Flashcards in Epilepsy Deck (53)
What is the approach to a fallen patient.
History- Patient and eye witness before and after
Onset - environment and what they looked like
Event itself - movement, responsiveness awareness
Afterwards - Speed of recovery deficits
List some risk factors for epilepsy.
Seizures in the past
Why is social history very important?
Driving is illegal whilst uncontrolled and un medicated need to alert the DVLA.
List some respiratory drugs which can trigger a fit.
Give an example of an analgesic that can precipitate a fit.
Give an example of an anti emetic which can trigger a fit.
Which opioid can trigger a fit?
What investigations should someone who has presented with a new onset seizure/fall undergo?
Why is an ECG so important for someone who has fallen?
To rule out syncope or Long QT syndrome all of which can present with falls.
When is a CT used instead of an MRI?
Residual focal signs
Trauma - e.g. skull fractures
Suggestion of other pathology
List some differential diagnosis for epilepsy.
MS - tonic spasms
What is epilepsy?
The tendency to have recurrent usually spontaneous epileptic seizures.
In counselling the patient what should be explained?
Seizures doesn't mean epilepsy is certain
Risk of recurrence
Driving and the risks
What is the physiology behind an epileptic fit?
Abnormal synchronisation of neuronal activity. Causing focal or generalised cessation of normal activity.
What is the most common cause of lack of synchronisation behind epilepsy?
Too much excitatory AP
Too much inhibitory is rarer
Focal seizures can be divided into what?
Simple - no impairment of consciousness
Dicognative - impaired consciousness
Focal Motor seizure
Head and eye deviation
Focal Sensory Seizure
Auras - floating lights
Conscious Focal Seizures
What is the physiology behind focal seizures.
Due to structural abnormality i.e too many synaptic connection
How can focal seizures become generalised?
If the AP irritates enough tissue it can be propagated throughout the brain.
When do most people present with Primary Generalised Epilepsy?
Childhood early teens
How do most people with Primary generalised epilepsy present?
Early morning jerks
What are risk factors for triggering a seizure in someone with Primary Generalised Epilepsy?
Are EEGs useful in Primary Generalised Epilepsy?
Yes as they can help identify the subtype
What is the mainstay of treatment for someone with Primary Generalised Epilepsy?
If someone with Primary Generalised Epilepsy is looking to conceive what must happen?
Sodium Valproate stopped before trying to conceive as it is teratogenic.
Lamotrigine is used
A Focal seizure which has become a generalised seizure is classified as what?
Focal seizures present themselves at what age?