What are the risk factors for epilepsy?
- Premature birth
- Genetic conditions
- Brain development malformations
- Family Hx
- Head trauma, infections (meningitis, encephalitis) or tumours
- Cerebrovascular disease and strke
- Dementia and neurodegenerative disorders
How do you investigate epilepsy?
- All patients must be referred to a specialist for assessment and investigation in <2weeks
- EEG
- MRI brain
- ECG
- U+Es
- Glucose
- Urinalysis
What are focal seizures?
Localised disturbance in the cortex occurring in one hemisphere
What are generalised seizures?
Both hemispheres are involved
What are the divisions of focal seizures?
- Simple partial
- Complex partial
- Secondary generalised seizure
What are the divisions of generalised epilepsy?
- Tonic-clonic
- Absence
- Absence with special features
- Myoclonic
- Atonic
What are simple partial seizures?
- Patient is conscious
- Focal motor, sensory, autonomic or psychic symptoms
- No post-ictal symptoms
What are complex partial seizures?
- Awareness is impaired – either at seizure onset or following simple partial aura
- Most commonly arise in temporal lobe where post-ictal confusion is a feature
- Automatism (lip smacking or picking at clothes)
What are secondary generalised seizures?
Focal seizure that evolves to a bilateral, convulsive seizure
What are the features of temporal lobe involvement?
HEAD
H - Hallucinations (auditory/gustatory/olfactory)
E - Epigastric rising/Emotional
A - Automatisms (lip smacking/grabbing/plucking)
D - Déjà vu/dysphasia
What are the features of frontal lobe involvement?
- Motor features
- Jacksonian march
- Behavioural disturbances
- Dysphasia or speech arrest
- Post-ictal Todd’s palsy
What are the features of parietal lobe involvement?
- Sensory disturbances (tingling, numbness, pain)
- Motor symptoms (due to spread to pre-central gyrus)
What are the features of occipital lobe involvement?
- Visual phenomena (spots, lines, flashes, floaters)
What are tonic clonic seizures?
Before:
o May experience an aura
During:
o Loss of consciousness and tonic (muscle tensing) and clonic (muscle jerking) episodes
o May be associated tongue biting, incontinence, groaning and irregular breathing
After:
o Prolonged post-ictal period
o Confused, drowsy, depressed, irritable
What are absence seizures?
- Usually occur in children
- Blank, stares into space and that lasts 10-20s
- During: unaware of their surroundings and won’t respond
- 90% of patients stop having absence seizures as they get older
What are myoclonic seizures?
- Sudden and brief muscle contractions predominating in the arms
- Patient remains awake during the episode
- Typically happen in children
What are tonic seizures?
- Increase in tone and loss of awareness
* Normally seen as a part of an epilepsy syndrome
What are clonic seizures?
• Similar to tonic-clonic seizures but without the preceding tonic phase
What are atonic seizures?
- Brief loss of muscle tone
- No loss of consciousness
- Don’t last >3minutes
- Begin in childhood
- The occur in the context of epilepsy syndromes (Lennox-Gadtaut syndrome)
What are infantile spasms?
- Commonly associated with tuberous sclerosis
- Rare disorder starting at 6 months of age
- Clusters of full body spasms
How are infantile spasms managed?
o Prednisolone
o Vigabatrin
What is status epilepticus?
Seizures lasting >5 minutes or >3 seizures in 1 hour
What are psychogenic non-epileptic attacks/NEAD/pseudo-seizures?
Subconscious/psychological mechanisms
When would you suspect psychogenic non-epileptic attacks/NEAD/pseudo-seizures?
- Gradual onset
- Prolonged duration
- Abrupt termination
- Closed eyes +/- resistance to eye opening
- Rapid breathing
- Fluctuating motor activity
- Episodes of motionless or unresponsiveness
