Epilepsy & Blackouts

Question 1

What can cause a blackout?

Answer 1

• Vasovagal Syncope
• Hypoxic Seizure
• Concussive Seizures
• Cardiac Arrhythmia
• Non-epileptic attacks

Question 2

Define and describe Vasovagal syncope?

Answer 2

FAINTING
Its the body overeacting to certain stimuli such as the sight of blood or extreme emotional distress

• Light headed
• Nausea
• Hot/Sweating
• Tinnitus
• Tunnel Vision

Question 3

What could trigger vasovagal syncope?

Answer 3

• Prolonged Standing or standing up too fast
• Trauma
• Venepuncture
• Seeing/experiencing medical procedures
• Urination
• Coughing

Question 4

Whats the difference between a seizure and syncope?

Answer 4

• Syncope tends to happen when your upright
• Pallor is common in syncope
• Syncope has a gradual onset vs a sudden onset seizure
• Injury & incontinence are rare in syncope
• Recover rapidly from syncope but not seizure
• Syncope is triggered, precipitants for seizures are rare

Question 5

How does a hypoxic seizure occur?

Answer 5

People who faint and then are kept upright keep fainting and dont breath –> Seizure

Occurs a lot in aircraft where people cant end up lying down

Question 6

What is a non-epileptic attack?

Answer 6

SEizures similar to epilepsy but not caused by electrical activity in the brain.

They are often linked to stress or past abuse

Question 7

Which gender are more likely to suffer blackouts?

Answer 7

Women

Question 8

When you have a patient who blacked out what do you want to know?

Answer 8

• What they were doing
• Any warning feelings or Aura
• Similar previous history
• Any injury or incontinence
• How responsive are/were they, what collour did they go, did they move or make sound
• Whats their pulse like
• Past medical, psych, alcohol/drug and family history

Question 9

If someone’s had their first seizure how would you investigate?

Answer 9

• Blood Sugar (Cause of fainting)
• ECG (Cardiac Arrythmias)
• Consider drugs/alcohol
• CT head

Question 10

What features on a first seizure would suggest epilepsy?

Answer 10

Primary Generalised Epilepsy:

• History of myoclonic jerks (particularly in morning)
• Absences
• Feeling strange +/- flickering lights

Focal Onset Epilepsy:

• Deja Vu
• Rising in abdomen
• Episodes where they look blank and smack lips

Question 11

How would you advise someone who’s just had their first seizure?

Answer 11

• Driving Regulations
• Inquire about employment or potentially dangerous activities
• Refer to clinic

Question 12

Define Epilepsy?

Answer 12

a neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain.

Question 13

When does epilepsy present?

Answer 13

Mainly in infants then its pretty low until the elderly where theres another spike

Question 14

With what groups is epilepsy more common?

Answer 14

People with learning difficulties (22% of people with LD)

Question 15

What are the classifications of Epilepsy?

Answer 15

Primary Generalised Epilepsy (Generally congenital and young)
Focal or Partial Epilepsy (Any age, due to focal brain damage)

Question 16

What are the types of Primary Generalised Epileptic Seizure

Answer 16

• Tonic Clonic (Tense-Jerky)
• Myoclonic (Very brief twitch contractions)
• Clonic
• Tonic
• Atonic (Very rapid collapse to floor)
• Absence (most common in kids, tends to grow out by age 12)

Question 17

How are focal onset seizures different?

Answer 17

They vary by which are of the brain is affected

May come with Aura

They may retain awareness/responsiveness (Simple) OR may have impaired awareness (Complex)

Can develop into a secondary generalized seizure
So:
Simple/Complex partial seizures
+/- Secondary Generalisation

Question 18

How does an MRI/EEG change between focal/partial and primary generalized epileptic seizures?

Answer 18

An EEG would show generalised vs focal abnormalities in brain function

An MRI or CT may show a physical cause in a focal epileptic but not primary generalised

Question 19

How would you make epilepsy visible in order to test with an EEG?

Answer 19

Hyperventilation
Photic Stimulation
Sleep Deprivation

Will show up best in Primary Generalised Epilepsy

Question 20

What other test can be done for epilepsy?

Answer 20

Video-Telemetry

Basically an EEG with a camera over several days

Question 21

What are the rules for driving with epilepsy?

Answer 21

Normal licenses:

• Seizure Free for a year Or had seizures but only from sleep.
• If you have a daytime seizure ever then you will need 3 yrs of none or purely nocturnal seizures

HGV/PSV:
- Seizure and medication free for 10yrs

Question 22

How do we treat Epilepsy?

Answer 22

1st line:

• Sodium Valproate (Anti-convulsant) for Primary Generalised
• Carbamazepine (Anti-convulsant) for Partial
• Ethosuximide for Absence seizures

2nd line involves combining and switching out medications till you have some that work

There are many more drugs in our lecture but im not listing them all

Question 23

Side effects of Sodium valproate and Carbamezapine?

Answer 23

SV:

• Tremor/Ataxia
• Weight Gain
• Hair Loss
• Pancreatitis/Hepatitis

Carbamazepine:

• Ataxia
• Low Serum Na
• Severe Skin rash
• Nystagmus/Blurred Vision

Question 24

What is Status Epilepticus?

Answer 24

A prolonged or Recurrent seizure that lasts for >5mins with no recovery period in between

(Most common type is TCSE - Tonic Clonic Status Epilepticus)

Usually caused by stroke, tumour, haemorrhage or alcohol and 90% of deaths are due to the underlying cause not the seizure itself

Can lead to neuro problems (brain damage) in children

Question 25

How do we treat TCSE?

Answer 25

1st line - Lorazepam (Benzodiazepines) 2nd line - Valproate 3rd line - Anaesthesia e.g. propofol

Question 26

What is Carbamazepine also used for?

Answer 26

As well as being an anticonvulsant it treats nerve pain in conditions such as Trigeminal Neuralgia