2.4 Seizures + Antiepileptic Drugs Flashcards
What are some different causes for “blackouts/funny turns”?
- Syncopal (most common)
- Seizures
- Metabolic (e.g. hypoglycaemia)
- Brainstem stroke
- Psychogenic
A patient has recently blacked out. What sort of history questions do we have for the patient?
- Circumstances? (where were they, what where they doing - coughing, laughing, eating, exercising, voiding)
- Prodrome? (what’s the last thing you remember? any symptoms before LOC?)
- Post-drome? (First memory - ambulance = seizure, wake up = faint - tongue biting (lateral = seizure), symptoms on recovery, weakness on recovery (brainstem stroke?), speed of motor vehicle accident?
You’re taking a collateral history of a patient who has recently fainted. What sort of questions might you have?
- Confirm circumstances
- Vocalisation?
- How did they fall (crumple: vasovagal, stiff: seizure)
- Colour
- How long unconscious?
- Speed of recovery
Which of seizure vs syncope has high-speed vs low-speed car accidents?
- Seizure, contraction of muscles, stomp on accelerator, causes high-speed
- Syncope, take foot off accelerator, low-speed crash
What features are not useful for differentiating syncope from seizure?
- Incontinence
- Twitching
- Injury (other than lateral tongue biting)
- Dizziness
- Eye movements
Signs of psychogenic seizures
- Crying
- Slow onset
- Side-to-side head movement
- Eye closure
Define seizure
Transient occurrence of signs or symptoms due to abnormal excessive or synchronous brain activity
Focal vs generalised seizure
Focal: 1 part of a cerebral hemisphere
Generalised: Rapidly engaging networks, both hemispheres
A patient has 3 seizures within 24 hours. How many seizures does this technically count as?
- One
- Anything within 24 hours is really only one
Define epilepsy (in terms of diagnostic criteria)
- Multiple seizures more than 24 hours apart
Or:
- 1 unprovoked seizure with >=60% chance of recurrence over 10 years
Or:
- When an epilepsy syndrome can be identified
Unprovoked vs acute symptomatic seizure
Unprovoked: no precipitating factors
Acute symptomatic: in response to a recent CNS/systemic insult
What are some different aetiologies of epilepsy?
- Metabolic (usually transient, sometimes hereditary)
- Cortical malformations
- Autoimmune
- Stroke
- Tumours
- Infection (esp. 3rd world)
- Neurodegeneration
- Genetic
M CASTING (Mid Acting)
Which is more likely to cause seizures: low grade or high grade tumours?
Low grade -> tissue is more likely to be functional, thus allowing for abnormal electrical activity
Describe generalised seizures
Begin at some area in the brain, but rapidly engage bilaterally
Describe focal seizures
Seizure that begins in one area on one side of the brain. May eventually spread.
What is developmental epileptic encephalopathy?
Group of syndromes characterised by:
- Epilepsy
- Developmental delay/impairment
- Cognitive impairment
List some causes for developmental epileptic encephalopathy
- Perinatal stroke
- Infections
- Trauma
Describe genotypic- phenotypic variability in the context of epilepsy
A single genotype can produce multiple phenotypes -> so one mutation will not always cause the same type of epilepsy.
Why is “genetic” different to “inherited”
Epigenetics and mutations acquired de novo
List the neurological elements of consciousness
ARMS
- Awareness
- Responsiveness
- Memory
- Sense of self
