04.06 Neuro
04.06 Neuro [PDF link]: Seizures & epilepsy – Generalised seizures: tonic-clonic (GTCS), absence seizures, atonic seizures, Focal seizures, Others: febrile convulsions (febcon), psychogenic non-epileptic seizures, alcohol-withdrawal seizures, Status epilepticus, Seizures vs syncope. Anticonvulsants / antiepileptics – Sodium valproate, Carbamazepine, Lamotrigine, Levetiracetam (Keppra), Phenytoin
External links
Status epileptics management: NICE guidelines
KIDS calculator for doses in status epilepticus: KIDS [meant for children, but can also be used in adults – weight-based calculations]
Seizures history taking: GeekyMedics
Clerking for seizures
PC: Seizure
HPC:
Before
What were they doing before seizure?
Pre-ictal / aural smx (eg changes in vision/motor sensation)
Ask: chest pain, palpitations, dyspnoea, lightheadedness, orthostatic hypotension
During
Witnessed? Description of activity (eg GTCS)
Did it begin in one area of the body before spreading?
Ask: LOC, head injury, other injury, foaming/frothing at mouth, eyes rolling back, tongue-biting, urinary incontinence
LOC may not necessarily be impaired, eg focal seizures, psychogenic epileptic activity
Seizure lasted for how long?
Self-terminating? or what drugs used?
After
Post-ictal period – how long? When did they come to themselves?
Other: systems review to see if any intercurrent illnesses causing lowered seizure threshold
Ask: recent cough/colds, fevers, CIBH (nausea, vomiting, loose stools), urinary smx
PMH:
Epilepsy?
DHx:
Anti-epileptics?
Drugs lowering efficacy/availability of anti-epileptics?
FHx:
Epilepsy?
Consanguinity?
SHx:
Alcohol – how much? when did they last drink? (risk of alcohol-induced seizures or delirium tremens)
Smoking
Illicit drugs
Driving – ** I have counselled patient against driving for the next 6mo/1y (depending on presentation; see Neuro 04.14)
O/E:
** Important to do neuro exam
Obs: NEWS _
Ix:
Bloods:
VBG: lactate
CXR:
CT head:
MRI head:
Imp:
1. Seizure
Plan
Monitor for next 24h for further seizures
?MRI head for structural defects
?Referral for first seizure clinic
