Epilepsy Flashcards
What is epilepsy?
Recurrent spontaneous, intermittent, abnormal hyper proliferation of neurones → seizures
What are the 2 main types of epilepsy? How are these further divided?
- Generalised: Myoclonic, Tonic, Clonic, Tonic-Clonic, Atonic, Absence
- Focal/Partial: Simple, Complex
What is the criteria needed to diagnose epilepsy?
> 2 seizures >2weeks apart
Describe what myoclonic seizures look like
Shock like movement of one/several parts of the body
Describe what tonic seizures look like
Stiff sustained contractions
Describe what clonic seizures look like
Rhythmic jerking of one limb/side/whole body
Describe what tonic-clonic seizures look like
Stiffness + rhythmic jerking
Associated w/post-ictal confusion & drowsiness
Describe what atonic seizures look like
Myoclonic jerks
Sudden loss of muscle tone → fall to floor
NO loc
Describe what absence seizures look like
Abrupt psychomotor arrest (5-15secs)
Upward deviation of eyelid
Perioral myoclonus (mouth twitching)
Describe a simple seizure
AKA Focal Aware seizure
No post-ictal Sx
Awareness intact
Focal motor, sensory, autonomic, psych Sx
Describe a complex seizure
AKA Focal Unaware seizure Awareness impaired Post-ictal Sx OR rapid recovery Sx: Lip-smacking, grunting CAN BECOME A GENERALISED SEIZURE
What auras are there pre-seizure?
TEMPORAL: COMMON Gastric discomfort, anxiety, hallucinations, memory disturbance, lip smacking, head turning
OCCIPITAL: Multi-coloured bright lights spreading from one homonymous field, flashes, floaters
FRONTAL: Dystonic posture w/rapid recovery
CENTRO-PARIETAL: C/L paraesthesia (pain, tingling, numb) spreads from 1 limb to 1 side
How is epilepsy investigated?
ECG: Arrhythmia/ Long QT
EEG +/- sleep-deprived EEG
MRI/CT: NOT ROUTINELY DONE- New diagnosis → exclude infective/vascular causes
Bloods: Find causes- U&E, Ca, Glucose
When is an EEG indicated?
> 2 seizures
OR
1 seizure if considered necessary by neurologist
Is an EEG helpful in the diagnosis of epilepsy?
Support diagnosis
Cannot exclude/refute epilepsy
Use photic/hyperV techniques to provoke seizure
Often just done for generalised/status
When should an epileptic be referred to secondary care?
All patients with diagnosis
Re-refer if seizure not controlled or dose change
When should an epileptic be referred to tertiary care?
Seizures not controlled Drugs ineffective Child <2yo Structural lesion Diagnostic doubt ACCESS GIVEN TO ALL PATIENTS WITH EPILEPSY
How is epilepsy managed?
1) Anti-epileptic: After diagnosis confirmed/ usually after 2nd seizure
2) Med fail: Surgical resection/ Vagal nerve stimulation
3) Ketogenic diet, deep brain stimulation
What anti-epileptics are given for the different types of seizures?
- Myoclonic: 1) Sodium Valproate 2) Kepra
- Focal: Carbamazepine or Lamotrigine
- Absence/tonic-clonic/atonic: 1) Sodium Valproate, 2) Lamotrigine
When is Sodium Valproate contraindicated?
Woman of child bearing age/sexually active
Pregnant
Give Lamotrigine
What is the pathway for giving/changing AEDs?
Monotherapy → ↑dose of maximal tolerated → switch to 2nd line → combine
When should you consider stopping an AED?
> 2years seizure free
Wean down over 3months
What needs to be reviewed an an annual epilepsy review?
- Seizure diary: no. frequency, date of most recent, type
- Meds: Name, dose, adherence, SE, cognitive problems, effect, adjust dose if needed
- Bloods: Folate, Vit D, FBC
- Lifestyle: Driving, contraception, pregnancy planning, employment
What is the prognosis of epilepsy?
90% absence fits in children resolve
60-70% seizure free
