Flashcards in Epilepsy Deck (47)
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1
what are the important parts of a seizures history
-Onset
-What were they doing?
-Environment, etc
-Light-head or other syncopal symptoms
-What did they look like
-Pallor, breathing (presyncope)
-Posturing of limbs, head turning (seizure)
Event itself
-Type of movements
-Tonic phase, clonic movements
-Corpopedal spasms, rigor
-Responsiveness and awareness throughout
Afterwards
-Speed of recovery (recover fast after faint), sleepiness/disorientation, deficits
2
if there is bilateral movement and retained consciousness is it a seizure
no
3
what type of seizure causes right hand to go up and the head to turn
frontal lobe seizures
4
is biting your tongue and incontinence specific to seizures
no
5
what are the risk factors for epilepsy
birth
developmental delay
previous seizures (inc 2+ more febrile seizures)
head injury
family Hx
drugs
alcohol
6
when can epilepsy be a problem for a patients occupation
if HGV driver or if they carry a firearm
7
what medications can lower seizure threshold
antibiotics (penicillin, cephalosporins, quinolones)
analgesics (tramadol)
anti-emetics (prochlorperazine)
opioids (diamorphine, pethidine)
aminophyline/ theophyline
8
what exams for seizures in clinic
don't usually examine in first clinic
if diagnosis of syncope do cardio exam, lying and standing BP
can do neuro exam if see them shortly after event
9
what investigations should you do for a collapse/ seizure
ALWAYS DO ECG
prolonged QT can provoke seizure
can do imaging- MRIb/ CTb if indicated
10
what is an EEG useful for
classification of epilepsy
confirmation of non epileptic attacks
surgical evaluation
confirmation of non convulsive attacks= actually only time its used
never used in acute attack to diagnose
11
when are CT scans done acutely
Clinical or radiological skull fracture Deteriorating GCS
Focal signs- might suggest stroke/ bleed
Head injury with seizure
Failure to be GCS 15/15 4 hours after arrival Suggestion of other pathology – eg SAH
12
should you do an EEG
not really
positive/ negative test means nothing in diagnosis of epilepsy
13
when after a seizures can you drive
1st seizure – car = 6 months, 5 years for HGV/PCV
Epilepsy – car = 1 year or 3years during sleep (nocturnal seizures), 10 years off medication for HGV/PCV
14
what is epilepsy
a tendency to recurrent, usually spontaneous seizures
15
what are the features of global (primary generalised) epilepsy
(who gets it, when, what are seizures like)
genetic predisposition
present in childhood and adolescence
can have tonic clonic, abscence, myoclonic, clonic and tonic seizures
16
what is seen on EEG in global epilepsy
generalised spike wave abnormalities
17
what is an epileptic seizures
abnormal synchronisation of neuronal activity (usually excitatory) which interrupts normal brain activity (can be focally or generalised) and is usually brief
18
why do you get epileptic seizures
too much excitation
too little inhibition
changes:
-cell number/ type
-connectivity
-synaptic function
-voltage gates channel function
genetic, acquired brain, metabolic, toxic and environmental factors
19
what is juvenile myclonic epilepsy
form of primary generalised epilepsy
get early morning jerks
generalised seizures
risk factors- sleep deprivation, flashing lights
20
what is the treatment for primary generalised epilepsy
sodium valproate (is teratogenic and cosmetic effects)
lamotrigine alternative
21
what is focal epilepsy
seizures that occur around an abnormal area of brain (stroke/ tumour) which irritates the brain and causes abnormal electrical activity
22
what is generalised epilepsy
when abnormal electrical activity hits a pathway and spreads to other part of brain (corticothalamic circuitry)
seizure can start from a focal point, and then secondary generalisation
23
what are the types of partial/ focal epileptic seizures
simple- without impaired consciousness
complex- with impaired consciousness
or
-motor (rhythmic jerking, posturing, head and eye deviation, automatisms, volacisation)
-sensory (somatosensory, olfactory, gustatory, visual, auditory)
-pyschic (memories, deja vu, jamais vu, depersonalisation, aphasia, complex visual hallucinations)
24
what are the types of generalised epileptic seizures
absence (go blank, stare into distance)
myoclonic (jerking of limbs)
atonic (loose muscle tone)
tonic
tonic clonic
25
what is the age of onset of focal onset epilepsy
can be any age- due to underlying structural cause
26
what is the treatment for focal onset epilepsy
initially:
lamotrigine (1st line)/ carbamazepine
(sodium valproate works well but not given because of SEs)
can then add on:
Gabapentin
Tiagabine
Pregabalin
Zonisamide
Vigabatrin
Clonazepam
Clobazam
27
how do antiepileptic drugs work
inhibit v activates Na+ channels (reduces pre synaptic excitability and the ability of APs to spread) (carbamazepine, oxcarbazepine, phenytoin, lamotrigine)
enhances activity of v gated K+ channels (stabilises neurone, reduces its excitability) (retigabine)
inhibition of V activates Ca+ channels that trigger neurotransmitter release (gabapentin and prehabalin)
28
what is the treatment for generalised absence seizures
sodium valproate
ethosuximide
29
what is the treamtment for generalised myoclonic seizures
sodium valproate
levetiracetam
clonazepam
30
