Epilepsy Flashcards
Define epilepsy
Epilepsy – tendency to recurrent (at least 2) unprovoked seizures
Seizure – abnormal and excessive synchronised discharge of a set of cerebral neurones
Generalised – affect both sides of the brain at once, loss of consciousness
• Focal – arise in specific loci of the cortex in one hemisphere
• Simple – a small part of one of the lobes is affected, conscious
• Complex – a larger part of one hemisphere is affected, reduced/LOC
What are the causes/risk factors of epilepsy?
Primary – idiopathic Secondary • Vascular – haemorrhage, infarction • Infection – meningitis, encephalitis, abscess • Trauma • Alcohol withdrawal (drugs) • Metabolic – hypo/hypernatraemia, hypo/hyperglycaemia, hypoxia • Inflammation – vasculitis • Neoplasm – tumour • Degenerative – Alzheimer’s disease
Seizure mimics
• Syncope
• Migraine
• Non-epileptic seizures
Triggers • Flashing lights • Drugs • Sleep deprivation • Metabolic
What are the signs and symptoms of epilepsy?
Simple focal/partial seizures Temporal lobe: • a ‘rising’ feeling in the stomach • déjà vu • olfactory/gustatory hallucinations • a sudden intense feeling of fear or joy Frontal lobe: • a strange feeling like a ‘wave’ going through the head • stiffness or twitching in part of the body e.g. Jacksonian march – spasm spreading from mouth or digit Parietal lobe: • a feeling of numbness or tingling • a sensation that an arm or leg feels bigger or smaller than it actually is Occipital lobe: • visual disturbances such as coloured or flashing lights • hallucinations
Complex focal/partial seizures Temporal lobe: • picking up objects for no reason or fiddling with clothing • chewing or lip-smacking movements • muttering or repeating words that don't make sense • wandering around in a confused way Frontal lobe: Automatisms • making a loud cry or scream • strange repetitive postures or movements such as cycling or kicking Parietal/occipital lobe: • Less common • Affect senses or visio • Usually last around 15 - 30 seconds
What investigations are carried out for epilepsy?
• Bloods - FBC – anaemia (hypoxia), infection - U&Es – electrolyte imbalance - LFTs - Glucose - Prolactin – transient rise after true seizure -Toxicology screen • ABG • EEG – epileptiform activity • CT/MRI – exclude SOL or haemorrhage • Lumbar puncture – infection
What is the management for epilepsy?
Aim is for monotherapy (single AED) – if switching drugs, taper doses
Focal seizures
• Lamotrigine
• Carbamazepine
Generalised seizures
• Sodium valproate
Other AEDs • Phenytoin • Levetiracetam • Topiramate • Gabapentin • Vigabatrin • Ethosuximide (absence)
Patient education
• Avoid triggers
• Inform DVLA – drive only after 6-12 seizure free months
• Teratogenicity of AEDs in pregnancy
Status epilepticus
• Airways, Breathing, Circulation, don’t ever forget Glucose
• IV lorazepam or diazepam
- Repeat after 15mins if needed
- IV phenytoin if they fail to respond
- General anaesthesia and intubation if they still fail to respond
What are the complications of epilepsy?
• Refractory seizures • Fractures • Head trauma • Sudden unexpected death in epilepsy (SUDEP) • Drug side effects
