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Flashcards in FN: Epilespy Deck (25):
1

Definition

Recurrent tendancy to spontaneous, intermittant, abnormal electrical activity in part of the brain manifest as seizures

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Causes

2/3 are idiopathic (often familial)
1. Congenital
2. Acquired
3. Non-epileptic/provoked seizures

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Congenital causes

NG
Tuberous sclerosis
TORCH
Perintal anoxia

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Acquired

Vascular: CVA
Cortical scarring: trauma infection
SOL
Other: SLE, PAN, MS, sarcoidosis

5

Non epileptic/ provoked seizures

1. Withdrawal: EtOH, opiates, benzos
2. Metabolic: glucose, Na, Ca, urea, Nh3
3. Raised ICP: trauma, haemorhage, cortical venous thrombosis
4. Infection: meningitis, encephalitis, cycticerosis HIV
5. Eclampsia
6. Pseudoseizures

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Prodrome defintion

Patient or others may notice change in mood or behaviour lasting hours - days
Not part of seizure

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Aura

A simple partial seizure (usually temporal) which may precede other manisfestations
Experienced as a strange feeling:
1. Epigastric rising
2. Deja/jamais vu
3. Automatism
4. Smells, lights, sound

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PArtial (focal)

Features referable to part of one hemisphere

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Primary Generalised

No warning/aura
Discharge throughout cortex w/o localising features

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simple

awareness unimpaired

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Complex

Awareness impaired

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Secondary generalised

Focal seizure - generalised
e.g. aura - tonic-clonic

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Diagnostic pointers

Aura
Specific trigger e.g. flashing lights
Lateral tongue biting (>incontinence)
Typical movements e.g. tonic-clonic
Cyanosis
Post-ictal phase

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Simple partial presenting features

Focal motor, sensory, autonomic or psychic symptoms

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Complex partial : 5As

Aura
Autonomic change in skin colour, temperature, palps
Awareness lost: motor arrest, motionless stare
automatism:lip-smacking, fumbling, chewing, swallowing
Amnesia

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Complex partial seizures usually arise form

Temporal lobe

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Abscences (Petit mal)

Abrupt onset and offset
Short

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Tonic-clonic (Grand mal)

LOC
Tonic: limbs stiffen
Clonic: rhythmic jerking of limbs
± cyanosis, incontinence, tongue biting (lateral)
Post-ictal confusion and drowsiness

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Myoclonic seizure

Sudden jerk of limb, face or trunk

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Atonic (akinetic seizures)

Sudden loss of muscle tone – fall
No LOC

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West syndrome/ Infantile Spasms

Clusters of head nodding and arm jerks
EEG shows hypsarrhythmia

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Temporal localising features

Automations: lip smacking, chewing, fumbling
Deja/jamais vu
Delusional behaviour
Abdominal: rising, n/v
Emotional disturbance: terror, panic, anger, elation
Tastes, smells

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Frontal localising features

Motor features: arrest, jacksonian march, Todds palsy

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Parietal localising features

Sensory disturbance: tingling, numbness

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Occipital localising features

Visual phenomena: spots, lines, flashes

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