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Epilepsy (Aetiology (Stroke, Tuberous sclerosis, Space occupying lesion e…
Epilepsy
Aetiology
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Cortical scarring - head injury years before onset, cerebrovascular disease, CNS infection
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Diagnosis
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CT head - used in emergency to look for space occupying lesion, also used to identify or exclude structural abnormalities that could be causing symptoms
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Blood tests - FBC, electrolytes, Ca, renal function, liver function, urine biochemistry and blood glucose levels. Done to rule out metabolic causes and discover comorbidities
To make a clinical diagnosis, from history there needs to be at least 2 or more unprovoked seizures occurring > 24 hrs apart to DIAGNOSE EPILEPSY
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Epidemiology
Incidence is age-dependent, it is highest at the extremes of life with most cases starting before 20yrs or after the age of 60yrs
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Key Facts
Convulsions are the motor signs of electrical discharges when there is no abnormal metabolic circumstances e.g. hypoxia or low Na
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Definition
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Seizure - paroxysmal/unprovoked event in which changes of behaviour, sensation or cognitive processes are caused by excessive, hyper synchronous neuronal discharges in the brain
The recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain, manifesting in seizures
Clinical Presentation
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Partial/focal seizures
Complex partial seizure - affecting awareness or memory before, during or immediately after the seizure, most commonly arise from the temporal lobe
Partial seizure with secondary generalisation - in patients with partial seizures spreads widely causing a secondary generalised seizure
Simple partial seizure - not affecting consciousness or memory, awareness in unimpaired, no post-octal symptoms
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Pathophysiology
Elements of a seizure
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Prodrome - may last hours or days may not occur, may result in change of mood or behaviour
Post-ictally - may be headache, confusion, myalgia and a sore tongue, temporary weakness or dysphagia
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Treatment
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Drugs - AED (anti-epileptic drugs) e.g. sodium valproate, carbamazepine
Differential Diagnosis
Postural syncope, cardiac arrhythmia, TIA, migraine, hyperventilation, hypoglycaemia, panic attacks or non-epileptic seizure