Epilepsy Flashcards by Wasim Silmi

Define epilepsy

A recurrent tendency to have unprovoked seizures.

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Define seizure

An abnormal paroxysmal discharge of cerebral neurons

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Define convulsion

the motor signs of electrical discharges

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Which neurotransmitters balance excitation and inhibition

Excitation:
Glutamate
Aspartate

Inhibition:
GABA

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Causes of secondary seizures (4)

Tumours
Infection
Inflammation
Trauma

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What should you always establish at the start when taking a collapse history in OSCE?

Whether there was a witness

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Triggers of an epileptic seizure (5)

Lack of sleep
Flickering lights
Alcohol
Stress
No trigger

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What can happen before an epileptic seizure

Aura

strange feeling in the gut, deja vu, strange smells, flashing lights

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How long does an epileptic seizure last

Under three minutes

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Things that are associated with happening during a seizure (3)

Tongue biting
Incontinence
Jerking movements

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Speed of recovery from an epileptic seizure

Slow

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Things that are associated with happening post-ictal (3)

Post-ictal confusion
Post-ictal headache
Post-ictal myalgia

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What is Todds paresis

is a syndrome associated with weakness or paralysis of part or all of the body after a focal-onset seizure. It most commonly affects one limb or one half of the body but can have a wide range of presentations. Approximately 13% of all seizures show signs ofTodd paresisin onepresentation or another.

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What is a syndrome associated with weakness or paralysis of part or all of the body after a focal-onset seizure known as

Todds paresis

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How long does Todds paresis last for

This postictal syndrome may last anywhere from minutes to days, with the vast majority of patients seeing spontaneous and complete resolution within 36 hours. Complete resolution of symptoms is seen within 15 hours on average

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What should you ask about regarding before an epileptic seizure (2)

Triggers: alcohol, stress lack of sleep, lights
Aura: rising epigastric sensation, deja-vu, out of body experience

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What should you ask about regarding during an epileptic seizure (5)

< 3 minutes
LOC
Tongue biting
Jerking 
Incontinence

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What should you ask about regarding after an epileptic seizure (5)

Slow recovery
Post-ictal headache
Confusion
myalgia
Todd’s paresis

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2 main types of seizures

Focal and generalised

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3 types of focal seizures

Focal impaired awareness seizures
Focal aware seizures
Focal seizures with secondary generalised weakness

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6 types of generalised seizures

Tonic-clonic seizures
Myoclonic seizures
Clonic seizures
Tonic seizures
Atonic seizures
Absence seizures

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What happens during the tonic phase

all the muscles go stiff

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What happens during the clonic phase

there is quick and rhythmical jerking of the limbs.

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What happens in a tonic clonic seizure

there is first a tonic phase and then a clonic phase.

What is the most common type of epileptic seizure

tonic clonic

in which phase is there quick and rhythmical jerking of the limbs.

clonic

in which phase do all the muscles go stiff

tonic

What is a tonic clonic seizure also known as

grand mal

What is a grand mal seizure also known as

tonic-clonic

What is a petit mal seizure also known as

absence

What is a absence seizure also known as

petit mal

Which type of seizure is most common in puberty

Myoclonic

When are atonic seizures most common

in children

When are absence seizures most common

children

Whats the difference between clonic and myoclonic seizures

Myoclonic are loads of small contractions whereas clonic are big contractions

What happens in a atonic seizure

Loss of muscle tone

What happens in a temporal lobe focal seizure (3)

Aura (epigastric discomfort, epigastric discomfort) Automatisms (playing with fingers, lip smacking) Hallucinations

What happens in a occipital lobe focal seizure (3)

Visual phenomena (spots, lines, flashes)

What happens in a parietal lobe focal seizure (3)

Sensory disturbances (pain, tingling, numbness)

What happens in a frontal lobe focal seizure (4)

Motor symptoms Jacksonian march: muscular spasm spreads from distal part of limb to larger area of the body Post-ictal flaccid weakness (Todd’s palsy) Involuntary actions (disinhibition)

What is the diagnostic criteria for epilepsy

2 or more unprovoked seizures occurring more than 24 hours apart

Ix for suspected epilepsy

EEG Bloods Brain imaging (CT, MRI)

What do we request in the bloods of someone suspected of epilepsy and why (4)

``` Blood glucose (hypoglycaemia can cause seizures) FBC (evaluate systemic or CNS infection) Electrolyte panel (electrolyte disturbances can provoke seizures) Serum prolactin (can be transiently elevated following seizures) ```

Which AEDs are recommended for focal seizures

Carbamazepine | Lamotrigine

Which AEDs are recommended for generalised seizures

1st line: sodium valproate | 2nd line: carbamazepine

SE's of most AED's

Psychiatric symptoms e.g. depression | Weight gain

S.E's of carbamazapine

Neutropenia and osteoporosis

S.E's of lamotrigine

Stevens-Johnson syndrome (severe skin reaction)

Which AED's are recommended for pregnancy (1) and which should be avoided (2)

Avoid sodium valproate and phenytoin | Lamotrigine is preferred

What is the definition of status epilepticus

seizure lasting > 5 minutes or repeated seizures | without recovery or regain of consciousness in between

Triggers of status epileptics (3)

non-adherence to medication alcohol abuse, OD & toxicity

Mx of status epilepticus (6 steps)

ABC approach We should secure airway and give 100% oxygen IV access and continuous monitoring of sats, BP, ECG and glucose IV lorazepam Repeat after 10 minutes if seizure doesn't terminate If after 10 minutes it still hasn't terminated give phenytoin Then transfer to ITU

What should we always monitor in status epilepticus (4)

Sars BP ECG and !glucose!

Which trigger of status epilepticus should you immediately exclude and how do you resolve it

Hypoglycaemia - 50ml of 50% glucose should be given immediately

What type of drug is the first line treatment for SE

Benzodiazepine

How do BZD's work

bind to the gamma-aminobutyric acid (GABA)-A receptors, increasing channel opening frequency at the receptor, with subsequent increased chloride conductance and neuronal hyperpolarization, leading to enhanced inhibitory neurotransmission and antiepileptic action

Complication of epilepsy (4)

SUDEP (sudden death in epilepsy) Behavioural problems Fractures (from seizures) Complications from drugs

A 16-year-old boy presents to A & E after collapsing on a cricket game. According to his cricket coach, the boy was unconscious for about one minute during which time, he was moving his arms and legs around. Further review revealed that he had experienced a similar episode a month before. What is the most appropriate drug for this patient?

Sodium valproate