Seizures and Epilepsy

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  • Created by: liv
  • Created on: 19-12-22 16:01
What is a seizure?
A sudden, uncontrolled electrical disturbance in the brain
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When are seizures considered to be epilepsy?
Having 2 or more seizures at least 24 hours apart
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What are the 2 types of seizures?
Generalised
Focal
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What is the difference between generalised and focal seizures?
Generalised seizures affect both sides of the brain at the same time
Focal seizures happen in one area of the brain
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What is the most common presentation of a seizure?
Tonic clonic
Muscle stiffness and jerking
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What symptoms may occur during a focal seizure?
Staring blankly into space
Non-purposeful repetitive movement
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What happens after a seizure?
There will be a post-ictal phase
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How will a post-ictal phase present?
Gradual slowing down of seizure
Gradual recovery
Confusion
Headache
Drowsy
Nauseous
Hypertensive
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Clinical signs of seizure
Reduced sats
Cyanosis
Tachycardia
Pupils unresponsive during tonic clonic
Jerking and stiffening
Loss of consciousness
Breathing problems
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Red flags during seizure
Fever - consider infection
GCS persistently < 15
Focal neurological deficit
Raised ICP
Pregnancy
Prolonged seizure
Patient on anticoagulants
Sudden onset headache
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Relevant questions to ask
What happened before
What happened during
What happened after
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Relevant physical examination
ECG - arrhythmias can cause convulsive syncope
Neurological exam - stroke can cause seizures
Identify injuries - tongue biting etc
GCS, AVPU
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Pharmacological interventions
Diazepam
Oxygen
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DIAZEPAM
(action, dose, presentation, indications)
Action: anticonvulsant, sedative
Dose: 10mg
Max dose: 20mg
Presentation: 10mg/2ml
Indications: convulsion lasting >5mins, repeated convulsions (3+ in an hour), eclamptic convulsions lasting >2min
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Benzodiazepine treatment for tonic clonic seizure
Give 1st benzo
Attempt IV or IO access
If still convulsing 10mins after first dose give 2nd benzo
If still convulsing 10mins after second dose, seek advice on 3rd dose
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OXYGEN
(action, dose, presentation, indications)
Action: reversing hypoxia
Dose: 15L for seizure
Presentation: gas
Indication: low sats
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Management plan for seizure
Airway - consider OPA
Breathing - O2
Circulation - BP, hr
Disability - AVPU, GCS, BM
Expose - temperature, injuries, rash, pregnancy
IV access
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When should seizures be conveyed to hospital?
All patients with first seizure
Consider referral to epilepsy specialist team
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What is a PNES
Psychogenic Non-epileptic Seizure
It is a seizure that may look epileptic but are instead caused by psychological factors
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Potential causes of PNES
Mood or personality disorders
Mental health issues
Trauma or abuse
Substance use
Previous traumatic brain injury
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Symptoms of PNES that differ to epileptic seizure
Wildly thrashing
Side to side head movements
Stuttering or shouting phrases
Lack of post ictal phase
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Interventions for PNES
No pharmacological interventions required as these will not be effective and are potentially dangerous due to risk of side effects
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Other cards in this set

Card 2

Front

When are seizures considered to be epilepsy?

Back

Having 2 or more seizures at least 24 hours apart

Card 3

Front

What are the 2 types of seizures?

Back

Preview of the front of card 3

Card 4

Front

What is the difference between generalised and focal seizures?

Back

Preview of the front of card 4

Card 5

Front

What is the most common presentation of a seizure?

Back

Preview of the front of card 5
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