Epilepsy & LOC in Adults + Epilepsy Case

QAR

Epilepsy QAR.txt

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Definition and Mechanism

Can be treatable long term without anti epileptic drugs

International league agasint epilepsy definition

for example after stroke if got a seizure then considered epilsepy because high chance of next and also special epilepsy syndromes

Classification and DD

Seondary generalised ⇒ focal to tonic clonic seizrues

Focal motor seizure which starts from primary motor ⇒ jacksonian march Can have sensory march as well with just sensations....sensory cortex

Even occipatal ⇒ visual seizures ⇒ colourful blobs of light ⇒ then motor to sensory manifestations

Must be able to diagnosed the focal point ..most likely come from this area of the brain

In genarilised 1. spreads rapidly - rapdily engagement 2. no consistent starting focal area

Secondary generalised ⇒ focal to tonic clonic ....starts consistently so not really generalised

Needs to take history for all 3 phases to check for DD and seizure mimics Like post ictal period which is important for DD Most popular type is GTN serizures but not actually most common Ictal cry ⇒ all muscles stiffen so diaphargm pushed agasint closes glottis = ictal cry

Pschogenic = pseudo seizures Anxiety attacls

Just because have psychiatrical issues dont mean they dont have seizures and epilepsy. Can have both.

Psychogenic non-epileptic attacks (PNEA) Side to side moveing of head, eyes are closed, on and off for hours in a waxing and waning patterns....predictors for PNEA ⇒ research

warmth body, sweating, loss of conciousnesa and coming back and rapidly orientated and no other features ...syncopic patients become more pale compaired to sezures vs cyanosed

Can mimic because less blood to the Reticular activating sysrtem can trigger and mimic automatism and stiffness etc . Auotmatism is seen in seizures but syncope can mimic it.

childhood absence epilepsy

First 3 are common. last 3 not common. So need to know the first 3 well.

Earlier classified as ideopathic but now genetic generalised

Name myoclonic suggests myoclonic component is most predominant

Usually diagnosed as after GTC because myoclonic stuff is of less then a second and taken as nervous twitches so need to ask about this and consider this

So need to ask about myoclonic (twitches) especially in the morning and after tired...and if alcohol or drugs

Need to differenciate from the below because different main component of absence Need to identify the particular epilsesy syndrome because 1. different drugs are needed and some are very very effective (valproate). no need to trial and error drugs 2. Different prognosis...age depednant resolution or life long or what.

Its idfferent from childhood absence because GTN is not commonly seen and in childhood more absence seizures

Intractable cannot resolve with treatment but childhood absense can easily be treated

The 3 below no need to remember

PTA, head injury, depressed fracture, missile then high chance of epilepsy

Head trauma = mainly RTAs worldwide Drig intoxiation = alcohol

Neurodegenerative = dementia, parkinsons etc

Diagnosis and Investigations

blood work to check whether secondary or not

Urine toxicology = alcohol, methampehtamine, apple etc drugs ..certain types of toxins can trigger sizures

EEG is not to confirm or exlude diagnosis but to aid diagnosis

Can be normal in patient and abnormal in normal people Ambulatory to difference from nt epileptic seizures

can be used to confirm diagnosis as an aide . But not practical or affordable so gold standrd is good hsistory taking and finding out what happened.

Temporal epilspey most common type of eplipsy .... CT is usually done in sri lanka but MRI is gold standard

MRI for organic cause like hopocampal sclerosis

PET scan for sugery purposes before uselef Surgery to take out part that can be taken out safely and if not responsive to medications

Management

10% of the population will have a seizures. only 2 out of the 10 will have epilepsy.

carbazepine can cause steven johnson and pt can die from it

can be important for mcqs

example carbazepin with ocp = must either use another contraception or epilepctic drugs

Also with warfarin Valproate is an inhibitor Need to know interactions of drugs with other drugs

old ones like zabamzaepin, valproate, phenytoin bound to protein...so for example in prengancy protien leves change....ad can change levels and trigger seizures etc