Epilepsy Flashcards
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.
Difficult birth
Seizures in the past
Head injury
Drugs
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.
Theophyline
Aminophyline
Give an example of an analgesic that can precipitate a fit.
Tramadol
Give an example of an anti emetic which can trigger a fit.
Prochlorperazine
Which opioid can trigger a fit?
Diamorphine
What investigations should someone who has presented with a new onset seizure/fall undergo?
ECG
CT/MRI
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
Faling GCS
Suggestion of other pathology
List some differential diagnosis for epilepsy.
Syncope Panic attack Sleep phenomena TIA MIgraine Hypoglycaemia 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
Rhythmic jerking.
Head and eye deviation
Vocalisation
Focal Sensory Seizure
Auras - floating lights
Somatosensory changes
Conscious Focal Seizures
Deja Vu
Depersonalisation
Hallucination
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
Generalised Seizures
What are risk factors for triggering a seizure in someone with Primary Generalised Epilepsy?
Sleep deprivation
Flashing Lights
