Flashcards in epilepsy Deck (30):
What does ictus mean?
Sudden neurological event
Define a seizure. How does it differ from epilepsy?
Seizure= abnormal, hypersynchronous neural activity
Epilepsy= tendency to repeated spontaneous seizures (unprovoked seizures)
Epilepsy is generally classified as a SYNDROME.
How many first seizures lead to epilepsy
To diagnose epilepsy syndrome, we need to know what details about the patient?
1. Seizure type
3. Clinical course
4. Interictal EEG
5. Genetics, family Hx
What are some common triggers for a seizure?
sleep deprivation, hang over, tramadol etc
What seizures come under generalised seizures?
GTCS (generalised tonic clonic seizure)
What seizures come under focal/partial seizures?
Dyscognitive (complex partial seizure)
Secondarily generalised seizure
Describe absence seizures
• Usually occurs in children, usually post hyperventilation; alteration of consciousness (stay upright, no warning); Facial twitch, staring, oral myoclonias
• 2 Hz spike and wave discharges
Usually lasts 2-10 seconds
• Tonic phase (arms down, eyes open, cry)
• Clonic phase (flexion/extension
• Apnoea (cyanosis or plethora)- they usually have a period where they don't breathe
• Lasts 1-5 mins
• Minor injury common- tongue biting
Post ictal confusion (slow recovery) over 1 hr
• Sudden, involuntary muscle twitch
• Typically related with sleep deprivation
• Usually seen as a prodrome to GTCS
Common in metabolic encephalopathy/ sleep myoclonus --> not related to epilepsy
Is consciousness impaired in an aura?
Describe secondarily generalised convulsions
• May be hard to distinguish from a primary GTCS vs late stage focal seizure
• Recognisable partial phase variable
• Automatic behaviour
• Not responsive
• Ictal cry may be present
Usually arises from some focal pathology unlike GTCS which has some genetic basis
describe focal dyscognitive seizures
• Affects consciousness- ask about memory. Bilateral temporal lobes involved.
• Similar to absence seizure but are LONGER, less distinct offset, less frequent and involve automatisms. --> automatic movements
• Tone is maintained
+ Post-ictal confusion. Distinct from the absence seizure.
Describe juvenile myoclonic epilepsy
• Onset 12-18 years
• Sleep deprivation triggered
• Prognosis= responds very well to sodium valproate
• Not often refractory
• Usually seizures result from non compliance to drugs
• Spontaneous remission is rare (lasts through to adulthood)
Partial simple= focal, no loss of consciousness.
Partial complex= focal impaired consciousness
Generalised seizures can be divided into 2 main categories. What are they?
non convulsive and convulsive
What are some differentials for seizure?
3. TIA (not really the same)
4. Migraines (aura lasts for a lot long
Describe the characteristics of psychogenic seizure
• Psychogenic non-epilepsy seizures (PNES) = pseudoseizures
• Fluctuating intensity
• Very long
• Eyes closed (pseudo sleep). Eyes are usually open in real seizures
• Non anatomical tremor
what are some common anti-epileptic drugs?
sodium valproate, lamotrigine, topiramate, phenytoin, carbamezapine, gabapentin, pregabalin, levetiracetam
what are 4 medical complications of an uncontrolled seizure?
The acute medical complications of uncontrolled seizures include traumatic injury, aspiration pneumonia, lactic acidosis, cardiac arrhythmia and neurological injury. While the first four will usually be prevented by good supportive care, neurological injury can occur simply with prolonged uncontrolled seizures even if adequate oxygenation is maintained.
is a patient able to drive if they have new onset (first seizure) epilepsy?
The fitness to drive guidelines recommends that a conditional license can be granted after a period of at least 6 months without seizures
what sorts of things should epileptic patients be advised against?
Driving --> Ausroads guidelines. You need to be seizure free for 12 months to drive a private vehicle. (6 months for newly diagnosed seizures).
what ix would you do if a person came into ED after a seizure?
blood sugar + U and Es, FBE, and urine drugs of abuse screen, Anti-epileptic drugs levels to confirm medical compliance
diagnosis of pseudogenic seizure?
patients do not hurt themselves
what are some triggers of seizures?
sleep deprivation, alcohol, non compliance to medication, stress, flashing lights, drugs of abuse, recent trauma, metabolic conditions, pregnancy
What do we mean by status epilepticus?
Status epilepticus refers to either continuous seizure activity or repeated seizures without full recovery of consciousness between attacks. Nonconvulsive status epilepticus may be generalised (absence status) or partial (focal) (complex partial or simple partial status). Convulsive status epilepticus is a medical emergency.
what is todd's paresis?
post ictal paralysis/weakness on one side of the body. Indicates focal seizure, and that seizure focus is contralateral to the deficit
what are some ix would you order for a seizure?
1. BSL, toxicity screen
3.CT brain (initial)
4. MRI brain
acute management of a seizure?
benzodiazepines + manage AIRWAY