Seizures/epilepsy Flashcards
Define epilepsy
Tendency to recurring seizures
Differentials of a blackout/loss of consciousness (5)
Epileptic seizure Syncope Non-epileptic seizure, e.g. psychogenic seizure Arrhythmia Head trauma/concussive seizure
Name 3 types of syncope
Reflex syncope, e.g. after taking blood, straining on toilet
Orthostatic syncope, e.g. dehydration, anti-hypertensives
Cardiogenic syncope, e.g. arrhythmias
Questions to ask when assessing a collapse/blackout
- patient account (3)
- witness account (6)
Patient account
- history of events leading up to collapse
- history of the episode itself (any warning symptoms, awareness of it happening)
- any recollection of what happened afterwards
Witness account -how was the patient prior -describe the patient during the episode: eyes open/closed any jerking pallor breathing pattern duration
Seizure markers/signs (4)
Prolonged disorientation/confusion
Tongue biting
Incontinence
Muscle pains
Symptoms (4) /signs (2) of cardiogenic syncope, e.g. from arrhythmia
Chest pain
Dyspnoea
Clammy/sweaty
Palpitations
Pallor - pale grey
Few brief jerks
Symptoms (2) /signs (3) of reflex syncope, e.g. after blood taken
Lightheaded
Sweaty
Vision blacking out
Pale
Few brief jerks
Define a seizure
Sudden burst of electrical activity in brain temporarily affecting function
Causes of provoked seizures (4)
Alcohol/drug withdrawal
Within few days after head injury
Within 24hrs of stroke
Severe electrolyte disturbance
2 classifications of seizures
Generalised
Focal
Define generalised seizures vs focal seizures
Involve both hemispheres and therefore involve the whole body
Involves just one hemisphere
Name 6 types of generalised seizures
Absence seizures Tonic seizures Atonic seizures Clonic seizures Myoclonic seizures Tonic-clonic seizures
Clinical features of absence seizures (2) + who are they found in most
Staring blankly for 5-10 secs
Automatisms - lip smacking, blinking
Children
Phases of a generalised tonic clonic seizure, formerly GRAND MAL seizure (2)
Tonic phase
- body stiffens; goes rigid
- cry or groan before clonic phase
Clonic phase
- muscles rapidly rhythmically contract then relax
- urinary incontinence
Clinical features of generalised tonic clonic seizures
- tonic phase (4)
- clonic phase (4)
- post tonic-clonic state (1)
Tonic phase: Loss of consciousness (not always) - collapse Groaning Stiff/rigid muscles initially Tongue biting
Clonic phase: Limb jerking - quick and rhythmic Eyes open - staring or rolled upwards Dribbling Urinary incontinence
POST-ICTAL STATE (confusion for hours etc) after tonic clonic seizure stops
What are myoclonic seizures
- characteristic feature
- duration
Brief, shock like jerks/twitch of a muscle or a group of muscles, usually lasting no more than a second or two
What are atonic seizures
Sudden loss or decrease of normal muscle tone and the person often falls to the ground
What are tonic seizures
stiffening of your muscles. These seizures usually affect muscles in your back, arms and legs and may cause you to fall to the ground
What are clonic seizures
Repeated or rhythmic, jerking muscle movements
Juvenile myoclonic epilepsy is a type of what generalised seizure + what is triggered by (2)
Myoclonic
Alcohol
Sleep deprivation - BIG RF
List the 2 types of focal (partial seizures)
Focal aware seizure (used to be called simple partial seizure) = fully aware of what’s happening
Focal impaired awareness seizure (used to be called complex partial seizure) = change or loss of consciousness
Are focal or generalised seizures more common in people with epilepsy
Focal
Focal seizures most commonly arise from pathology in what lobe
Temporal
Symptoms/signs of focal seizures
- motor (5)
- sensory (4)
*mostly seen in focal AWARE seizures rather than focal impaired seizure
Motor:
Muscle jerking of one side of body/specific part of body
Automatisms - lip smacking, chewing, picking at clothes
Staring into space
Post-ictal weakness of one side
Sensory: Feeling fear/anxiety Feeling de ja vu Aphasia Changes to vision, hearing, smell, taste
List some automatisms (4)
Lip smacking
Picking at clothes
Chewing
Eyelid fluttering
What are secondary generalised seizures
Focal seizures that have evolved into generalised seizures, i.e. once limited to one hemisphere but now affects brain bilaterally
Investigation of seizures (6)
EEG ECG - to rule out long QT syndrome FBC Blood glucose U+Es - maybe hypo/hypernatraemia, uraemia Toxicology screen - for illicit drugs CT
First line treatment drug options of ongoing *primary generalised epilepsies (4) + what class of drugs are they
*e.g. tonic/atonic/clonic/tonic-clonic/myoclonic/absence seizures
Anticonvulsants:
- sodium valproate - contraindicated in women of child bearing age OR
- lamotrigine OR
- topiramate OR
- levetiracetam
First line treatment drug options of *focal seizures (4) + what drug class they are
*e.g. focal aware or focal impaired seizure
Anticonvulsants:
- Carbamazepine OR
- Lamotrigine OR
- Oxcarbazepine OR
- Levetiracetam
First line treatment of absence seizures (1)
Ethosuximide
Treatment of an ACUTE generalised or focal seizure (2)
- 1st line
- 2nd line - if above doesn’t work
IV benzodiazepine - lorazepam
IV phenytoin (an anti-epileptic) - if above doesn’t work
Side effects of the following anti-epileptics:
- phenytoin (3)
- sodium valproate (5)
- carbamazepine (4)
- lamotrigine (2)
- levetiracetam (2)
Phenytoin - arrhythmia, hepatitis, drug-drug interactions
Sodium valproate - tremor, ataxia, nausea, drowsy, hepatitis
Carbamazepine - ataxia, drowsy, nystagmus, blurry vision
Lamotrigine (best tolerated, least side effects) - skin rash, sleep disturbance
Levetiracetam - irritable, depression
What is the best tolerated + least side effects anti-epileptic
Lamotrigine
What is status epilepticus + it is usually persistence/recurrence of which type of seizure
> 5 mins of either continuous seizure activity
OR
repetitive seizures without regaining consciousness between them for >5 mins
Tonic-clonic seizure
Treatment of status epilepticus
-1st line (2)
First line
- 100% oxygen
- IV benzodiazepine - lorazepam
Risk factors of status epileptics (2)
Not taking anticonvulsants properly
Chronic alcohol
Why is it important to treat an acute or prolonged seizure ASAP
During long convulsive seizures, body struggles to circulate oxygen so brain doesn’t get enough oxygen and can lead to brain damage so important to give oxygen ASAP
After a SINGLE SEIZURE, someone can drive a car/HGV after how long if investigations are normal and no further seizures
Car - 6 months
HGV - 5 years
Patients DIAGNOSED WITH EPILEPSY can drive a car once they have been seizure free or have only had seizures arising from sleep after how long
1 year
If patients with epilepsy have daytime seizures but then becomes nocturnal, how long does this have to be established before they can drive a car
3 years
Epileptics can only drive a HGV/PSC if they have been seizure free for how long + if they’re not on anti-epileptics
10 years
What is the post-ictal state
Altered state of consciousness after an epileptic seizure
-confusion, drowsy, amnesia for hours after seizure
Absence seizure can be reliably tested by doing what
Inducing it by HYPERVENTILATION
Focal seizures are often preceded by what weird sign
Smelling a weird burnt smell or hallucinating
Focal seizures often secondary generalise into what type of seizure
Tonic clonic
