Week 5- overview of Epilepsy Flashcards

Question

what is epilepsy syndromes?

Answer 1

These are epilepsies with specific signs and symptoms that can be clustered together. Factors used to help identify a specific epilepsy syndromes include: • Age of onset of seizures • Types of seizures • Specific EEG patterns and imaging

Answer 2

- Look for an epilepsy identity card or jewellery. - Protect them from injury - Do not restrain them or put anything in their mouth. - When the seizure stops, check their airway and place them in the recovery position. - Observe them until they have recovered. - Examine for, and manage, any injuries. - Arrange emergency admission (call for an ambulance) if it is their first seizure; a seizure reoccurs shortly after the first one; the person is injured or having trouble breathing after the seizure, or is difficult to wake up.

Answer 3

• Status epilepticus is defined as a prolonged convulsive seizure lasting 5minutes or longer OR recurrent seizures one after the other without recovery in between -its a medical emergency

Answer 4

* Patients who have existing epilepsy | * Patients that have never had seizures

Answer 5

``` • Triggered by head injury, metabolic disturbance (hypoglycaemia), cerebrovascular event (stroke) or alcohol withrdrawal ```

Answer 6

-should time the seizure • Airways, respiratory and cardiac function must be secured • Buccal midazolam (first line) or rectal diazepam can be prescribed for use in the community in patients that have had previous episodes of prolonged or serial convulsive seizures. • This should only be administered by trained personnel or specified by an individually agreed protocol drawn up by the specialist, family members or carers. -Depending on response to treatment/pt’s condition/care plan an ambulance may need to be called if: • Seizure continues 5mins after emergency medication has been given • Pt’s history of frequent serial seizures, who has convulsive status epilepticus or this is the first episode requiring emergency treatment • Concerns/difficulties monitoring pt’s airways, respiratory and cardiac functions.

Answer 7

• The seizure is timed from onset=to know what treatment can be given • Establish IV access – • Airways must be secured and regular monitoring of cardiac and respiratory functions set up. • Give high conc of oxygen • Give high potency of thiamine (if suggestion of alcohol abuse) e.g Pabrinex • Give glucose if patient is hypoglycaemic

Answer 8

• Get a bit more information about the patient • Start setting up other investigations to help management – Chest X-ray, CT scan • Give IV lorazepam (0.1mg/kg – max of 4mg) or IV diazepam if lorazepam not available. Alternative to this is buccal midazolam if no IV access. Max of 2 doses to be given including the pre-hospital dose.

Answer 9

Alert anesthetist and ICU – if patient is not responding to treatment more intervention and care is needed and therefore these people need to become involved • Give 2nd line IV AED – and this will depend on the hospital protocols in place. In the NICE guidance they mention use of Phenytoin, Fosphenytoin sodium and phenobarbitol. However newer AEDs as listed in this diagram could potentially be used

Answer 10

Transfer to ICU and general anesthesia would be administered: • Propofol • Midazolam (titrated to effect) • Thiopental sodium • EEG monitoring needs to set up when giving anaesthetic • Anasthetic continued for 12-24hours after last clinical/electrographic seizure the dose tapered.