Epilepsy - Other notes
Epilepsy
- Other notes
Causes of secondary seizures
- Intracranial hemorrhage (subdural, epidural, subarachnoid, intraparenchymal)
- Structural abnormalities
* Vascular lesions (aneurysm, AV malformation)
* Mass lesions
* Degenerative diseases
* Congenital abnormalities
- Trauma
- Infection (meningitis, encephalitis, abscess)
- Metabolic disturbances
* Hypo/hyperglycaemia
* Hypo/hypernatremia
* Hyperosmolar state
* Uremia
* Hepatic failure
* Hypocalcemia
* Hypomagnesaemia
- Toxins and drugs
* Cocaine, lidocaine
* Antidepressants
* Theophylline
* Alcohol withdrawal
* Drug withdrawal
- Eclampsia (may occur up to 8 weeks postpartum)
- Hypertensive encephalopathy
- Anoxic-ischaemic injury (cardiac arrest, severe hypoxemia)
Differential diagnosis
Syncope
- Usually has premonitory symptoms such as dizziness, diaphoresis, nausea, and tunnel vision (unless cardiac syncope, which can occur suddenly without any warning)
- Some patients may have brief tonic-clonic activity, but recovery is quick and with very little post-ictal symptoms.
- Injury or incontinence may occur
Pseudoseizure
- Psychiatric rather than neurogenic
- No postictal confusion
- Characteristic movements include side-to-side head thrashing, rhythmic pelvic thrusting, clonic extremity motions that are alternating rather than symmetrical
- Incontinence and injury are uncommon
Hyperventilation syndrome
- Gradual onset, with dyspnoea, anxiety, perioral numbness (perioral numbness also occurs in hypocalcaemia)
- Reproducible by hyperventilation
Migraine
- May be preceded by an aura similar to that seen in partial seizures
- Most common aura in migraine is scintillating scotoma
- May also have focal neurologic symptoms such as homonymous hemianopia, and hemiparesis
Movement disorders
- Dystonia, chorea, myoclonic jerks, tremours, or tics
- Consciousness always preserved
- The movement, though involuntary, can be temporarily suppressed by the patient
Narcolepsy/cataplexy
- Brief attacks of uncontrollable daytime sleepiness
