If someone has a blackout but its confirmed not to be epilepsy what could it be ?
- Syncope
- One off seizure
- Sleep disorder
- Movement disorder
What are the 3 different types of syncope ?
- Reflex - Taking blood
- Cardiogenic - Arrythmias
- Orthostatic - Dehydration/Medication related
What may stop syncope from occurring ?
Sitting the person down/getting them a drink
Which type of syncope is usually seen on exertion ?
Cardiogenic
When assessing a patient for syncope what should you do ?
- BP, pulse
- Listen to heart
- ECG
What is the definition of epilepsy ?
Tendency to have recurrent seizures
Name the generalised seizures
- Absence seizures
- Juvenile myoclonic epilepsy
- Generalised tonic-clonic seizures
Name the focal seizures
- Simple partial seizures
- Complex partial seizures
- Secondary generalised
What is seen on investigation of generalised seizures ?
- Generalised abnormality on EEG
What is seen on investigation of focal seizures ?
Focal abnormality of EEG
How do generalised seizures usually present ?
< 25 years old
No warning
How do focal seizures usually present ?
Any age
May get a warning sign
MRI may show cause
Features of generalised tonic clonic seizures
- Eyes rolling
- Period of rigidity and then jerking
- Tongue bitting
- Groans
- Tend to cluster/ may be irritable beforehand
Features of absence seizures
- Often in children
- Triggered by bright lights or hyperventilation
- Sudden arrest in activity then continues what they are doing
- Staring and eyelid flickering
Features of juvenile myoclonic epilepsy
- Lack of sleep or alcohol may triggers then
- Can have an absence seizure or GTC
- Will often have early morning myoclonus and drop things or have brief jerks
Features of a complex partial seizures
- Aura
- Temporal lobe
- Lip smacking and repetitive movements
- Sudden arrest of activity and staring into space
Which seizure type do you not lose consciousness ?
Simple partial seizures
How do you investigate seizures ?
- ECG and routine bloods to rule out other causes
- CT of head in >50s
- MRI in most patients
- EEG
- Video-telemetry is unsure of diagnosis
What is the management of epilepsy ?
Non-medication
- Conversation with an epilepsy nurse
- Discussion around driving
- Discuss anti-epileptic drugs
What are the first line treatments of epilepsy ?
- Soidum valproate
- Lamotrigene
- Ethosuxamide in absence seizures
What are the second line treatments of epilepsy ?
- Valproic acid
- Topiramate
What are the side effects of Lamotrigene ?
Difficulty sleeping and a rash
Contraindications of Sodium Valproate and Valproic acid ?
Side effects ?
Pregnancy or women or child-bearing age. Sodium valproate can cause weight gain and nausea
What drug can be used during pregnancy to treat epilepsy ?
Topiramate
