Epilepsy Flashcards
What should you always ask the patient about a suspected seizure?
What happened before?
During?
After?
Was there an eye witness who could describe their before, during and after?
What should you ask the patient and eye witness about the onset of a suspected seizure?
- What were they doing? Environment (flashing lights?)
- Symptoms (syncope?)
- What did they look like? (Pale, deep breathing, limb posture, head turning)
What should you ask the patient/ eyewitness about during the event?
- Making movements? (Tonic/clonic, Corpopedal spasms, rigors)
- Was pt responsive/aware throughout?
What should you ask the patient/eye witness about after the event?
- Speed of recovery
- sleepiness/disorientation
- Neurological deficits
What are potential risk factors for epilepsy?
- Birth/ developmental problems
- seizures in past (inc. febrile fits)
- head injury (inc. LOC)
- family history
- drugs, alcohol
If you suspect a patient is just experiencing syncope, what examinations are important?
cardiovascular examination
Lying + Standing BP important
Even if you are suspective of a seizure, what investigation should always be done and why?
ECG
- may diagnose Long QT which is fatal AND can make patients prone to seizures
What patients get an acute CT?
- skull fracture
- Deteriorating/unresolving GCS
- Focal signs
- Head injury with seizure
- Suggestion of other pathology – eg Subarachnoid Haemorrhage
Why are EEGs usually not necessary?
Many of the general population have an abnormal EEG despite not having epilepsy
How long must epileptic patients wait after a seizure to drive again?
1st SEIZURE (not epilepsy) – car = 6 months, 5 years for HGV
Epilepsy – car = 1 year or 3 years during sleep
1 yr if conscious seizures exclusively
10 years off medication for HGV
Raising a limb and turning of the head indicates a seizure in what part of the brain?
Frontal lobe seizure phenomenon
Tongue biting and loss of urinary continence are specific features of generalised seizures. TRUE/FALSE?
FALSE
these symptoms are NOT seizure specific
e.g. pt can lose urinary continence during a vaso-vagal episode
Why should you check a patient’s drug history before making a diagnosis of seizure?
Incase they are on medication which could cause syncope/ fall
e.g. BP meds
What classes of drug are known to induce seizures?
antibiotics - penicillins, quinolones etc
painkillers (tramadol) and opioids
Anti-emetics e.g. prochlorperazine
What indicates the need for an EEG?
- to classify epilepsy
- to confirm non-epileptic attacks
- to confirm non-convulsive status epilepticus
What are the differential diagnoses for epilepsy?
Syncope
Non-epileptic attack disorder
Panic attacks
Sleep phenomena
When does generalised epilepsy normally present, and what is the diagnostic pattern of this on EEG?
Present in childhood and adolescence
- generalised spike-wave abnormalities on EEG
What is the treatment of choice for Primary Generalised epilepsy?
Sodium valproate treatment of choice, but teratogenic.
=> Lamotrigine as alternative.
Describe the usual symptoms of juvenile myoclonic epilepsy
- Early morning jerks
- Generalised seizures
- Risk factors: sleep deprivation/flashing lights
Describe the pathophysiology of focal onset epilepsy.
- Due to underlying structural cause (brain injury/haemorrhage etc)
- Area around this becomes irritated
- Causes abnormal discharges of energy
=> seizure
Focal seizures can also become generalised. TRUE/FALSE?
TRUE
if a focal seizure excites a neighbouring pathway which can spread activity around the brain, then the seizures can become generalised
What treatment is first line for focal epilepsy?
Carbamazepine or lamotrigine
Sodium valproate works as well, but not first choice because of side effects
What is the most common cause of focal/partial epilepsy in patients <30 years?
complex partial seizures
due to hippocampal sclerosis
Why should carbamazepine not be used for generalised seizures?
It can make them worse
