Week 5 - A - Epilespy, Treatment and Driving - Partial/focal, Primary generalised, Non-epileptic attack disorders, Status elepticus Flashcards
What is epilepsy?
Epilepsy is a recurrent tendency to spontaneous, intermittent and abnomral electrical activity in the brain that can result in episodes of sensory disturbance, loss of consciousness or convulsions
What is epilepsy again and what are convulsions?
Epilepsy is a recurrent tendency to spontaneous, intermittent and abnormal electrical brain activity that can cause episodes of sensory disturbance, loss of consciousness or convulsions Convulsions are the motor signs of the abnormal electrical discharges
Diagnosing epilepsy is largely based on the history. What are the key points to cover when someone has had a suspected epileptic fit?
Onset - important to know what they were doing? were there any light headnedness or symptoms that could have pointed to syncope The event itself - what happened? What was the type of movement, were they responsive and aware throughout the seizure Afterwards - speed of recovery or any defecit
What actually is syncope? What is it commonly known as? What is presyncope?
Syncope is a temporary loss of consciousness usually related to a low blood pressure which means there is insufficient blood flow to the brain - commonly called fainting or passing out Presyncope is the state of feeling light headed and dizzy, often feeling faint which is associated with postural (orthostatic) hypotension - different from syncope which is actually passing out
Different types of movements could occur during epilepsy, state what tonic clonic movements are? State what a carpopedal spasm is and its cause?
Tonic clonic movements are when the body increases in stiffness (the increased tone), and then the body rapidly jerks )the clonic phase) and usually this type of seizure is preceeded by a loss of consciousness in the patient A carpopedal spasm is when the body becomes acutely hypoxic causing reduced ionsiation of calcium and phosphate which leads to contraction of the hands and feet
In the carpopedal spasm it has been stated that it is due to their being hypoxia reducing ionisation of calcium and phosphate What will happen to a patient in hypocalcaemia? (what are the two signs in hypocalcaemia)
Get Chovstek’s sign and Troussea sign In Troussea - after inflation of a sphyg above SBP for 3 minutes, carbopedal spasm will occur In CHovsteks - tapping th facial nerve just lateral to the ear will cause ipsilateral contraction of the face
Which hormone will increase in hypocalcaemia? Why?
Calcium levels are sensed by a G-protein couples receptor on the parathyroid gland and therefore PTH will be increased in the blood in response to reduced calcium levels
What are some risk factors for developing epilepsy? What is the prevalence of epilespy? * The incidence of epilepsy looks at the number of new cases of epilepsy in a given year or period of time. It’s often given in a ratio such as “x” out of 1,000 persons develop epilepsy each year. * The prevalence of epilepsy looks at the number of people with epilepsy at any given point in time. This includes people with new onset epilepsy as well as those who have had epilepsy for a number of years.
Risk Factors - Premature birth, head trauma, family history, drugs, previous seizures The prevalence of epilepsy is 1in100 people
What age does epilspey tend to present? What is the seizure in children that can increase the risk of occurence of epilepsy? What age group of children does it commonly affect?
Epilepsy tends to either present in children or in adults Febrile seizures can occur in children - the children have a fever and then have a tonic-clonic seizure - affects children between the age of 6 months and five years Slightly increases the risk of the occurence of epilepsy after this happens
How long do febrile seizures tend to last? What can be given (if in hospital) after 5 mins of seizure?
Febrile seizures tend to last less than 20 minutes but if the seizure is continuing for greater than 5 mins - can be treated as if status elepticus ie IV lorazepam, buccal midazolam or rectal diazepam
Would you examine a patient with suspected syncope for epilepsy in seizure clinic? If a patient has been diagnosed with syncope, which examinations would be important?
Unlikely to in seizure clinic due to it showing little benefit. The history is much more important. Carrying out an EEG in these patients is likely to provide false positives It would be important to carry out a cardiovascular examination as well as a lying and standing blood pressure
In cases where there is presyncope and you suspect postural (orthostatic hypotension), how is the lying and standing blood pressure carried out?
Ideally the patient has been sitting or lying down for 5 minutes before the first blood pressure is taken, ask the patient to stand for at least one minute and take the standing BP and then take another standing BP at 3 minutes If there is a drop in Systolic BP >/=20mmHg or A drop in Diastolic BP >/=10mmHg After 3 minutes of standing The patient is then diagnosed with orthostatic hypotension
Which drugs can exacerbate epilepsy?
Most if not ll drugs have a potential to exacerbate epilepsy Ie antibiotics - penicillins and trycyclis, cocaine and tramadol also
If an epileptic person was being treated for depression with antidepressants, however there epilepsy was getting worse, would you cease treatment?
Do not stop the anti-depressive treatment, the depression is often the thing that will kill the patient with epilepsy and therefore don’t hold of treatment in the fear you could potentially make the epilepsy worse
What is the one key test that should be done on a fallen patient (with suspected seizure)?
The key test that should be done in a fallen patient would be to carry out an ECG on the patient
Imaging is often carried out in a patient with falls if suspecting seizures, what scans are carried out? What scan is useful for the confirmation that a person has had an epileptic attack? and can confirm non-epilpetic attacks?
MRI scan is useful as it provides the best brain quality CT is sometimes carried for reasons which i will discuss on net flashcard EEG - electroencephalogram
What is the reason for carrying out an MRI scan in a patient with falls and suspected seizures? When is a CT scan carried out over the MRI?
MRI to see if there is focal ie tumour causes of the siezures A CT scan is carried out if there is clinical or radiological fracture or a decreasing GCS, head injury with seizure or failure to have GCS 15/15 within 4 hours of coming to hospital
What is the main use of carrying out an EEG after a first seizure?
An EEG is used to confirm epilsepy and a normal EEG will not exclude epilepsy as the cause but makes epilepsy being a causative factor unlikely - a normal EEG could mean that the patient is having a non-epileptic attack An Electroencephalogram also helps assess the risk recurrence of other seizures
If patient presents with multiple seizures, how is an EEG useful?
It can help classify the seizure as generalised or partial (focal)
What are the likely differential diagnosis’s of epilepsy?
Syncope Non-epileptic attack disorder Panic attacks/hyperventilation syndromes Sleep phenomena
What is non-epileptic attack disorder also known as? (NEAD) What happens in a non epileptic attacks? What is it usually due to?
Non epileptic attack disorder is also known as psychogenic non-epileptic attacks or functional disorder (The use of older terms including pseudoseizures and hysterical seizures are discouraged) * The causes of these seizures is usually emotional or stress-related in origin * Usually the seizures last greater than 2minutes and there is often violent thrashing , or just a gneralised tonic clonic seizure * EEG is always normal
Non epileptic attack disorders (psychogenic non-epileptic seizures) like borderline personality disorder are associated with a history of what? The differential diagnosis of PNES firstly involves ruling out epilepsy as the cause of the seizure episodes, along with other organic causes of non-epileptic seizures What is the most frequently used treatment?
Some studies suggest that NEAD are associated with a history of child abuse The disease is most common in females of around 20 years of age The most frequently use treatment for this condition is pshycotherapy - most commonly cognitive behavioral therapy
Driving and safety in a patient with epilespy What are the laws on driving in these patients? Talk about patients who drive normal cars first
If the seizure was a one time thing - the patient must not drive their car, their license will be taken and they can re-apply in 6 months to the DVLA - will lose their license for six months If the patient has had more than one seizure - the patient will lose their license for one year and then can re-apply to the DVLA
What are the laws on driving for people who drive buses, lorries or coaches? What is the three letter acronym for those who drive buses or coaches and for those who drive lorries?
* Buses or coaches - three letter acronym is PCV - passenger carrying vehicle * Lorries - HGV - high goods vehicle If only one seizure - then patient loses their license Before reapplying - patient must show they are 5 years seizure and medication free If more than one seizure - patients loses their license also Before reapplying - must show they are 10 years seizure and medication free
What is sudep and what are it risk factors?
SUDEP - sudden unexplained death in epilepsy Risk factos are uncontrolled epilepsy, patients who drink alcohol and is predominanntly nocturnal seizures in partners who sleep alone
What is epilepsy defined as again? How long do epileptic seizures last (convulsions)?
Epilepsy is the recurrent spontaneous, intermittent and abnormal electrical activity in the brain causing impaired sensation, loss of consciousness or convulsions Epileptic seizures last from seconds to minutes
What are the two main types of epileptic seizure? (broad categories)
Generalised seizures Partial (focalised) seizures
Frontal lobe features of epilepsy present how?
Motor features due to location of the precentral gyrus which has the primary motor cortex of the brain Motor arrest Subtle behavioral differences Dysphasia - Broca’s area location
How do simple partial seizures usually present? How long do they usually last?
They present with unimpaired awareness with focal motor, sensory, autonomic or psychic symptoms. and there is no post-ictal symptoms once the seizure is done They usually last less than one minute
How do complex partial seizures usually present? Which lobe do they most commonly arise from? How long do they usually last?
Complex partial seizures may have a simple partial onest (aura) and then progress to complex Or awareness is impaired from the outset They most commonly arise in the temporal lobe And post ictal confusion is very common with seizures arising from the temporal lobe
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B - this is the answer Although due to her age would most likely give the patient lamotrogine over sodium valproate
What is refractory status elepticus?
Refractory status epilepticus (RSE) can be defined as status epilepticus that continues despite treatment with benzodiazepines and one antiepileptic drug.
If the seizure has bilateral involvement, for it to be epilepsy the patient must lose consciousness, t or f?
TRUE -
