Epilepsy Flashcards
(30 cards)
What is epilepsy?
A recurrent tendency to spontaneous intermittent abnormal electrical activity in part (or all) of the brain manifesting as seizures
What is a prodrome?
- A change in mood or habit lasting hours or days that may precede a seizure
- It is not part of the seizure
What is the aura?
- A feeling that a seizure is about to come on. The patient is aware of this preceding the seizure
- It is part of the seizure
What does post-ictal mean?
Afetr the seizure
What symptoms are associated with post-ictal patients?
- Headache
- Confusion
- Myalgia
- Sore tounge
What are the causes of epilepsy?
- 2/3 are idiopathic (often familial)
- Structural → Cortical scarring, developmental, space occupying leision, stroke, hippocampal scleriosis, vascular formations, vascular malformations.
- Other→ Tuberous sclerosis, SLE, Sarcoidosis
What is the major differential diagnosis to a seizure that needs to be ruled out?
Syncopal attack → Reflex anoxic convulsions give a seizure like appearance but with no post-ictal symptoms.
What is a partial seizure?
- Has a focal onset
- Each focal area has symptoms associated with it.
- Temporal, frontal, Parietal, Occipital
What are the associated symptoms of a temporal lobe focal seizure?
Post-ictal confusion is common
- Automatism → Complex motor phenomena with impaired awareness and little recollection afterwards
- Abdominal rising sensation or pain
- Dysphasia
- Memory phenomena → De javue or jamais vue (everything seems strange)
- Hippocampal involvment→ Emotional involvment (eg. sudden terror)
- Uncal involvment → Hallusination of smell or taste
- Delusional behaviour
What are the associated symptoms of a frontal lobe focal seizure?
characterised by rapid recovery and little post-ictal symptoms
- Motor features → Posturing, versive movements of the head and eyes, peddeling of the legs
- Jacksonian march → spreading focal motor seizure with retained awareness
- Motor arrest
- Subtle speach disturbance
- Aphasia
- Post-ictal todds palsy → transient neurological defecit (paresis)
What are the associated symptoms of a occipital lobe focal seizure?
• Visual phenomena → spots, lines, flashes
What are the associated symptoms of a parietal lobe focal seizure?
- Sensory disturbance → Tingling, numbness, pain
* Motor disturbance
What are the 2 main types of epileptic seizure?
Generalised and partial
What are the 3 types of partial seizure?
- Simple partial → Aweareness is unimpaired. No post-ictal symptoms
- Complex partial → Awareness is impaired. Commonly start in temporal lobe.
- Partial seizure with secondary generalisation → Focal start to seizure (simple or complex) that then becomes general
What are the 5 types of generalised seizures?
- Absence seizure → Stops mid sentence and then continuos where they left off. Presents in childhood
- Tonic clonic seizure → Loss of consciouness with (tonic) limb stiffness followed by (clonic) jerks. post-ictal confusion and drowsiness
- Myoclonic seizures → Sudden jerk of limb face or trunk → Violent
- Atonic seizures Sudden loss of muscle tone causing a fall. No LOC
- Infantile spasms → Commonly assoc. with tuberous sclerosis
What drugs should be advised after 1 fit?
NONE! psych! unless risk of reccurence is high → Structural brain leision etc.
What drugs are prescribed for generalised tonic-clonic seizures?
- 1st line → Sodium valporate and lamotrogine
- 2nd line → Carbemazepine or topiramate
- 3rd line → levetiracem, oxcarbazapine, clobazam
What drugs are prescribed for absence seizures?
• sodium valporate, Lamotrigine, ethosuxamide
What drugs are prescribed for tonic, atonic and myotionic seizures?
Avoid Carbemazepine or oxcarbazapine!!!
- 1st line → Sodium valporate and lamotrogine
- 2nd line → topiramate
- 3rd line → levetiracem, clobazam
What drugs are prescribed for partial and secondary generalised seizures?
1st line → Carbemazipine
2nd line → Sodium valporate, lamotrigine
What is a non-epileptic attack disorder associated with?
- Traumatic childhood experience
- biting tip of tounge
- Essentially faking it.
What is the leading cause of generalised idiopathic epilepsy thought to be?
Febrile convulsions causing scarring of the hippocampus
What is status epilepticus?
- A seizure lasting more than 30 mins or repeat seizures without regaining consciousness.
- Aim to terminate seizures in <20 mins
What is a differential diagnosis for a pateint with status epilepticus if they are pregnant?
Eclampsia
