Week 232 - Epilepsy Flashcards
Week 232
What is a petit mal seizure?
This is now known as a FOCAL seizure. Occure in one part of the brain.
Week 232
What is epilepsy?
A tendency to recurrent unprovoked seizures
Present in 0.5% of population (~1 in 200 UK children)
Week 232
What is a grand mal seizure?
This is actually a TONIC-CLONIC siezure
May be preceded by a Prodrome (‘funny feeling/behaviour’ but no EEG changes) +/or an
Aura (simple partial seizure, with EEG changes)
Tonic Phase - Pt becomes rigid, may collapse if standing Don’t breathe - may become cyanosed
Clonic Phase - Arrhythmic jerking of body/limbs
Breathing is irregular, cyanosis may persist
Tongue biting & incontinence of urine may occur
Post-Ictal Phase
May last several hours, seizures may recur during it
Todd’s Paralysis: rarely occurs - Temporary limb paralysis
Week 232
What is Levetiracetam (Keppra)?
Levetiracetam (Lev-et-teer-rass-et-am) is a medicine which is used in myoclonic epilepsy, generalised epilepsy and partial epilepsy.
Week 232
What is Lamotrigine?
This is an antiepileptic drug, often used in adolescent girls.
Side effects are: Rash and irritability
Week 232
What is the lifetime prevalence of epilepsy?
5-10 people per 1000
Week 232
Does a single seizure qualify as epilepsy?
No. At least two seizures - epilepsy is the continuing tendency to have such seizures.
Week 232
How are seizures classified?
According to the localisation of seizure, and the aetiology. I.e. Generalise or Partial Further divided to Tonic-clonic, Absence Myoclonic (Generalised): Complex, simple, (partial)
Week 232
What is the most common type of partial epilepsy?
Temporal lobe epilepsy (60%)
Week 232
What are the differences between symptomatic and cryptogenic aetiologies of epilepsy?
Symptomatic - clear cause, i.e. brain tumour
Cryptogenic - Likely underlying cause, but not yet identified.
Week 232
What are the differentials for epilepsy?
- Syncope/vasp-Vagal
- Postural hypotension
- TIA (not v often)
- Trauma
- Non-Epileptic attacks
- Sleep disorders
- Hypoglycaemia
Week 232
Name some seizure “markers”, useful if you don’t have a history.
Stereotyped
lateral tongue biting
Week 232
What are the three P’s of Syncope?
Posture - standing
Provocation - heat, venesection, micturition
Prodrome - Nausea, clammy, blurry vision, deafness, tinnitus
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What are the red flags for cardiogenic syncope?
Other cardiac symptoms
FH of sudden death
If it occurs on exertion
Rapid recovery
FH of IHD
No warning
Week 232
What is JME epilepsy?
Juvenile myoclonic epilepsy. A young person with an epileptic episode, and Myoclonic jerks.
Week 232
A partial seizure with concomitant loss of consciousness is known as what?
A complex partial seizure
Week 232
What are the three A’s of temporal lobe (complex partial) seizure?
Aura - warning sign
- changes in taste/smell/hearing/sight
- rising sensation Arrest
- motor and speech Automation
- Manual or oro-facial (i.e. smacking lips) Post-Ictal confusion
Week 232
In occipital lobe siezures, what do patients tend to see during aura?
Coloured balls of light
Week 232 What are the “clues” leading you to a diagnosis of a non-epileptic attack?
Awareness retained gradual onset Prolonged - up to a couple of hours! Frequent No response to AED Preceded by autonomic arousal Eyes closed and resist opening Back arching Biting tip of tongue
Week 232
What mediates a non-epileptic attack?
They are psychologically mediated.
Week 232
What % of diagnosed epilepsy patients actually have NEAD (non-epileptic attack disorder)?
About 20% actually suffer from Non-Epileptic attack disorder.
Week 232
What are the indications for a LOC being a seizure?
- .Trigger
- Sudden onset
- Prodrome
- Lasts 1-5 minutes
- Common, rhythmic, synchronous jerks
- Cyanosis
- Tongue biting is common
- Prolonged recovery
Week 231
How is “coma” defined?
Unrouseable
Unresponsive
Unaware of ext. stimuli (pain/verbal)
GCS low
Week 231
Define: Arousal
Level of consciousness/alertness Function of reticular activating system in pons and midbrain





