• Clinical history EEG\> can show typical patterns in different forms of epilepsy and support the diagnosis. MRI \> used to diagnose structural problems that may be associated with seizures and other pathology such as tumours. ECG to exclude problems in the heart.

Epilepsy Flashcards by Alaa Husain

Seizure

sudden irregular discharge of electrical activity in the brain causing a physical manifestation such as sensory disturbance, unconsciousness or convulsions

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Convulsion

uncontrolled shaking movements of the body due to rapid and repeated contraction and relaxation of muscles

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Aura

perceptual disturbance experienced by some prior to a seizure, e.g. strange light, unpleasant smell, confusing thoughts

(not everyone w/ seizure gets Aura)

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Epilepsy

neurological disorder marked by sudden recurrent episodes of sensory disturbance, LOC or convulsions, associated with abnormal electrical activity in the brain

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What causes epilepsy? (4)

Increased excitatory activity

decreased inhibitory activity

Loss of homeostatic control

spread of neuronal activity

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difference between primary and secondary causes of epilepsy

Primary: idiopathic

secondary: identifiable cause >> head trauma, hypoxia, tumor, stroke, infection, hypoglycemia, drugs

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Status epilepticus

medical emergency.

It is defined as seizures lasting >5 mins or more than 3 seizures in one hour.

Management of status epileptics in the hospital:

Take an ABCDE approach:

Secure the airway
Give high-concentration oxygen
Assess cardiac and respiratory function
Check blood G levels
IV access (insert a cannula)

IV lorazepam 4mg, repeated after 10 minutes if the seizure continues
If seizures persist: IV phenobarbital or phenytoin
If no response (‘refractory status’) w/in 45 minutes from onset induction of GA

Medical options in the community:

Buccal midazolam
Rectal diazepam

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CL ASSIFICATION OF SEIZURES

.generalized> “matat” il bint mn il seizure

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PARTIAL VS GENERALISED

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PARTIAL SEIZURES

how r their consciousness levels different?

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most common partial seizure?

symptoms?

when does it commonly occur?

Temporal lobe epilepsy

– 1st/2nd decade in most people, following seizure with fever or an early injury to the brain

– auras –e.g. auditory hallucination, rush of memories

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2nd common type of partial seizure

Frontol lope epilepsy

Abnormal movements when motor areas affected (contralateral side)

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GENERALISED

.• Tonic-clonic: 2 parts - 1st tonic (muscles Tense), 2nd clonic (Convulsions)

• Absence: ‘daydreaming’

• Status epilepticus: medical emergency

• Myoclonic: brief shock-like muscle jerks

• Atonic: ‘without tone’ – drop attack

• Tonic: increased tone (stiff)

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Having convo, them suddenly u stop…. and carry on then like nthn happened

tx?

Absence

1st line: sodium valproate or ethosuximide

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Standing 3ady tsolfeen, faj2a ogaf wa i stretch my hands out, then contnue normal

Tonic

increase tone in hand

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brief shock-like muscle jerks

Myoclonic Chna lama ag3D >> ba3dayn faj2a y7ooshny bard😂😂

1st line: sodium valproate

Other options: lamotrigine, levetiracetam or topiramate

typically happen in children as part of juvenile myoclonic epilepsy

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Atonic Seizures

They may be indicative of Lennox-Gastaut syndrome.

Management is:

1st line: sodium valproate

Second line: lamotrigine

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Infantile spasms

This is also known as West syndrome.

It is a rare (1 in 4000) disorder starting in infancy at around 6 months of age.

It is characterised by clusters of full body spasms.

poor prognosis: 1/3 die by age 25, however 1/3 are seizure free. It can be difficult to treat but

first line treatments are:

Prednisolone
Vigabatrin

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INVESTIGATIONS (3)

• Clinical history

EEG> can show typical patterns in different forms of epilepsy and support the diagnosis.
MRI > used to diagnose structural problems that may be associated with seizures and other pathology such as tumours.
ECG to exclude problems in the heart.

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CLINICAL HISTORY

u wanna divide it into asking what happened (before, during ,after)

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what is an EEG, if it is not diagnostic, why do we use it? what msut u warn the pateitn?

Study These Flashcards

EEG (ELECTROENCEPHALOGRAM)

to supports diagnosis from the history!

patient warned that it may induce a seizure

When should we NOT use EEG.

Study These Flashcards

if u think from the history that its probably a syncope (risk of false positive result)

If eeg is unclear? What do can we do?

Study These Flashcards

– Repeated standard EEGs

– Sleep EEGs (sleep deprivation or melatonin in children/young people)

– Long-term video or ambulatory EEG (have elctrodes attached and get on w/ their daily lives

DIFFERENTIAL DIAGNOSES

Study These Flashcards

Vascular: Stroke, TIA
Infection: Abscess, Meningitis
Trauma: Intracerebral haemorrhage
Autoimmune: SLE
Metabolic: Hypoxia, Electrolyte imbalance, Hypoglycaemia, Thyroid dysfunction
Iatrogenic: Drugs, Alcohol Withdrawal
Neoplastic: Intracerebral mass

INITIAL MANAGEMENT OF SEIZURES

EPILEPSY AND DRIVING

* If suffers epilepsy when awake, licence is taken away until 1 year seizure-free * If due to medication change: 6 months seizure-free * Seizures whilst asleep or don’t affect driving or consciousness – assessment of case by DVLA * If one-off seizure then can apply when 6 months seizure-free and assessment by DVLA

Emergency seizure managment

difference btw Delirium & Dementia

***Delirium***: Acute confuson state ( something that comes in quite suddenly) & its there bc somthing precipitated it. ex in elderly: if they have some sort of infection, severe pain, constipation\>\> anything like that can set it off & they can become acutely confused!

Difference in recovery & duration w/ syncope and epilepsy

**Syncope**: rapidly regains full lucidity (within 20-30 seconds) **Seizure**: post-ictal period of confusion and/or agitation lasting several minutes to hours (often not recalled by the patient) **Syncope**: \<20 seconds typically **Seizure**: often longer than 20 seconds

How can we work out if the "situation" is going to become a progressive decline (like in dementia) or resolve (like in Delirium?)

we use the Confusion assessment method – **CAM** Score (if they have any of the 4\> they score a point) (if 2 or more\> most likely Delirium)

Dementia vs delirium

Dementia

***“Progressive decline in higher cortical function*** leading to a globa limpairment of memory, intellect & personality which effects the individuals ability to cope with activities of daily living.”

common types of dementias?

1. Alzheimers 2. Demetia w/ Lewy body 3. Vascular Dementia

INVESTIGATIONS of dementia

* Full History + MMSE (collateral from family) * Full Neurological Examination * Blood tests – for reversible causes: TFTs, Vitamin B12 * CT/MRI head * Memory Clinic follow up (*Minimental state examination- G*ive patien score out of 24, this classifies them into mild moderate or severe cognition) Helps see rate of progression as well!

what do u see on a CT scan w/ someone w/ Dementia?

what do u see on a MRI scan w/ someone w/ Dementia?

causes of Dementia?

theraputic targets for antiepleptics examples of drugs in each class

3 GABA TYPE Classes & DRUGS

INITIATING ANTI-EPILEPTICS, how to start, what liver interactions sould u be aware of?

* Start with **monotherapy** and if ineffective change to monotherapy with different AED * First-line for generalised or tonic-clonic seizures – **_sodium valproate (or lamotrigine)_** – If ineffective, other adjuncts considered (e.g. Levetiracetam, topiramate or sodium valproate AND lamotrigine) • Titrate up to achieve a balance of therapeutic effect vs adverse side effects _• Beware of interactions!!!!_ **– Liver enzyme inducers** • Carbamazepine • Phenyotin **– Liver enzyme inhibitors** • Sodium valproate

if someone taking COCP, what should u do?

may need to increase estrogen dose to at least 50mcg & advise use of additional methods of contraception

common ADVERSE EFFECTS and drugs causing each

how to u change an epileptic? why would u wanna change it?

* Change if unacceptable side effects, failure of treatment or on inappropriate drug * Start at initial dose and slowly increase to middle of recommended therapeutic range * Then slowly withdraw old drug over about 6 weeks

rules for cessation of antiepileptic what is the aim? (each drug, how much dose reduced in how many wks) what about if they were on more than one drug?, what should be the time frame btw withdrawing one drug from the other? what must u inform the patient?

Gradually taper off Aim is to **avoid withdrawal features** – Recurrent seizures – Anxiety and restlessness 1. Lamotrigine,carbamazepine,phenytoin,sodiumvalproate,vigabatrin – Reduce dose by **10**% every **2-4 weeks** 2. Ethosuximide,barbiturates,benzodiazepines – Reduce dose by **10**% every **4-8 weeks** * If on more than one drug, withdraw from one drug at a time – **1 month** between complete withdrawal from one drug and starting withdrawal from another

which is contraindicated in preganany? what is its effect on baby? pregnancy dosage rules? what should u advice her b4 getting pregnant?

**Na Valproate** * causes decreased SERUM FOLATE * craniofacial and skeletal abnormalities\> Na valproate syndrome * developmental disorders after birth prescribe lowest effective dose, divided throughout day, in conrolled-release tablets start folate supplementation b4 pregnancy

which drug must be monitored? why? howto we monitor? what r we checking for?

what common congenital malformations does phenytoin cause?

**Common congenital malformations** – Cleft lip and palate – Congenital heart defects (septal defects) **Cardiac depressant** (arrhythmias) **Toxicity !!** \> nausea, CNS dysfunction (confusion, nystagmus, ataxia), decreased consciousness, coma!

how to treat partial seizures

how to treat generalized seizures

1st line therpay for primary generalized? 1st line therpay for partial seizures? druge choice for women in child baring age absent seizure?

Na valproate Carbamezapine Lamotrigine Lamotrigine & valproate & clonazepam\> short tem use tho

types of Benzodiazipines given during emergency and mode of administration

**Lorazepam:** IV bolus 4mg is 1st line in emergency **Midazolam**: Buccal if no IV access in emergency **Diazepam**- can be given rectally in no acces

why is Lorezepam preferred over diazepam ?

lasts longer and longer half life

Epilepsy Flashcards

(52 cards)