Epilepsy Flashcards
Differential diagnoses for blackouts
Syncope First seizure Hypoxic seizure Concussive seizure Cardiac arrythmia Non-epileptic attack e.g. narcolepsy
Important features of the history of a patient presenting with a blackout
What they were doing at the time
What (if any) warning feelings did they get
What they were doing the night before
Have they had anything similar in the past
How did they feel after
Any injury, tongue biting or incontinence
Details of history to obtain from a witness of a blackout
Detailed description of observations before and during attacks, including level of responsiveness, motor phenomena, pulse, colour, breathing, vocalisation
Detailed description of behaviour following attack
Additional potentially relevant information from the history of a patient presenting with a blackout
Age Sex PMH including head injury, birth trauma and febrile convulsions Past psychiatric history Alcohol and drug use Family history
What is the most common cause of fainting?
Vasovagal syncope
Prodrome of syncope
Light-headedness Hot Sweating Nausea Tinnitus Tunnel vision
Triggers of vasovagal syncope
Prolonged standing Standing up quickly Trauma Venipuncture Micturition Coughing
Features of syncope
Upright position Pallor common Gradual onset Injury rare Incontinence rare Rapid recovery Precipitants common
Features of seizure
Any posture Pallor uncommon Sudden onset Injury quite common Incontinence common Slow recovery Precipitants rare
Typical patient/presentation of primary generalised seizures
Under 25 years old May have a family history No warning May have history of absences and myoclonic jerks as well as GTCS Generalised abnormality on EEG
When do hypoxic seizures occur?
When individuals are kept upright when in a faint e.g. in an aircraft, at the dentist, when helping someone to their feet
When do concussive seizures occur?
After any blow to the head
When should cardiac arrhythmias be considered in patients presenting with blackouts
FH of sudden death, cardiac problems
History of collapse with exercise
Give an examples of a functional cardiac problem that could cause collapse
Long QT syndrome
Features of non-epileptic attacks
More common in women than in men Can be frequent May look strange Can be prolonged History of other medically unexplained symptoms History of abuse Superficial resemblance of tonic clonic seizure or "swoon" May involve strange movements
Investigations of possible first seizures
Blood sugar
ECG
Consider alcohol and drugs
CT head
Features of focal/partial seizures
May have an aura
Can occur at any age
Cause can be any focal brain abnormality
Simple partial and focal seizures can become secondarily generalised
Focal abnormality on EEG
Cause may be seen on MRI
When is epilepsy usually diagnosed?
After a second unprovoked attack
May sometimes be diagnosed on history taking after a first seizure if history is clearly indicative of epilepsy
Features suggestive of epilepsy
History of myoclonic jerks
Absences
Feeling “strange” with flickering lights
History of déjà vu
Rising sensation from abdomen
Episodes of looking blank with lip-smacking
Fiddling with clothes
What is an epileptic seizure?
Intermittent stereotypes disturbance of consciousness, behaviour, emotion, motor function or sensation which is believed to be from abnormal neuronal discharge
