Epilepsy I Flashcards
What are the important features of taking a history in a patient who has fallen down?
Get patient experience before, during and after event
Eye witness is critical = ask for demonstration of movements
What questions do you ask about the onset of someone falling?
What were they doing, environment, light headedness or syncope, pallor, breathing, posturing of limbs, head turning
What types of movements may someone exhibit when they fall down?
Tonic phase, clonic movements, corpopedal spasms, rigor
What are the important parts of the aftermath of a falling incident?
Speed of recovery, sleepiness, disorientation, deficits
What are the risk factors for epilepsy?
Birth and development, seizures in past (including febrile), head injury (especially loss of consciousness), drugs, family history
What is done in a seizure clinic?
Don’t examine patient in first visit = take history only
If diagnosis of syncope = CV examination and take lying and standing BP
What are high risk drugs for causing epilepsy?
Tramadol, prochloperazine, morphine and other opioids
What is the most important investigation to do in someone who has collasped?
ECG = must exclude long QT syndrome as it can present with syncopal seizures which mimic epilepsy
What imaging is done in clinic?
MRI = better than CT for imaging brain and doesn’t give dose of radiation
Which patients get a CT scan done acutely?
Skull fracture, deteriorating GCS, focal signs, head injury with seizures, failure of GCS to be 15 after 4hrs, suggestion of other pathology
What are the indications for doing an EEG?
To determine if someone is in non-convulsant status
To classify type of epilepsy
To confirm non-epileptic attacks
For surgical evaluation
Are EEGs always abnormal in epileptics?
No = EEG can be normal in epilepsy, and abnormal in non-epileptics
What are the differentials of epilepsy?
Syncope, panic attacks, TIA, hypoglycaemia, cataplexy, tonic spasm of MS, non-epileptic attack disorder, sleep phenomena, migraine, parasomnias, periodic paralysis
What are some features of seizure counselling?
Reassure patient = seizures don’t always mean epilepsy
Risk of recurrences and of sudden unexplained death in epilepsy (SUDEP)
What are the rules for driving with a history of seizures?
Seizures = must be free of seizure for 6 months or 5 years for HGV Epilepsy = clear for 1 year or 3 years during sleep, 10 years off medication for HGV
What safety advice is given to patients with seizures and epilepsy?
Avoid using deep far friers, baths and climbing ladders
Rock climbing and open water swimming not advised
What is epilepsy?
Tendancy to recurrent, usually spontaneous epileptic seizures
What causes epilepsy?
Abnormal synchronisation of neuronal activity = usually excitatory with high frequency AP, sometimes inhibitory
What occurs in epilepsy?
Interruption of normal brain activity = focally or generalised, usually brief (seconds-minutes)
What is the incidence of epilepsy?
Most common in infancy and old age
Occurs in 50-80/100,000
Mortality = 1/400 per annum, 1/100 in young people
What causes focal epilepsy?
Part of the brain is structurally abnormal = can cause both focal and generalised seizures (irritates cortical pathways)
What occurs in generalised epilepsy?
Cortical networks involved so only generalised seizures occur
What are the categories of focal deficits?
Motor, sensory and psychic
What are some motor focal deficits?
Rhythmic jerking, posturing, head and eye deviation, automatisms, vocalisations
