- If medication changed/withdrawn in last 6 months then do not drive for 12 months.
- Need to be off medication for 10 years and seizure free to drive HGV.
Definition of status epilepticus
Seizure that has lasted for more than 5 minutes.
Multiple seizures within 30minutes.
Second seizurethat occurs before full neurological recovery from the first.
Management of status epilepticus?
ABCDE
1st line = IV lorazepam (2-4mg) (maximum doses = 2). (Usually a 4mg bonus repeated once after 10-20minutes)
2nd line = Phenytoin (15-18mg/kg) at rate of 50mg/minute
3rd line -= general anaethesia e.g. propofol or midazolam
What is non-epileptic attack disorder?
Functional seizures that are largely mediated at the subconscious level and have a strong correlation with past trauma, especially childhood sexual abuse.
Presentation of non epileptic attack disorder?
Excessively long seizures; 10-20minutes.
Coordinated, symmetrical, florid convulsions with large movements.
Maintenance of normal breathing.
No associated tongue biting or incontinence.
Made worse by used of anticonvulsants.
Management = counselling and psychological therapies.
