Epilepsy Flashcards
What could be the cause of a blackout?
Syncope First epileptic seizure Hypoxic seizure Concussive seizure Cardiac arrhythmia Narcolepsy Movement disorder Migraine
How do you tel what type of blackout a person had?
History from patent
History form witnesses
Diagnostic investigations
What symptoms can occur prior to syncope?
Light-headed Nausea Hot and sweating Tinnitus Tunnel vision
What are the triggers for vasovagal syncope?
Prolonged standing Standing up quickly Trauma Venepuncture Watching/experiencing medical procedures Coughing Micturition
What are the main differences in the features of syncope and seizures?
Syncope: upright posture, pallor common, gradual onset. rapid recovery, incontinence rare, injury rare
Seizure: any posture, pallor uncommon, sudden onset. incontinence common, slow recovery, injury quite common
What is the main cause of a hypoxic seizure?
Continued oxygen deprivation
Where can hypoxic seizures occur?
Individuals kept upright in a faint
Aircraft
Dentist
What is the cause of a concussive seizure?
After a blow to the head
What are some of the features of a non epileptic attack?
More common in females
History of abuse
Can be prolonged
May look bizarre
History of medically unexplained problems
Resemble a generalised tonic clonic seizure
What are the investigations for a possible first seizure?
Blood sugar
ECG
Consider alcohol and drug influence
CT head
What advice should be given to patients?
Driving regulations
Enquire about employment
Enquire about potentially dangerous leisure activities
Provide safety info sheets
What are the features suggestive of epilepsy?
History of myoclonic jerks especially in morning
Absences or feeling strange with flickering lights
History of deja vu rising sensation from abdomen
What is epileptic seizure?
Intermittent stereotyped disturbance od consciousness, behaviour, emotion, motor function or sensation which, on clinical grounds is believed to result from abnormal neuronal discharges
What are the ILAE classifications of epilepsy for generalised seizures?
Tonic-clonic Myoclonic Clonic Tonic Atonic Absence
What is the classification of a focal seizure?
Characterised according to aura, motor features, autonomic features and degree of awareness or responsiveness
May evolve into convulsive seizure
What are the differences between a generalised and a focal seizure?
Generalised: no warning, under 25yo, history of absences and myoclonic jerks, EEG abnormality, family history
Focal: any age, focal abnormality on EEG, MRI may show cause
What are the main investigations for diagnosing epilepsy?
EEG
MRI (under 50yo)
Video-telemetry if unsure
What is the first line treatment for primary generalised epilepsy?
Sodium valproate
Lamotrigine
Levetiracetam
What is the first line treatment for partial and secondary generalised seizures?
Lamotrigine
Carbamazepine
What is the first line treatment for absence seizures?
Ethosuximide
What are the side effects of sodium valproate?
Tremor Weight gain Ataxia Nausea Drowsiness Transient hair loss Pancreatitis Hepatitis
What are the side effects of carbamazepine/
Ataxia Drowsiness Nystagmus Blurred vision Low serum sodium levels Skin rash
What are the side effects of lamotrigine?
Skin rash
Difficulty sleeping
What are the side effects of levetiracetam?
irritability
Depression
