What are the common causes of blackout?
Syncope First seizure Hypoxic seizure Concussive seizure Cardiac arrhythmia Non epileptic attack
What are some causes of a non epileptic attack?
Narcolepsy
Movement disorder
Migraine
What history must be taken from the patient post blackout?
What were they doing at the time?
Warning symptoms
What were they doing the night before?
If anything similar has happened in the past
How did they feel afterwards?
Any injury, tongue biting or incontinence?
What information from what they were doing the night before would be relevant?
Alcohol intake
What history should be taken from witnesses after a blackout?
Level of responsiveness Motor phenomena Pulse Colour Breathing Vocalisation Behaviour before and after attack
What additional information may be relevant after a blackout?
Age Sex PMH, including psych Alhohol and drug abuse Family history
What PMH may be relevant for someone who has blacked out?
Head injury
Birth trauma
Febrile convulsions
Diabetes
What is the most common type of syncope?
Vasovagal
What is the prodrome to syncope?
Light headed, nausea
Hot, sweating
Tinnitus
Tunnel vision
What are triggers for syncope?
Prolonged standing Standing up quickly Trauma Venepuncture Watching/expeiencing medial procedures Mictrurition Coughing
What ar the features of syncope?
Upright posture Pallor common Gradual onset Injury rare Incontinence rare Rapid recovery Prcipitants common
What are the features of a seizure?
Any position Pallor uncommon Sudden onset Injury and incontinence quite common Slow recovery Precipitants rare
What are hypoxic seizures?
Seizures caused by individuals being kept upright when they faint
What are the types of non epileptic seizure?
Hypoxic seizure
Concussive seizure
Cardiac arrhythmia
Hypoglycaemic fit
What heart problems can cause seizures?
Structural or functional
When should heart conditions particularly be taken into account after a seizure?
With family history of sudden death
Cardiac history
Collapse occurs during exercise
What investigations should be done for a possible;e first seizure?
Always blood sugar, ECG
Consider CT head and alcohol and drug screen
When is epilepsy diagnosed?
After a 2nd unprovoked attack or after taking history or first presenting seizure
What are the features suggestive of epilepsy?
Myoclonic jerks Absences or feeling strange around flickering lights Deja vu Rising sensation in abdomen Look blank Lip smacking Fiddling with clothes
What is an epileptic seizure?
Intermittent stereotyped disturbance or consciousness, behaviour, emotion, motor function or sensation which, on clinical grounds, is believed to result from abnormal neuronal discharges
What is epilepsy?
Condition in which seizures recur, usually spontaneously
What are the 2 main classifications of epilepsy?
Generalised
Focal
What ar the types of generalised seizures
Tonic clonic seizures Myoclonic seizures Clonic seizures Tonic seizures Atonic seizures Absence seizures
What are clonic seizures?
Jerking seizures
What are tonic seizures?
Stiff seizure
What often happens in atonic seizures?
Rapid collapse to floor, often causing face and head injuries
Who are absence seizures normally in?
Children, tend to grow out of it by age 12
What are characteristics of focal seizures?
Aura, moor features, autonomic features, degree of awareness or responsiveness
What can focal seizures develop to?
Generalised convulsive seizures
What is the difference in onset between primary generalised and focal seizures?
generalised= no warning Focal= aura
What is the difference in diagnosis between primary generalised and focal seizures?
Generalised= diagnosed <25 years FOcal= any age, MRI may show cause
What is the difference on EEG between primary generalised and focal seizures?
Generalised= generalised abnormality Focal= focal abnormality
What investigations should be done for epilepsy?
EEG
MRI for patients under 50
CT for over 50s
Video telemetry if uncertain
What is the first line treatment of primary generalised epilepsy?
sodium valproate, lamotrigine, levetiracetam
What is the first line treatment of partial and secondary generalised seizures?
Lamotrigine
Carbamazepine
What is the first line of treatment for absence seizure?
Ethosuximide
What is the secondary treatment of generalised epilepsy?
Topiramate
Zonisamide
Carbamazepine
What is the second line treatment of partial seizures?
Sodium valproate Topiramate Leviteracetam Gabapentin Pregabilin Zonisamide Lacosamide Lerampanel Benzodiazepines
What are the side effects pf sodium valproate?
Tremor Weight gain Ataxia Drowsiness Transient hair loss Pancreatitis Hepatitis
What are the side effects of carbamazepine?
Ataxia Drowsiness Nystagmus Blurred vision Low serum sodium Skin rash
What are the side effects of lamotrigine?
Skin rash
Difficulty sleeping
What are the side effects of levetiracetam?
Irritability, depression
What are the side effects of topiramate?
Weight loss
Word finding difficulties
Tingling hands and feet
What are the side effects pf zonisamide?
Bowel upset
Cognitive problems
What are the side effects of lacosamide?
Dizziness
What are the side effects of pregabilin?
Weight gain
What are the side effects of vigabatrin?
Behavioural problems
Visual field defects
What is status epilepticus?
Prolonged or recurrent tonic clonic seizures persisting for more than 30 minutes with no period of recovery in between
Who does status epilepticus normally occur in?
Those with no history of epilepsy
What is the mortality of status epilepticus?
5-10%
What is the first line treatment of status epilepticus?
Midazolam
Lorazepam
Diazepam
What is the second line treatment of status epilepticus?
Phenytoin
Valproate
What is the third line treatment of status epilepticus?
Anaesthesia
What are the features of non epileptic attacks?
May be more frequent than epileptic seizures
May look bizarreMay be prolonged
What may a patient presenting with non epileptic attacks have?
History of other medially unexplained symptoms or history of abuse
What are the movements of non epileptic attacks like>
May superficially resemble tonic clonic seizures
May resemble a swoon
May have bizarre movements e.g. alternating