Epilepsy Flashcards
what is the most important tool to investigating a possible case of epilepsy
the history
what are the 2 classification of epilepsy seizures
generalised seizures
partial/focal seizures
what drugs may precipitate epileptic seizures
- aminophylline
- theophylline
- antibiotics e.g. penicillins, cephalosporins, quinolones
- anti-emetics e.g. prochlorperazine
- opioids e.g. diamorphine
what is often a first line investigation for suspected epilepsy
ECG
who gets a CT scan acutely
Clinical or radiological skull fracture Deteriorating GCS Focal signs Head injury with seizure Failure to be GCS 15/15 4 hours after arrival Suggestion of other pathology – eg SAH
when is an EEG useful
Classification of epilepsy
Confirmation of non-epileptic attacks
Surgical evaluation
Confirmation of non-convulsive status
what is the Ddx for a seizures
Syncope Non-epileptic attack disorder (pseudoseizures, psychogenic non-epileptic attacks) Panic attacks / Hyperventilation attacks Sleep phenomena TIAs Migraine Hypoglycaemia Parasomnias Paroxysmal movement disorders Cataplexy Periodic paralyses Tonic spasms of MS
what is the proposed cause of epileptic seizures
abnormal excessive or synchronous neuronal activity
imbalance between excitation and inhibition
what does symptoms in a focal seizure depend on
on which cortical area is affected
i.e. if temporal lobe affected then awareness of the environment becomes impaired
what is partial seizures further spilt into
simple - without impaired consciousness
complex - with impaired consciousness
what are the types of generalised seizures
Absence Myoclonic Atonic Tonic Tonic clonic (primary generalised)
what type of epilepsy has the most genetic predisposition
generalised epilepsy
what is seen on an EEG in generalised epilepsy
generalised spike-wave abnormalities
what is the first line treatment for generalised epilepsy
Sodium valproate
how does treatment for generalised epilepsy differ
the first line is the same i.e. Sodium valproate
the second line options depend on the type of seizure i.e. tonic-clonic, absence, myoclonic
what is the second line treatment for tonic-clonic seizures
Lamotrigine or Carbamazepine
what is second line for absent seizures
Lamotrigine or Ethosuximide
what is second line for myoclonic seizures
Lamotrigine or Clonazepam
what is the first line treatment for PARTIAL seizures
Carbamazepine
what is 2nd line for PARTIAL seizures
Lamotrigine or Sodium valproate
what is 3rd line for PARTIAL seizures
gabapentin
if a > 30y/o presents with epilepsy what is the most likely type
focal/partial seizure
what is frequently seen in complex partial seizures
hippocampal sclerosis
what are causes of partial/focal seizures
tuberous sclerosis neurofibromatosis intracerebral haemorrhage AV malformation cerebral infarction cerebral abscess subdural empyema HIV vasculitis
