Epilepsy Flashcards
(39 cards)
Signs of a non-epileptic seizure/Psychogenic non-epileptic seizure
Last longer, eyes are shut, Sinusoidal movements, Atonia, Post-ictal crying
Medically unexplained symptoms present
History of abuse (sexual)
EEG shows no ictal activity.
Refractory to normal drugs used in epilepsy
Common in females.
Definition of epilepsy
Tendency to experience recurrent and unprovoked epileptic seizures
Epileptic seizures
Paroxysmal, synchronous and excessive abnormal electrical activity in the brain causing symptoms such as disturbance of consciousness, behaviour, emotion, motor function, or sensation.
Status epilepticus
Prolonged convulsive or non-convulsive tonic clonic seizure lasting for 5 minutes or longer, or recurrent seizures (3 in 1 hr) with no regain in consciousness.
Types of partial seizures
Focal origin, 60% originate from temporal lobe.
Simple - no loss of consciousness.
Complex - impairment in consciousness.
Secondary generalised seizures
Initially partial seizure with focal origin which spreads to both cerebral hemispheres.
Generalised seizure and types
Initial bilateral involvement of both the cerebral hemispheres. Loss of consciousness.
Includes absence, tonic-clonic, myoclonic, atonic, infantile spasm.
Most occur after waking up.
Absence seizure
Staring vacantly.
Postural tone not impaired.
EEG= 3 per second spike-and-wave discharge.
In young children
Provoke with hyperventilation/blowing windmill in clinic.
Signs of a partial seizure in the TEMPORAL lobe
Aura of epigastric sensation, autonomic changes (flushing, BP), deja-vu, taste or olfactory hallucinations.
Motor arrest, lip smacking, chewing, dystonia.
Slow evolution over 1-2mins
Post-ictal confusion.
Signs of a partial seizure in the FRONTAL lobe
Aburpt onset aura. Vocal during seizure with cry. Tonic spasms Fencing posture Pelvic thrust Bring duration. Rapid recovery
Generalised tonic-clonic seizure
Tonic = stiffness, clonic = jerk.
Sudden LOC and fall.
Initial tonic phase with high frequency and low amplitude of movements.
Clonic phase lasts longer than tonic phase.
Can loose bowl and bladder control.
Hard to rouse after, post-ictal confusion, headache, myalgia, retrograde amnesia.
Last 1-2mins
Myoclonic seizure
Abrupt, brief and sudden involuntary movements
Atonic Seizure
Sudden loss of muscle tone but not consciousness. Tonic = increase muscle tone so rigid they fall.
Causes and risk factors for epilepsy
Genetic predisposition. Neuro abnormalities. Perinatal brain injury e.g. hypoxia Febrile seizures in childhood Intracranial infections, malignancies or surgery.
Differential diagnosis of epileptic seizure
Syncope Cardiac arrythmia Panic attack + hyperventilation Non-epileptic seizure Hypoglycaemia
Signs of syncope
Transient acute LOC and loss of postural tone due to reduced cerebral perfusion.
Provoked by pain, prolonged standing and postural change.
‘Aura’ of feeling faint, right headed, blurred vision.
Skin change to pale
No incontinence, tongue biting or ‘post ictal’ confusion.
Managing suspected/diagnosed epilepsy
- Refer to specialist to confirm a diagnosis, in this time advise against driving, swimming and dangerous leisure activities. Give carer info on when to recognise a seizure and if possible video and document it.
- Consider trial of anti-epileptic
- Once diagnosed patient needs to tell DVLA and can’t drive until 1yr seizure free.
Name 4 Antiepileptic drugs
Carbamazepine
Lamotrigine
Sodium Valproate
Phenytoin
Management of an epileptic seizure
Do not restrain
Protect them from injury with with cushions and removal of harmful nearby objects.
When seizure ceased assess airway and potential injuries.
Watch and treat as status epileptics if appropriate (last longer than 5mins or more than 3 in hour)
Management of status epileptics
1) Buccal midazolam (First line treatment in community/prehospital). Alternative = rectal diazepam.
2) In hospital A-E resuscitation (oxygen, BM, secure airway, IV access) and IV lorazepam.
3) IV phenytoin.
4) RSI and anaesthetic aid.
Blood investigations if poss (U&E, LFT, FBC, glucose)
Give oxygen
EEG
Not diagnostic!
Spike then slow wave pattern
Drug withdrawal
If over 2yrs symptom free consider withdrawal
Causes of a non-epileptic seizure
hypoxia, alcohol, drugs (cocaine, tricyclics), head trauma, cerebrovascular pathology (haemorrhage)
Trigges of an epileptic seizure
Flickering lights, sleep deprivation, alcohol, stress, caffeine.
