Flashcards in Epilepsy Deck (16)
What is epilepsy?
A disease characterised by: an enduring predisposition to generate epileptic seizures and by the neurobiological, cognitive, psychological and social consequences of this condition
Name 5 areas of the brain?
What is a seizure?
A transient occurrence of signs and symptoms due to abnormal excessive or synchronous neuronal activity in the brain
What is the risk of a single seizure?
What is the risk of epilepsy?
What is a generalised seizure?
Originates within and rapidly engages neuronal networks in both hemispheres
What is a focal seizure?
Arise within an area confined to one hemisphere. They can spread within the same hemisphere and or to areas in the contralateral hemisphere and then evolve into a generalised convulsive seizure
What is the cause of epilepsy?
How do we diagnose epilepsy?
Very easy to mis-diagnose - could be syncope, psychogenic, hypoglycaemia
Need to get witness account
Take a long time to recover after a seizure vs eg syncope
What investigations can be done after the 1st seizure?
1) EEG (electro encephalogy) (30% +ve)- 20 minute brain recording to look at electrical activity, brain rhythms, waveform
(can do sleep deprived EEG, prolonged EEG (48hrs), repeated EEG, cant do it after a blackout)
2) IMAGING - MRI or CT (10% +ve) - not needed if complete and rapid response to antiepileptic drugs,
3) ECG - not always accurate, after seizure you get arrythmias or atrial fibrilation. Seizures due to cardiac causes are very bad
What are the driving regulations for epilepsy?
Legal responsibility to tell the DVLA
After 1st seizure = 6 month restriction on driving
After 2nd seizure/ eilepsy diagnosis = 12 month restriction
What treatment is there for epilepsy?
1st line drugs :
carbamazepine (can make generalised seizure worse)
valproate (ot for pregnant women)
phenobarbitol - not given after 1st seizure
SURGERY - not easy as cant always work out where epilepsy coming from so use grids on brain surface or stereo EEG to know location to operate
NEUROMODULATORS - deep vein stimulators - go into thalamic part of brain and disrupt seizure generation or vagal nerve stimulator goes into neck and a signal is sent up to the brain to disrupt seizure generation
What are the complication associated with epilepsy?
Accidents / suicide
Status epilepticus when brain doesnt stop seizures and causes irreversible damage after 30 mins - give lorazepam, diazepam, then phenytoin, sodium valproate
SUDEP - brain inhibits seizure too strongly and brain is shut down. 0.1%/yr. Risk factors - young males, long duration of epilepsy, poor drug compliance, lack of supervision post seizure
What is the mechanism of SUDEP?
Cerebral electrical shutdown
What co morbidities are associated with epilepsy?
mental health disorders