13 Epilepsy Flashcards
(27 cards)
Pregnancy treatment
Lamotrigine, take 5mg folic acid before pregnancy
*lamotrigine levels fall during the second trimester.
Pregnancy anti convulsant complications?
Complication: Valproate: NTD, Phenytoin: Cleft palate, Carbamazepine: less teratogenic than other old anti epileptics
Focal aware/simple partial
Jaksonian March from pre central frontal
Temporal epilepsy
hippocampal sclerosis: Ascending epigastric pain aura, olfactory, gustatory, ictal fearing, autotimasm, lip smacking, chewing, swallowing, nose wiping, limb fiddling, picking, tapping, deja vu, auditory hallucination, piloerection (goosebumps)
Temporal epilepsy treatment?
Surgical treatment 70% success (specially if mesial temporal sclerosis with temporal horn enlargement uncontrolled on 2 drugs)
Frontal seizure?
complex automatism like laughing crying vocalization, speech arrest, dystonic posturing
Nocturnal frontal epilepsy
Shot stereotyped events, abrupt onset and termination, bizarre vocalization, Missdiagnosed as sleep walking, night terror, REM behavior disorder, psychogenic events
Occipital lobe
visual hallucination, illusion, blindness, tonic deviation of eye, nystagmus, repetitive eyelid closure or eyelid fluttering
Parietal
body image shrunk or enlarged/Somatic illusion (out of body experience), visual illusion/hallucination, head cold
Cerebellum
Numbness tongue
Psychogenic/Pseudo seizure
In favor: Pelvic/shoulder thrusting, bicycling legs, resistant to eye opening, waxes and wanes movement, more than 5 minutes, screaming, 90% females with role model (FH+) , crying after attacks, does not occur when alone, anterior tongue biting, side to side headshaking
In opposite true seizure?
lateral tongue biting, turning the head consistently to the right
Differentiate: Prolonged EEG video recording, Prolactin rises 30min post real seizure
Vasovagal syncope
Short, prodromal feeling hot nauseous vision going black before fainting, can have limb jerks/incontinent
Juvenile Myoclonic epilepsy
a subtype of idiopathic generalized epilepsy, Teenager, first thing after waking up in the morning, triggered by sleep deprivation, alcohol, anxiety, FH+, clumsiness when eating breakfast, prone to absence seizure/tonic clonic, Treat Levetiracetam, lamotrigine
Absence/Petit mal
Generalised, children 3-10, 2x female, trigger hyperventilation stress, 95% become seizure free in adolescence
staring, can have stereotyped like chewing/blinking, 10-20 secs, loss of awareness but not loss of consciousness
some notes abbout seizure
*All generalized seizures have no consciousness except myoclonic.
Generalized male: Valproate
*All generalized seizures have no consciousness except myoclonic.
Generalized male: Valproate
Valproate contraindication: Focal, Young female, Liver, Mitochondrial
Generalised Female + focal: Lamotrigine, levetiracetam -> carbamazepine
tOnic: LamOtrigine
Myoclonic: Levetiracetam
Pregnancy: Lamotrigine
focal: levetiracetam, lamotrigine
Absence/Petit mal EEG and management?
EMG: Bilateral 3Hz spike and wave
Treatment: ethosuximide, valproate
Worsens: Carbamazepine
Factors to increase risk of seizure after discontinuation of therapy
Older age at diagnosis, myoclonic or tonic clonic, multiple anticonvulsant, imaging or eeg abnormal
gelastic seizure
Crying or giggling, hypothalamic hamartoma
Alcohol withdrawal
1-2 days deprivation, thin
EMG: 4-6Hz slow wave frontal
catamenial epilepsy
at certain point of menstrual cycle
Seizure on exercise in a diabetic person
Hypoglycemic episode (hypokalemia)
Seizure on alcohol in gliclazide diabetic person
first insulin respond
*case: indian, nodule thigh, seizure
Cysticercosis by taenia solium
(If u eat the worm, intestinal tenia, if u eat the eggs fecal/oral contamination u get cysticercosis)
