Syncope (add)

Question 1

What is Epilepsy?

Answer 1

This is a repeated tendency to have sudden and intermittent abnormal electrical activity in the brain.

– This leads to seizures, and convulsions (motor signs of electrical discharges)

– 2/3 cases are idiopathic, but can also be due to cortical scarring (head injury, sclerosis, stroke, lesions)

– Seizures are usually preceded by prodrome (hours) where there is a change in mood/behaviour

– Post-ictally give headache, confusion and myalgia and weakness lasting for 15 minutes.

Question 2

Epilepsy types

Answer 2

• Focal (partial) – this originates within networks linked to one hemisphere, seen with underlying disease
• Generalised – this leads to widespread discharge, with no localising features

Question 3

Focal (partial) Epilepsy is subdivided into

Answer 3

– Simple –> without impairment of consciousness, only focal motor, sensory, autonomic

– Complex –> awareness impaired (commonly arising from temporal lobe)

– Focal to bilateral –> this is where electrical disturbance starts focally, becoming generalised

Question 4

Focal (partial) epilepsy symptoms

Answer 4

The seizures usually give different symptoms depending on the area of brain affected:

Occipital:

Visual phenomena like flashes

Parietal:

Sensory disturbances – tingling and numbness (paraesthesia), neglect

Frontal:

Motor features of head and leg movements, posturing, post-ictal weakness + Jacksonian march

Temporal:

Complex motor phenomena (lip smacking)

Emotional disturbances and hallucinations

– Déjà vu/Dysphasia post-ictally

Question 5

Generalised epilepsy is subdivided into

Answer 5

Tonic-clonic (grand mal):

Gives loss on consciousness. Limbs stiffen (tonic) then jerk (clonic)

Myoclonic:

An involuntary muscle jerk of limb/face/trunk, impaired relaxation of muscle may cause the patient to be thrown to the ground

Absence (petit mal):

Brief (<10s) pauses usually in childhood (4-8) with no convulsions

Patient usually experience many per day

EEG shows 3Hz generalised symmetrical

People who have generalised seizures may also bite their tongue and experience incontinence of urine.

– Classic presentation is posterior dislocation of shoulder, after being “thrown” to the floor.

Question 6

Epilepsy investigations

Answer 6

– EEG –> does not exclude epilepsy

– Imaging –> CT head and MRI to identify structural lesions