What 2 types of focal onset seizures are there
- simple partial
- complex partial
the above 2 may then develop into secondary generalised tonic clonic
What 3 types of generalised seizures are there
- generalised tonic clonic
- absence
- myoclonic
Difference between simple and complex partial seizures
Simple: awareness not affected (often referred to as aura)
Complex: loss of awareness
What are common seizure automatisms that one should ask witnesses about
- lip smacking/ licking
- fidding with things eg clothes
What question should you ask to find out if a person really was confused after they woke up
Ask about next memory of waking up
If passers-by fussing over them = syncope
If in ambulance with paramedics = like seizure (will take longer to recover)
Symptoms of focal epilepsy in occipital lobe
Visual disturbance
Symptoms of focal epilepsy in parietal lobe
Unusual sensations throughout body, lasting a few seconds
Symptoms of focal epilepsy in frontal lobe
Starts with thumb twitching on 1 side. Spreads to arms, trunk, leg.
Symptoms of focal epilepsy in pre-frontal lobe
Patient going into weird stretched postures
Symptoms of focal epilepsy in medial temporal lobe
- Fear/panic
- Epigastric rising sensation (like dip in roller coaster)
- Olfactory hallucinations
- Deja vu
- Impaired awareness
- Automatisms
Common cause of focal epilepsy in medial temporal lobe
Hippocampal sclerosis
How to differentiate generalised tonic clonic vs secondary generalised seizure
-type of symptoms
generalised tonic clonic: tonic clonic movements start immediately
secondary generalised: will start off with focal symptoms (1 sided) before becoming full on tonic clonic
How to differentiate absence vs complex partial seizure
-age of onset
Absence: childhood onset (never onset in adulthood)
Complex partial: onset at any age
How to differentiate absence vs complex partial seizure
-presence of aura
Absence: no aura
Complex partial: often has aura
How to differentiate absence vs complex partial seizure
- duration of seizure
- presence of confusion after
Absence: rarely last >10s, no post-ictal confusion
Complex partial: Usually lasts at least 30s, presence of post-ictal confusion
How to differentiate absence vs complex partial seizure
-presence of photosensitivity
Absence: may have photosensitivity
Complex partial: never photosensitive
Important differential diagnosis to epilepsy in someone with seizures
Non-epileptic attack disorder (NEAD)
aka dissociative/ pseudo/ functional seizures
How to differentiate Non-epileptic attack disorder (NEAD) from epilepsy
In NEAD, EEG will have absence of epileptic neuronal activity
What features of a seizure would suggest NEAD over epilepsy
- Sobbing (in usual seizure, people are too unaware to show emotion)
- Normal/ rapid breathing (no hypoxia)
- Asynchronous limb convulsions (tonic clonic seizures are synchronous)
Why must an ECG be done in patients who have had a seizure
Severe cardiac syncope can progress to anoxic seizures
What 3 features on ECG may indicate severe cardiac syncope
- Heart block (any kind)
- Evidence of ischaemia/ previous MI
- Prolonged QT interval (torsade du pointes)
Risk of recurrence of seizure after the first one
40-50%
Which 2 drugs are used to treat generalised epilepsy
- Sodium valproate (most effective)
2. Lamotrigine (first line for women. Less effective but less teratogenic than valproate)
Which 2 drugs are used to treat focal epilepsy
- Carbamazepine
- Lamotrigine
Both equally effective but Lamotrigine better tolerated
