Epilepsy Flashcards
(45 cards)
What is epilepsy?
Recurrent tendency of spontaneous, intermittent, abnormal electrical activity in parts of the brain manifesting as seizures
What are convulsions?
Motor signs of electrical discharges
What causes epilepsy?
2/3 idiopathic
Cortical scarring Developmental causes Space occupying lesions Stroke Hippocampal sclerosis Vascular malformations
What can patients experience before an epileptic event?
Prodrome lasting days/hours - change in mood or behaviour
What is an aura indicative of?
Focal seizure in the temporal lobe
What can aura involve?
Déjà vu
Strange feeling in gut
Strange smell
Flashing lights
What is the post-ictal phase?
Altered state of consciousness after an epileptic seizure
Typically 5-30 mins
What can patients experience in the post-ictal phase?
Headache Myalgia Confusion Temporary weakness - motor cortex Dysphagia - temporal seizures
What must happen to patients who have suffered with a seizure?
Referred for further investigation
What is important about an epileptic history? (long answer)
GET ONE FROM A WITNESS Rule out other causes - pseudoseizure Family history Previous head injury Birth problems
Ask what happened before, during and after the episode Before Illness? Medications? Triggers
During Headaches - migraines can manifest in similar ways Loss of consciousness? Lose control of bladder/bowels? Bite tongue/cheeks? Could you talk, move etc?
After
Confused, headache, myalgia?
What investigations would you ask for if you suspect epilepsy?
EEG
What are types of seizures?
Focal
Generalised - Absence, Tonic-clonic, Myoclonic, Atonic, (Tonic, Clonic)
What is the difference between focal and generalized seizures?
Focal seizures only affect one hemisphere and are usually associated with structural disease
Generalised originate at some point but spread bilaterally and rapidly distribute. They have no localising features
How are focal seizures managed?
Carbamazepine -1st line
Lamotrigine
What is used to manage generalised seizures?
Sodium valproate
What seizures can carbamazepine exacerbate?
Myoclonic and Absence
What is an absence seizure?
Brief (usually <10s) event where subject stop talking mid sentence then carry on where they left off
Often seen in childhood
What happens in a tonic-clonic seizure?
Lose consciousness
Limbs stiffen - tonic
Then jerk - clonic
Often lose continence, have aura before and severe headache after
What happens in a myoclonic seizure?
Sudden jerk of limb, face or trunk - suddenly thrown to ground
Violently disobedient limb
No loss of consciousness and continue as normal after
What happens in an atonic seizure?
Sudden loss of muscle tone –> fall
No loss of consciousness
What symptoms are indicative of temporal lobe seizures?
Complex motor phenomena Impaired awareness Oral movements - lip smacking, chewing, swallowing Deja vu Emotional disturbance Sound, smell, taste hallucination Delusional behaviour
What symptoms are indicative of frontal lobe seizures?
Motor feature - posturing or peddling movement Jacksonian march Motor arrest Subtle behavioural disturbance Speech arrest
What is a jacksonian march?
Tingling begin in periphery then spread to larger area of body
What symptoms are indicative of parietal lobe seizures?
Sensory disturbances
Tingling numbness
Pain
Motor symptoms
