Epilepsy

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  • Created by: LaurenSE
  • Created on: 14-10-15 16:33
What is a seizure?
Convulsion or other transient event caused by a paraoxysmal discharge of cerebral neurones
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What is epilepsy?
Continuing tendency to have seizures (2 or more), 30-120 second duration
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How common is epilepsy?
Common, 5% have an active problem, lifetime risk of seizure is 5%
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What are the differential diagnoses for epilepsy?
syncope (5-30 seconds), psychgenic (1-20 minutes), hypoglycaemia, TIA, migraine, BPPV, dystonia, parasomnia, acute hydrocephalus
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What causes a seizure?
Imbalance in the inhibitory and excitatory currents (Na, K) or neurotransmission (glutamate, GABA) in the brain
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What would the EEG show in epilepsy?
high-voltage spike and wave activity
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What is a partial seizure?
epileptic activity confined to one area of cortex with a recognisable clinical pattern
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What is a secondary generalised seizure?
Focal epileptic activity that spreads to both hemispheres
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What are features of a focal seizure?
Usually in older patients, onset from sleep, past history includes febrile convulsions/head injury/CNS infection/tumour, there is also post-ictal nose wiping
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What are the features of an idiopathic generalised seizure?
Younger patients, onset shortly after waking, photosensitivity, more common with positive FHx
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What types of generalised seizure are there?
petit mal, grand mal, myoclonic, akinetic
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What is a petit mal seizure?
typical absence seizure, usually begins in childhood, 3Hz spike and wave EEG, patient stares for a few seconds, eyelids twitch
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What is a grand mal seizure?
generalised tonic-clonic seizure, tonic phase: rigidity, falls, tongue biting, incontinence, clonic: generalised convulsion, mouth frothing, bilateral muscle jerking. Followed by drowsiness, confusion for several hours
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What is a myoclonic seizure?
Isolated muscle jerking
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What is an akinetic seizure?
Cessation of movement, falling, loss of consciousness
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What is first line treatment for a grand mal seizure?
Sodium valproate (teratogenic), or lamotrigine if valproate is unsuitable (exacerbates myoclonic seizures)
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What is first line treatment for a petit mal seizure?
Exosuximide or sodium valproate if high risk of grand mal seizures (lamotrigine second line)
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What is first line treatment for a myoclonic seizure?
Sodium valproate, levetiracetam or topiramate (more side effects) if valproate unsuitable
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What is first line treatment for an akinetic seizure?
Sodium valproate, add lamotrigine as adjunctive treatment if needed
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What is first line treatment for focal seizure?
Carbamazepine or lamotrigine (oxycarbazepine, sodium valproate second line)
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What is status epilepticus?
Seizure lasting more than 30 minutes, failure to regain consciousness
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How do you treat status epilepticus?
Early status: lorazepam IV 0.1mg/kg Established status: phenytoin infusion 15-18mg/kg at 50mg/minute Refractory status: GA propofol 1-2mg/kg bolus then 2-10mg/kg/hour
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Card 2

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What is epilepsy?

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Continuing tendency to have seizures (2 or more), 30-120 second duration

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How common is epilepsy?

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Card 4

Front

What are the differential diagnoses for epilepsy?

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Card 5

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What causes a seizure?

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