Seizures and Epilepsy Flashcards
What conditions are associated with Epilepsy?
Cerebral palsy,
Tuberous sclerosis,
Mitochondrial disease
What are some causes of non epileptic seizures?
Febrile convulsions,
Alcohol Withdrawal seizures,
Psychogenic non-epileptic seizures
What is the classification of seizures?
- Where seizure begins,
- Level of awareness during seizure,
- Other features
What are the different types of seizures?
- Focal seizures with awareness or impaired awareness. Can develop into generalised.
- Generalized seizures: Tonic-clonic, tonic, clonic, absence, myoclonic and atonic.
What are the symptoms of a focal seizure originating from the temporal lobe?
Aura - rising epigastric sensation, psychic phenomena eg, deja vu, can also have hallucinations.
Then seizure typically lasts 1min with automatisms eg, lip smacking, grabbing or pluckering.
What are the symptoms of a focal seizure originating from the frontal lobe?
MOTOR:
Head/leg movements, posturing, post ictal weakness, Jacksonian march
What are the symptoms of a focal seizure originating from the parietal lobe?
SENSORY:
Paeaesthesia
What are the symptoms of a focal seizure originating from the occipital lobe?
VISUAL:
Floaters/flashes
What are the symptoms of generalised seizures?
Absence seizures - brief pauses for less than 10 seconds.
Tonic clonic seizures - LOC with stiffening (tonic) and jerking (clonic) of limbs. Post-ictal confusion is common
Myoclonic - Sudden jerks of limb, trunk or face.
Atonic - sudden loss of muscle tone causing patient to fall but consciousness retained.
Patients may also experience tongue biting and incontinence
What are the excitatory and inhibitory neurotransmitters
Excitatory - Glutamate and aspartate which act on NMDA/ AMPA receptors causing a sodium and calcium influx.
Inhibitory - GABA (in CNS) or Glycine (in spinal cord) which act on the GABA receptor causing chloride influx
What is status epilepticus and the treatment?
When a seizure continues for more than 5 mins.
First line treatment is benzodiazepine either IV lorazepam or IV/rectal diazepam. This can be repeated. If seizures continue after second dose of benzo then give IV phenytoin or valproate
What are the investigations for seizures?
EEG and neuroimaging (usually MRI)
When do you start treatment after a seizure?
If the recurrence risk after the first seizure is high (neurological deficit, structural abnormality, EEG shows epileptic activity or patient concern) or they’ve had more than 2 seizures
What are important factors to consider about patients when treating epilepsy?
- Driving: Must be fit free for 12 months for more than 1 seizure and 6 months for a one off seizure.
- Other medications as many antiepileptics are P450 inducers/inhibitors.
- Women wanting to get pregnant
- Contraception interactions with antiepileptics needs to be considered
What is the treatment for generalised seizures?
Males: Sodium valproate
Females: Lamotrigine or levetiracetam
