Flashcards in Epilepsy & Blackouts Deck (26):
What can cause a blackout?
- Vasovagal Syncope
- Hypoxic Seizure
- Concussive Seizures
- Cardiac Arrhythmia
- Non-epileptic attacks
Define and describe Vasovagal syncope?
Its the body overeacting to certain stimuli such as the sight of blood or extreme emotional distress
- Light headed
- Tunnel Vision
What could trigger vasovagal syncope?
- Prolonged Standing or standing up too fast
- Seeing/experiencing medical procedures
Whats the difference between a seizure and syncope?
- Syncope tends to happen when your upright
- Pallor is common in syncope
- Syncope has a gradual onset vs a sudden onset seizure
- Injury & incontinence are rare in syncope
- Recover rapidly from syncope but not seizure
- Syncope is triggered, precipitants for seizures are rare
How does a hypoxic seizure occur?
People who faint and then are kept upright keep fainting and dont breath --> Seizure
Occurs a lot in aircraft where people cant end up lying down
What is a non-epileptic attack?
SEizures similar to epilepsy but not caused by electrical activity in the brain.
They are often linked to stress or past abuse
Which gender are more likely to suffer blackouts?
When you have a patient who blacked out what do you want to know?
- What they were doing
- Any warning feelings or Aura
- Similar previous history
- Any injury or incontinence
- How responsive are/were they, what collour did they go, did they move or make sound
- Whats their pulse like
- Past medical, psych, alcohol/drug and family history
If someone's had their first seizure how would you investigate?
- Blood Sugar (Cause of fainting)
- ECG (Cardiac Arrythmias)
- Consider drugs/alcohol
- CT head
What features on a first seizure would suggest epilepsy?
Primary Generalised Epilepsy:
- History of myoclonic jerks (particularly in morning)
- Feeling strange +/- flickering lights
Focal Onset Epilepsy:
- Deja Vu
- Rising in abdomen
- Episodes where they look blank and smack lips
How would you advise someone who's just had their first seizure?
- Driving Regulations
- Inquire about employment or potentially dangerous activities
- Refer to clinic
a neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain.
When does epilepsy present?
Mainly in infants then its pretty low until the elderly where theres another spike
With what groups is epilepsy more common?
People with learning difficulties (22% of people with LD)
What are the classifications of Epilepsy?
Primary Generalised Epilepsy (Generally congenital and young)
Focal or Partial Epilepsy (Any age, due to focal brain damage)
What are the types of Primary Generalised Epileptic Seizure
- Tonic Clonic (Tense-Jerky)
- Myoclonic (Very brief twitch contractions)
- Atonic (Very rapid collapse to floor)
- Absence (most common in kids, tends to grow out by age 12)
How are focal onset seizures different?
They vary by which are of the brain is affected
May come with Aura
They may retain awareness/responsiveness (Simple) OR may have impaired awareness (Complex)
Can develop into a secondary generalized seizure
Simple/Complex partial seizures
+/- Secondary Generalisation
How does an MRI/EEG change between focal/partial and primary generalized epileptic seizures?
An EEG would show generalised vs focal abnormalities in brain function
An MRI or CT may show a physical cause in a focal epileptic but not primary generalised
How would you make epilepsy visible in order to test with an EEG?
Will show up best in Primary Generalised Epilepsy
What other test can be done for epilepsy?
Basically an EEG with a camera over several days
What are the rules for driving with epilepsy?
- Seizure Free for a year Or had seizures but only from sleep.
- If you have a daytime seizure ever then you will need 3 yrs of none or purely nocturnal seizures
- Seizure and medication free for 10yrs
How do we treat Epilepsy?
- Sodium Valproate (Anti-convulsant) for Primary Generalised
- Carbamazepine (Anti-convulsant) for Partial
- Ethosuximide for Absence seizures
2nd line involves combining and switching out medications till you have some that work
There are many more drugs in our lecture but im not listing them all
Side effects of Sodium valproate and Carbamezapine?
- Weight Gain
- Hair Loss
- Low Serum Na
- Severe Skin rash
- Nystagmus/Blurred Vision
What is Status Epilepticus?
A prolonged or Recurrent seizure that lasts for >5mins with no recovery period in between
(Most common type is TCSE - Tonic Clonic Status Epilepticus)
Usually caused by stroke, tumour, haemorrhage or alcohol and 90% of deaths are due to the underlying cause not the seizure itself
Can lead to neuro problems (brain damage) in children
How do we treat TCSE?
1st line - Lorazepam (Benzodiazepines)
2nd line - Valproate
3rd line - Anaesthesia e.g. propofol