Epilepsy Flashcards
List some potential causes of blackouts
Syncope First seizure Hypoxic seizure Concussive seizure Cardiac arrhythmia Non-epileptic attack e.g. narcolepsy, migraine
What two forms of history taking are key in assisting diagnosis of the cause of a blackout?
Patient history
Witness history
What aspects of the witness history are important when investigating a blackout?
Detailed descriptions of observations before and after the event - level of responsiveness, motor phenomena, pulse, colour, breathing etc.
Detailed description of behaviour follow the event
Describe syncope
Vasovagal syncope is the most common cause of fainting Early symptoms: Light headed, nausea Hot, sweating Tinnitus Tunnel vision
Give some triggers for vasovagal syncope
Prolonged standing
Standing up quickly
Trauma
Venepuncture
How does posture in differ in syncope vs seizure?
Syncope - upright posture
Seizure - any posture
How does pallor differ in syncope vs seizure?
Syncope - pallor common
Seizure - pallor uncommon
How does the rate of onset vary between syncope and seizure
Syncope - gradual onset
Seizure - sudden onset
How does incontinence differ in syncope vs seizure?
Syncope - rare
Seizure - common
How does the presence of precipitants differ in syncope vs seizure?
Syncope - precipitants common
Seizure - precipitants rare
Describe hypoxic seizures
May superficially resemble a generalised tonic-clonic seizure
May resemble a swoon
Occur when individuals are kept upright in a faint
Can occur in an aircraft, at the dentist
Patient may have a succession of collapses
Seizure-like behaviour may occur
When do concussive seizures occur?
After any blow to the head
Describe non-epileptic attacks
Commoner in women
Can be frequent and prolonged
May have a history of medically unexplained symptoms
May have a history of abuse
What are the key initial investigations for possible first seizure?
Blood Sugar
ECG
Consideration of alcohol and drugs
CT head - sometimes
Outline the driving restrictions which apply to first seizures
A patient may drive a car 6 months after their first seizure if the show no further signs of seizure activity
A patient may drive an HGV or PSV 5 years after their first seizure if they have no further events and are not on medication for epilepsy
What history feature are suggestive of epilepsy?
Myoclonic jerks, especially first thing in the morning, absences or feeling strange with flickering lights - in keeping with primary generalised epilepsy
History of deja vu, rising sensation form the abdomen, episodes where patient looks blank, often accompanied by lip-smacking, fiddling with clothes - suggestive of focal onset epilepsy
Define an epileptic seizure
An intermittent stereotyped disturbance of consciousness, behaviour, emotion, motor function or sensation which, on clinical grounds, is believed to result from abnormal neuronal discharges
Define epilepsy
A condition in which seizures recur, usually spontaneously
List the seven classifications of seizures
Generalised Tonic-clonic Myoclonic Clonic Tonic Atonic Absence Focal
How are focal seizures characterised?
Aura
Motor features
Autonomic features
Degree of awareness/responsiveness
What type of EEG abnormality is seen with primary generalised seizures?
Generalised abnormality
What type of EEG abnormality is seen with focal/partial seizures?
Focal abnormality
Is there a relationship between epilepsy and learning difficulties?
Yes - many patients who suffer from epilepsy also have some form of learning disability
Give some investigations for epilepsy
EEG for primary generalised epilepsies including hyperventilation and photic stimulation
MRI for patients under 50 with possible focal onset seizures
Video-telemetry in uncertain
