What are the differences between a faint (syncope) and a seizure?
Startled look, falls to the ground, unresponsive but little/no movement, awakens and is quickly back to normal
Abnormal vocalisations / sensations / movements +/- loss of consciousness, slow to recover
When taking a funny turn history, ask what happened ___, ___ and ___ the event.
before, during and after
___ accounts are helpful for determining the cause of a collapse.
What should you ask about the onset of a funny turn?
What were you doing at the time?
How did you feel?
What did you look like?
If a patient is having recurring events, what could you ask them to give you?
What are some risk factors for epilepsy?
Birth / developmental problems
Hx head injury, tumours
Hx seizure (including febrile!)
Can people with a diagnosis of epilepsy drive?
A person with active epilepsy needs to stop driving and inform the DVLA
An epilepsy diagnosis has consequences for a patient's ___.
What should you examine in a patient presenting with syncope?
Full cardio exam
What are some notable drugs which may precipitate seizures?
Analgesics e.g tramadol
if a patient has worsening seizures, check these before adjusting anticonvulsants
What investigation must you get for someone with new onset seizures?
Why is obtaining an ECG important in anyone with new onset seizures?
Arrhythmias (e.g long QT syndrome) cause cerebral hypoperfusion, precipitating seizures
In which case would a patient presenting with a seizure get an immediate CT scan?
Serious acute underlying pathology is suspected cause
e.g head trauma, haemorrhage, stroke, tumour
Persistently low GCS after admission
What is an EEG?
like an ECG for your brain, "brain waves"
Are EEGs used to diagnose epilepsy?
What are EEGs used for?
Classification of epilepsy
Confirming non-epileptic attacks
Confirming non-convulsive status epilepticus
What are some epilepsy mimics?
What is epilepsy?
Tendency to have spontaneous, recurring epileptic seizures
What is an epileptic seizure?
UNPROVOKED abnormal discharges of electricity in the brain
Are the electrical discharges in an epileptic seizure excitatory or inhibitory?
What does focal epileptic seizure mean?
Discharge affects one area of the brain only
What does generalised epileptic seizure mean?
Discharge affects several areas of the brain
At what ages do patients typically develop
a) focal - older patients
b) generalised - children and teens
What is SUDEP?
Sudden death syndrome re: epilepsy
Patients with epilepsy are (more likely / less likely) to die than normal patients.
aspiration; nocturnal seizures; drink and drug problems, depression and suicide; learning difficulties
What is a focal seizure?
Discharge remains in one part of the brain
causing a focal epilepsy
What causes focal epilepsy?
Structural abnormality in one part of the brain
Focal epilepsy causes seizures with symptoms relating to the ___ of the brain the structural abnormally is in.
e.g motor sensory visual memory
What is a generalised seizure?
Discharge propagating via pathways to multiple areas of the brain
Can focal epilepsy cause generalised seizures?
Yes, if discharge propagates via pathways