Flashcards in Diagnosis and Management of Epilepsy Deck (33):
abnormal synchronous discharge of neurons in the cortex that produces stereotyped behaviours; usually self limited, lasting seconds to minutes
2 or more unprovoked seizures
Time after a seizure- seconds to hours
Characterized by disorientation and confusion
Time between seizures
Define an Aura
A warning sign of an impeding seizure
Define an EEG
Eelectroencephalograph: recording of gross electrical activity of the cortex via the scalp
What are the types and subtypes of seizures?
Partial: Simple or complex
Seizures can start partial and become generalized
Does a generalized seizure have an aura?
Does a partial seizure have an aura?
Yes both complex and simple
Does a generalized seizure have an altered LOC?
Does a partial seizure have an altered LOC?
Yes for complex, no for simple
Does a generalized seizure show postictal confusion?
Yes (except absence)
Does a partial seizure show postictal confusion?
No for simple, yes for complex
What are the subtypes of a generalized seizure?
Myotonic (like twitching while falling asleep)
Absence (though to originate from thalamus)
How does a complex partial seizure present?
Starts focally and becomes generalized
What would a partial (focal) seizure that includes loss of awareness classify as?
What are the features of an absence seizure in terms of age, aura, frequency, duration, change to tonic-clonic, post ictal confusion, EEG findings, CT/MRI findings, and treatment?
up to 100s/day
no change to tonic-clonic
no postictal confusion
generalized 3 Hz spies and waves
What are the features of a complex partial seizure in terms of age, aura, frequency, duration, change to tonic-clonic, post ictal confusion, EEG findings, CT/MRI findings, and treatment?
presents with aura
not very frequent
changes to tonic-clonic sometimes
presents with postictal confusion
focal epileptiform discharges
positive findings on CT/MRI
Define the prevalence of epilepsy in terms of lifetime risk and male/female`
1% of population has epilepsy
5% life time risk
Risk starts high in life, decreases, then increases again at later age
What are the primary and secondary causes of seizures?
Primary: idiopathic epilepsy
Secondary: Metabolic: nonadherence, Diabetic, EtOH withdrawal, Drugs,
Structural: Tumour, puss, bleeding, stroke
Do subcortical strokes cause seizures?
What do we look for in bloodwork to confirm seizures?
Na, Mg, Ca
Is EEG helpful in diagnosing seizures?
First EEG is 50% sensitive
Three EEG's are 80% sensitive, one of which is done sleep deprived
What are the ontario regulations in terms of driving for patients who present with a seizure?
Must be reported and instructed not to drive
Not able to drive for minimum 6 months
Ex. insulin induced seizure
How do antiepileptic drugs work?
increase GABA; ex. benzodiazepines
Alter ion channels (Na, Ca)
Or combination of the above
What is the process of managing AED? what is the success rate?
start with monotherapy, titrate up
If sz or complications, switch to another monotherapy drug
if sz try dual therapy using drugs with different mechanism of action
75% of patients will become seizure free
With each failed medication, the chance of becoming seizure free becomes lower
1 unprovoked seizure+ abnormal MRI, EEG, or physical. Treat?
1 provoked seizure + reversible cause. Treat?
1 provoked seizure +irreversible cause. Treat?
2 unprovoked seizures. Treat?
what are the first aid steps for a person seizing?
1- cushion head, remove glasses
2- loosen tight clothing
3- turn to the side to keep airway open
4- time seizure
5- don't put anything in the mouth
6- don't restrain
7- offer help postictally
8- ask about diabetes
Define status epilepticus
Ongoing seizure lasting >5 min
repeated seizures without return to baseline in the inter-ictal period
High morbidity and mortality