absence seizure (petit mal)
- begin suddenly, end abruptly
- 2-20 seconds
- a few times-100 times daily
- sudden black staring, daydreaming, switched off
- brief impairment of consciousness, awareness, responsiveness
- can get physical symptoms -blinking, lip smacking, fumbling, twitching
- no memory of episode
- common in children 4-14yrs
tonic-clonic seizure (grand mal)
- most common, typicsl seizure
- 30-120 seconds
- tonic and clonic phases
- post-ictal/recovery phase
tonic phase of tonic-clonic seizure (grand mal)
muscle contraction - stiffening of limbs loss of consciousness, fall cry/moan shallow breathing - cyanoiss tongue, cheek, lip biting - bleeding
clonic phase of tonic-clonic seizure (grand mal)
after tonic phase
rhythmic contraction and relaxation of muscles - jerking of limbs
can get bladder/bowel incontinence
post-ictal/recovery phase of tonic-clonic seizure
slow return to conscoiusness muscle relaxation confusion, grogginess, somnolence headache aching limbs amnesia of event
myoclonic seizures
sudden jerks/twitches short, few seconds can affect whole body commly arma/legs/head/trunk consciousness not impaired (single jerks) or impaired (cluster of jerks - clonic-tonic-clonic seizure) usually in morning after waking
tonic seizure
tightening of muscles - stiffeing of body
common during sleep
short 20 seconds
atonic seizures
'drop attacks/akinetic seizures' sudden loss of part or all muscle tone - limpness sudden head drop or total collapse forward fall - inc risk of head injury short lives rapid recovery - no post-ictal confusion
3 types of partial/focal seizures
- simple partial/focal seizures
- complex partial/focal seizures
- secondarily generalised seizures
simple partial/focal seizures
- fully conscious
- alert, can respond, remembers what happened
- small part of 1 side of brain
- no control over seizure
- symptoms: motor (stiffening, twitching, jerking), sensory (flashing lights, hallucinatons),autonomic (sweating, altered HR/BR, gastric), psychic (fear, anxiety, deja vu)
- post-ictal weakness
complex partial/focal seizures
- consciousness altered/lost
- cannot respond
- anmesia of event
- few seconds-3mins
- involves greater part of 1 hemisphere
- simple partial seizure (aura then impaired consciousness OR impaired conscoiusness at onset
- 1/both temporal lobes
- symptoms: autonomic movements
- recovery: mins-hrs, post ictal confusion and fatigue
secondarily generalised seizures
- partial seizures that spread to become tonic-clonic
- begin focally (partial seizure) and spreads to become generlised tonic-clonic seizure
- can get aura before
- 1-3mins
- post ictal confusion, somnolence, Todd’s paralysis
classification of seizures ILAE 2017
where seizure begins in brain
- focal, generalised, unnkown
level of awareness
- awareness/impaired awareness
nature of first prominent sugns/symptoms
- motor onset/non-motor onset
ILAE 1981 classification of EPILEPSY
- based on whether seizure arises in part of brain/whole brain
- whether assoaicted with identifiable neurologial abnormality/cause or not
(idiopathic, symptomatic, cryptogenic)
idiopathic epilepsy
no apparent/obvious identifiable cause
preumed genetic
symptomatic epilepsy
known/obvious identifiable cause
cryptogenic epilepsy
no currently known cause, but presumed likely cause
investigations for diagnosis of epilepsy
patient medical Hx seizure description physical examinaton lab assessment EEG/ECG neuroimagins (CT and MRI)
patient Hx for diagnosis
- perinatal and developmental Hx
- Hx of febrile seizure
- Hx CNS infection/traume
- FHx of epilepsy
seizure description for epilepsy diagnosis
past seizures, episodes, duration, patterns, motor/seosory/behavioural features
- pre-ictal aura
- post-ictal state
- triggers
observer accounts
videos
lab assessment for epilepsy diagnosis
FBC electrolytes blood glucose BUN toxicology screen
EEG for epilepsy diagnosis
- most useful
- recording ictal/inter-ictal spikes
- do they have epilepsy AND where is the ectopic focus?
standard/sleep/ambulatory/video-telemetry
neuroimaging for epilepsy diagnosis
CT/MRI
- to detect exclusion of scructural/organic casue of epilepsy
- detect underlying brain lesions/neurologicalbanormality
- main indication:
adult onset seisures, seizure with focal features. refractory/worsening seizures
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pain in practice (Andrew)108
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controlled drug release (MR opioids)55
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substance misuse - opioids60
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alcohol misuse54
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Topical preparations (Dodu)80
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depression (PB)76
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Bpolar Disorder (PB)69
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anxiety disorder66
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depression and anxiety in practice52
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bipolar disorder in practice50
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suppositories48
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Pharmacokinetics (AS)29
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Parkinson's disease (PB)95
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bioadhasives56
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transdermal drug delivery62
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insomnia in practice46
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epilepsy 122
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epilepsy 223
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epilepsy 329
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epilepsy 444
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parkinson's disease in practice57
-
drug + class3
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Alzheimer's 1 (PB)29
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Alzheimer's 2 (PB)42
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dementia in practice52
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pain and analgesia (Abdel)38
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Schizophrenia (AS)45
