Seizures, Epilepsy, Syncope Flashcards
Difference between seizures and epilepsy
Seizures - Sudden uncontrollable electrical brain activity that leads to changes in sensation, movement, consciousness, behaviour
Epilepsy - 2+ unprovoked seizures in under 24hrs
Definition of syncope
Cardiovascular reasons for LOC
Syncope - a result of brain hypoperfusion, from reduced CO
Structural heart conditions
-aortic stenosis, HOCM, dissection
Arrythmias
Vasovagal
Cough/straining
-increased intrathoracic pressure decreases cardiac return and CO
Volume depletion
-diuretics, HTN drugs, autonomic neuropathy
Main features of syncope
-situation
-before
-during
-after
Situation
-positional changes
-situational (standing too long, dehydration, stress)
Before - cardiac symptoms, SNS activation from hypoperfusion
-pale, sweaty
-lightheaded
-altered vision
During
-U1 min
-pale, sweaty, slow weak pulse
-some myoclonic jerks after LOC
After
-rapid recovery
-no confusion
Definition of seizures
Causes of seizures
Seizures - abnormal neuronal activity => decreased inhibitory activity
Epilepsy
Brain injury, infection, tumour
-stroke, MS, PD, dementia
PNES
Drug abuse, alcohol withdrawal
Main features of seizures
-triggers
-before
-during
-after
Triggers
-none
-stress, tired
-drugs, alcohol/withdrawal
-periods
-flashing lights
Before - neuro symptoms from decreased inhibitory activity
-altered sensation, movement, feelings
-dejavu, jamaisvu
-sensory aura (visual/olfactory)
During
-s-mins
-LOC possible
-bite tongue
-abnormal posture
-incontinence
-eyes open in epilepsy, closed in PNES
After
-amnesia
-post ictal phase
Investigations for LOC/seizures
Rule out infection (sepsis, meningitis, enceph), low glucose, cardiac causes, evidence of heavy alcohol use
HO
Examination - cranial, eyes, limbs
Bedside - urinedip, CBG, ECG
Bloods - FBC, LFT, RFT, U&E, BM, cultures
Imaging - echo, CT, MRI
Special - EEG, LP
Management for seizures
-non medical
-in the moment
Non medical
-identify and avoid triggers
-report to the DVLA (cannot drive for 6 months post-seizure, 12months epilepsy free)
Acute - normally end spontaneously
-SAFETY
-note start and end time of seizures, auras, post ictal phases
Rescue medication - BZ
SE => LAS, more BZ, AED infusion, GA
Medication given for epilepsy after the 2nd seizure
Epilepsy
-diagnosis and investigations
-management
1st seizure => EEG and MRI
-assess for other differentials
Start AED after 2nd seizure unless
-neuro deficit
-structural abnormality
-EEG unequivocal activity
-patient/family considers risk of future seizure unacceptable
Classification of seizures
- Start location
- Awareness
- Other features
Focal seizures characteristics
-1st line management
Start on 1 side
Awareness varies
Motor/non-motor
Aura
Lamotrigine/levetiracetam
Seizures characteristics
-Generalised
-Myoclonic
-Tonic/Atonic
-Absence
1st line management
Involve both sides of brain at onset
Full LOC
Generalised motor
Men - Valproate
Women - Lamotrigine/leviteracetam
-myoclonic - levetiracetam
-tonic/atonic - lamotrigine
Non-motor - absence
1st line - ethosuximide
2nd line - same as motor
Unknown onset
Focal to bilateral seizure
-characteristics
Unknown - reserved from when the origin is unknown
Focal => bilateral - starts focal but becomes bilateral
Examples of paediatric epilepsy
Infantile spasms - poor prognosis, 2ndary to neuro abnormality
Lennox Gastaut - may be extension of infantile spasms
Rolandic - parasthesia on waking
Juvenile myoclonic - sleep deprivation
Management of patients who drive
Report seizures to DVLA
Isolated seizure free for 6 months
Established epilepsy - 12 months seizure free
Management of patients on other medications
AEDs affect the P450 system => alters metabolism of other meds (warfarin)
Contraception and AEDs affect each other
