Epilepsy Flashcards
What is the approach to the fallen?
History
Patient; before, during and after
Eye witness; before, during and after
What are the important features to an epilepsy history?
Onset; what were they doing, light headedness or other syncopal symptoms, what did they look like (pallor, breathing, posturing of limbs, head turning)
Event itself;
Type of movements; tonic phase, clonic movements, corpopedal spasm, rigor, responsiveness and awareness throughout
Afterwards; speed of recovery, sleepiness/disorientation, deficits
What is common of a frontal lobe tonic clonic seizure?
Right hand moves upwards
Head turns to the right
Stiff movements
Clonus
What is important to do if you suspect syncope over epilepsy?
CV exam
L+S BP
What are common drugs which can precipitate epilepsy?
Theophylinne Amphetamines Tramadol Antibiotics; penicillins, cephalosporins, quinolones Antidepressants Anticholinergics Antiemetics; prochlorperazine Cocaine Opioids; diamorphine, pethidine
What investigation is the MOST important when working someone up for a seizure?
ECG; prolonged QT syndrome can trigger a generalised tonic clonic seizure and is LIFE THREATNING
Who gets a CT scan acutely?
Clinical or radiological skull#
Deteriorating GCS
Focal signs; stroke or bleed
Head injury with seizure
Failure to be GCS 14/15 4 hours after arrival
Suggestion of other pathology eg. SAH or stroke
When are EEGs helpful?
Classification of epilepsy
Confirmation of non-epileptic attacks
Surgical eval for epilepsy surgery
Confirmation of non-convulsive status
Can you diagnose epilepsy with an EEG?
NO
What are conditions that can “mimic” epilepsy?
Syncope Non-epileptic attack disorder (pseudoseizures, psychogenic non-epileptic attacks) Panic attacks/ hyperventilation attacks Sleep phenomena Hypoglycamia; ALWAYS DO A BG
What are the laws around driving and epilepsy?
1st seizure; 6 months or if HGV/PCV 5 years
Epilepsy; 1 year seizure free or 3 years seizure free if nocturnal epilepsy. If HGV/PCV; 10 years seizure free
What is a good description of myoclonus?
Clumsy and jerky in the morning
What is epilepsy?
A tendency to recurrent, usually spontaneous, epileptic seizures
What is an epileptic seizure?
Abnormal synchronisation of neuronal activity; usually excitatory with high frequency action potentials
Can be focal or generalised
Why do epileptic seizures happen?
Too little inhibition/ too much excitation
Changes in:
Cell number/type
Connectivity
Synaptic function
Voltage gated ion channel function
Genetic, acquired brain, metabolic (hypoglycaemia), toxic
What is SUDEP?
Sudden Unexplained Death in Epilepsy; seizure with subsequent cardiac arrest
What is a focal seizure?
Brain abnormal; stroke, haemorrhage, demyelination, tumour which will irritate the surrounding area resulting in abnormal discharge of electricity
If it hits a pathway; it will become generalised SO you can get a focal seizure with secondary generalisation
What is a generalised seizure?
A seizure that begins on a pathway such as the corticothalamic circuit and therefore every time a person has a seizure it will be generalised
This differs from focal seizures where you can have purely focal seizures which secondarily generalise
What is the difference between simple and complex partial/focal seizures?
Simple; without impaired consciousness
Complex; with impaired consciousness
What are the different types of generalised seizures?
Absence Myoclonic Atonic Tonic Tonic clonic
Which seizures can cause a loss of consciousness?
Complex partial seizure Generalised absence seizure
What motor symptoms can be involved in partial seizures?
Rhythmic jerking Posturing Head and eye deviation Cycling Automatisms (plucking) Vocalisation
What sensory symptoms an be involved in partial seizures?
Somatosensory Olfactory Gustatory Visual Auditory
What psychic symptoms can be involved in partial seizures?
Memories Deja vu Jamais Vu Depersonalisation Aphasia Complex visual hallucinations
