Epilepsy is characterised by _____ which are…
seizures
transient episodes of abnormal electrical activity in the brain
Name the common types of seizures seen in adults
Generalised tonic-clonic seizure
Focal seizure
Myoclonic seizure
Tonic seizure
Atonic seizure
What does a tonic-clonic seizure consist of?
Involves both hemispheres from onset.
Has a tonic phase which is a sudden loss of consciousness where the body stiffens and patient falls.
Then a clonic phase which involves rhythmic jerking of limbs
After the seizure is a postictal period of confusion, headache, fatigue and muscle soreness.
What is a focal seizure?
Localised to one are of one hemisphere.
May be focal aware so no loss of consciousness which may result in symptoms like jerking of one arm or sensory changes.
May be focal impaired awareness so has impaired consciousness with symptoms like blank staring, automatisms like lip smacking or picking at clothes.
May spread to become bilateral tonic-clonic.
What is a myoclonic seizure?
Starts generalised.
Patient remains conscious but has sudden, brief, shock-like stiffening of muscles, commonly arms/legs/back
Often seen in juvenile myoclonic epilepsy with jerks especially in the morning.
What is a tonic seizure?
Starts generalised.
Involves sudden, brief stiffening of muscles, often arms/legs/back
May cause falls if standing, but often occurs during sleep.
What is an atonic seizure?
Also called a “drop attack”
Starts generalised with a sudden loss of muscle tone so the patient goes limp and may fall. Only lasts a few seconds and often seen in children with severe epilepsies.
What are the more common types of seizures in children?
Absence seizures
Infantile spasms
Febrile convulsions
What is another name for a generalised tonic-clonic seizure?
A grand mal
What may be experienced before a generalised tonic-clonic seizure?
An aura - an abnormal sensation that gives a warning that a seizure will occur
What symptoms may be prevalent during a tonic-clonic seizure?
Tongue biting
Incontinence
Groaning
Irregular breathing
What may happen after a tonic-clonic seizure?
Post-ictal period with confusion, fatigue, irritability or low mood.
Where in teh brain do focal seizures commonly affect?
The temporal lobes
Focal seizures often affect h_____, s_____, m_____ and e_____
hearing, speech, memory and emotions
What is another name for the type of focal seizure whereby the patient loses awareness?
Complex partial seizure
List some common symptoms associated with partial seizures
Deja vu
Strange smells, tastes, sight or sound sensations
Unusual emotions
Abnormal behaviours
What syndrome ma an atonic seizure indicate?
Lennox-Gastaut syndrome
What is an absence seizure?
Usually seen in children. Patients becomes blank, stares into space and then abruptly returns to normal. During the seizure they are unaware and don’t respond to their surroundings. Most patients stop as they get older.
How long does an absence seizure typically last?
10-20 seconds
What is are infantile spasms also known as?
West syndrome
What age do infantile spasms typically start at?
6 months of age
How does an infantile spasm present?
Clusters of full-body spasms (trunk, neck and limbs eg sudden head drop, flexed arms)
What is the characteristic EEG finding in infantile spasms?
Hypsarrhythmia
Chaotic and disorganised pattern on EEG with high amplitude, random slow waves, multifocal spikes and sharp waves and no clear rythm.
Reflects severe disorganisation of brain electrical activity.
What is the triad of West syndrome?
Infantile spasms
Hypsarrhythmia on EEG
Developmental regression
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Acute Respiratory Distress Syndrome (ARDS)26
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Arrhythmias63
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Kallman Syndrome11
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Edward's syndrome8
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AKI22
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CKD42
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Epilepsy48
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Muscular dystrophies22
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Renal malformation20
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Klinefelter Syndrome6
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Noonan Syndrome3
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Von Willebrand Disease19
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Acute Myeloid Leukaemia (AML)34
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Acute Lymphoblastic Leukaemia (ALL)11
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Chronic myeloid leukaemia (CML)11
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Chronic Lymphoblastic Leukaemia (CLL)7
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Benign Bone Tumours13
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Infective Endocarditis21
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Pneumonia32
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HIV23
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Osgood-Schlatter disease9
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Transient Synovitis8
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Maintenance fluids11
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Glasgow Coma Scale15
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Glucose ranges in diabetes5
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Diabetes medication pathway15
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Down's Syndrome11
