1 / 20

Epilepsy week prereading

Epilepsy week prereading. Talley & O’Connor p400-402. Causes of unconsciousness = C.O.M.A. CO 2 narcosis (uncommon) Overdose Metabolic/endocrine Apoplexy (Stroke or other CNS insult) General inspection DRABC Posture (neck extension, decerebrate , decorticate) Involuntary movements.

greta
Download Presentation

Epilepsy week prereading

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Epilepsy week prereading

  2. Talley & O’Connor p400-402 • Causes of unconsciousness = C.O.M.A. • CO2narcosis (uncommon) • Overdose • Metabolic/endocrine • Apoplexy (Stroke or other CNS insult) • General inspection • DRABC • Posture (neck extension, decerebrate, decorticate) • Involuntary movements

  3. Talley & O’Connor p400-402 • Level of consciousness • GCS • Coma, stupor, drowsy, alert • AVPU:Alert, Voice response, Pain response, Unresponsive • Neck • Trauma, stiffness, Kernig’s sign • Head • Inspect, palpate, Battle’s sign

  4. Talley & O’Connor p400-402 • Face • General • Asymmetry, jaundice, myxoedema • Eyes • Pupils, fundus, haemorrhage, position, movement • Ears and nostrils • Blood and CSF • Mouth and tongue • Trauma, corrosion, gum hyperplasia, breath odor

  5. Talley & O’Connor p400-402 • Limbs • Trauma, needle marks, tone, reflexes, pain response • Trunk • Trauma, heart, lungs, abdomen • Other • Urine • Blood sugar • Body temp • Stomach contents (if indicated)

  6. Harrison’s chap 363 Partial seizure – discrete CNS focus • Simple – fully conscious • Motor, sensory, autonomic, or psychic symptoms • May progress (egJacksonian march) • May proceed to complex partial seizure • May proceed to general seizure • Complex – impaired consciousness • Preceded by aura (simple partial seizure) • Automatisms – unconscious behaviour • Postictal confusion, anterograde amnesia

  7. Harrison’s chap 363 Generalized seizure – affects both hemispheres • Absence seizure (petit mal) • Brief lapse of awareness • Subtle motor signs (eg blinking) • No post-ictal confusion • Tonic-clonic seizure (grand mal) • 10-20s general muscle contraction (tonic) • Periods of relaxation (clonic) • Post ictal flaccidity and unresponsiveness, then impaired consciousness, confusion, headache, fatigue • Atonic seizure • Brief loss of postural control and impaired consciousness • No post-ictal confusion • Myoclonic seizure • Sudden, brief muscle contraction • Focal or generalized • Eg jerk while falling asleep

  8. Harrison’s chap 363 Epilepsy syndromes (disorders featuring epilepsy) • Juvenile myoclonic epilepsy • Responds well to anticonvulsants • Lennox-Gastaut syndrome • Underlying CNS disease, poor prognosis • Mesial temporal lobe epilepsy syndrome • Refractory to anticonvulsants • Responds well to surgery • Other examples with known genetic basis

  9. Harrison’s chap 363 Causes of seizures • Neonates • Perinatal hypoxia, infection, drug withdrawal, trauma, metabolic, genetic, developmental • Children • Febrile, trauma, developmental, infection, genetic, idiopathic • Adolescents • Trauma, drugs, brain tumour, infection, genetic, idiopathic • Young adults • Trauma, drugs, brain tumour, alcohol withdrawal, idiopathic • Older adults • Trauma, CVA, brain tumour, alcohol withdrawal, metabolic disorder, degenerative CNS, idiopathic

  10. Harrison’s chap 363 Mechanisms of seizures • Initiation and propagation • high-frequency action potentials bursts • Hypersynchronization • Interstitial and synaptic funkiness with electrolytes and neurotransmitters • Funkiness spreads to surrounding areas • Epileptogenesis • Normal neural network becomes hyperexcitable • Injury? Development? • Genetic • Ion channelopathies

  11. Harrison’s chap 363 Antiepileptic drugs block initiation or propogation • Inhibit Na+-dependent action potentials: • phenytoin, carbamazepine, lamotrigine, topiramate, zonisamide • Inhibit voltage-gated Ca2+channels: • Phenytoin • Decrease glutamate release: • Lamotrigine • Potentiate GABA receptor function: • benzodiazepines and barbiturates • Increase GABA availability: • Valproicacid, gabapentin, tiagabine • Modulate release of synaptic vesicles: • Levetiracetam • (Probably) Inhibit T-type Ca2+ channels in thalamic neurons: • Ethosuximideand valproicacid

  12. Harrison’s chap 363 Approach to seizure management

  13. Harrison’s chap 363 Approach to seizure management

  14. Harrison’s chap 363 DDx of seizures • Syncope • Vasovagal, arrythmia, hypotension, cardiac failure • Psychological • Panic attack, psychogenic seizure, hyperventilation • Metabolic • Hypoglycemia, hypoxia, alcoholic blackout, DTs, psychoactive drugs • Migraine • TIA • Sleep disorders • Narcolepsy, cataplexy, benign sleep myoclonus • Movement disorders • Tic, nonepilepticmyoclonus, paroxysmal choreoathetosis • Special considerations in children • Breath-holding, apnea, night terrors, migraine, benign paroxysmal vertigo

  15. Harrison’s chap 363 Treatment of seizures and epilepsy • Treat underlying condition • Avoid precipitating factors • Antiepileptic drugs • Big table of doses and adverse effects • Some patients can eventually cease drug therapy

  16. Harrison’s chap 363 Treatment of seizures and epilepsy • Surgery • focal neocortical resection • anteromedialtemporal lobe resection • Amygdalohippocampectomy • Lesionectomy • multiple subpialtransection • Multilobar resection • Hemispherectomy • Corpus callosotomy

  17. Harrison’s chap 363 Status epilepticus • Continuous seizures • Repetitive seizures with impaired consciousness between • GCSE = generalized convulsive status epilepticus • GCSE > 5min is an emergency: • cardiorespiratory dysfunction, hyperthermia, metabolic derangement, irreversible CNS injury • EEG may be required to show seizure activity after 30-45 minutes

  18. Harrison’s chap 363 GCSE management • ABC and hyperthermia • IV access, lab tests for metabolic abnormalities • Anticonvulsants • Begin with Lorazepam • Valproate? • Phenytoin or Fosphenytoin • Admit to ICU if seizures continue • General anesthesia (propofol, midazolam, pentobarbital)

  19. Harrison’s chap 363 Ongoing epilepsy management • Interictalbehavior • Depression, memory deterioration, postictal psychosis or anxiety • Psychosocial issues • Cultural stigma, fears of death and mental retardation • Employment, driving, other activities • Legislation varies • Mortality • Underlying disease, Accidents, GCSE, SUDEP – Sudden unexpected death in epileptic patients

  20. Harrison’s chap 363 Special issues for women with epilepsy • Catamenial epilepsy • Association of seizures with menstruation • Pregnancy • Seizure frequency may increase or decrease • Teratogenic effect of antiepileptic drugs • Contraceptive pill • Interactions with medication • Breastfeeding • Drugs are expressed in breast milk, but no evidence of long term harm to infants

More Related