Seizures/ Epilepsy
Definition
Seizures:
Abnormal burst of electrical activity from all or part of the brain. resulting in symptoms related to the affected area of brain.
Epilepsy:
Recurrent seizures
Focal/ Partial seizures:
Features referable to one hemisphere
Generalised:
Both hemispheres
Epidemiology
Active epilepsy 1% of population
Aetiology
2/3 idiopathic.
Otherwise:
Clinical Features
Before:
During:
After:
Investigations
Bedside: EEG, BSL, urine b-HCG (if pregnancy, drugs may be different)
Bloods: FBC, UEC (metabolic derangements)
Imaging: Any relevant imaging if ?trauma
Management
Medications
Prognosis
Pregnancy
Source
Ms Danielle Truscott 2014
OHCM 8th Ed 2010
http://patient.info/health/epilepsy-a-general-introduction 2015
Seizures:
Abnormal burst of electrical activity from all or part of the brain. resulting in symptoms related to the affected area of brain.
Epilepsy:
Recurrent seizures
Focal/ Partial seizures:
Features referable to one hemisphere
Generalised:
Both hemispheres
Epidemiology
Active epilepsy 1% of population
Aetiology
2/3 idiopathic.
Otherwise:
- Alcohol/ Recreational drugs
- Malignancy
- Trauma
- Stroke
- Metabolic derangement
- Flickering lights
- Infections
- Sleep deprivation/ fatigue
- Irregular meals
- Menstruation
Clinical Features
Before:
- ?Prodrome (eg. change in behaviour/ mood, aura)
- Triggers (mentioned in "Causes")
- Focal --> secondary generalised
During:
- Tongue biting
- Blue lips
- Incontinence (not specific to epilepsy)
- May have impact on awareness
- Duration of seizures
- Focal
- Focal signs (automatism, taste, smell, hallucinations, fear, vision flashes/ spots, rising sensation in abdomen, deja vu/ jamais vu)
- Generalised
- Tonic-clonic (LOC)
- Myoclonic
- Atonic
- Absence
After:
- Confusion
- Aggressiveness
- No recollection of episode
- More rapid recovery if frontal lobe cf temporal lobe
Investigations
Bedside: EEG, BSL, urine b-HCG (if pregnancy, drugs may be different)
Bloods: FBC, UEC (metabolic derangements)
Imaging: Any relevant imaging if ?trauma
Management
Medications
- Partial/ 2o generalised: Carbamazepine
- Generalised: Sodium valproate (not good for pregnant women, but affects OCP least)
- Status epilepticus: Diazepam/ Midazolam initially then seizure meds
- Increase COCP/ change to other non oestrogen contraceptives
- Reduce to minimum stablised dose before conception
Prognosis
- 50% no more seizures in 5 years with meds
- 30% fewer seizures with meds
- 20% refractory with meds
Pregnancy
- Unplanned: Continue AED. Risks of convulsions outweigh sefx of AED (only 10%).
- Planned:
- OCP: Increase dose or timings/ use barriers/ Copper IUD
- Refer to specialist for consultation pre conception --> reduce to lowest effective dose/ change and stabilise
- 5mg folate daily
- Antenatal drug plasma level monitoring
- Antenatal scans
Source
Ms Danielle Truscott 2014
OHCM 8th Ed 2010
http://patient.info/health/epilepsy-a-general-introduction 2015