Dr Aidan Neligan

45 Pages·2016·1.11 MB·English

“Fits, Faints and Funny Turns”

Dr Aidan Neligan PhD MRCP
Consultant Neurologist
HUH and NHNN, Queen Square
18-01-2016
Moya et al., 2009
What is referred to a First Seizure
Clinic?
Prospective study of 200 consecutive adult patients

attending a 1st Seizure clinic over a 16 month period
69.5% GP referrals – 30.5% Hospital/A+E

28% given a new diagnosis of epilepsy, 13% a

diagnosis of a single unprovoked seizure
What are the remainder?

Is it similar in children?

McFadyen, 2004
Paediatric 1st Seizure Clinic
Referrals
Referrals to a paediatric 1st Seizure in

Canada between 01/012004-30/08/2005
127 referrals


Hamiwka et al., 2007
Paediatric 1st Seizure Clinic
Referrals II
Of the 94 children diagnosed with an

epileptic event, 36 (38%) had suffered at
least one previous.
In all cases, the referral letter did not

comment on previous events
Unrecognised events included absence (2),

myoclonic (5) and complex partial seizures
(8) and more subtle seizures

Hamiwka et al., 2007
1st Seizure Clinic
Episodes of TLOC

In the 1st Seizure Clinic, the main differential

lies between convulsive syncopal episodes
and epileptic events
History

Eye witness accounts

Epileptic (GTCSz) vs Syncope ?
Posture

Prodrome

Relation to exercise

Sleep

Stimulus

Predisposing factors – stress, SD, heat, dehydration,

diarrhoea
Nausea, sweating, pallor, pupillary dilation

Chest pain , palpitations, blurred vision, light-

headedness
Epileptic (GTCSz) vs Syncope II?
Description of Fall
Keeling over, stiff - Tonic phase epilepsy, rarely

syncope
Flaccid collapse – Syncope (all variants)


Movements
Beginning before the fall – GTCS

Beginning after the fall – GTCS, Syncope

Symmetrical, synchronous – GTCS

Asynchronous – Syncope, functional TLOC, may be

GTCS
Epileptic (GTCSz) vs Syncope III?
Movements (c)
Beginning at onset of unconsciousness – GTCS

Beginning after onset of consciousness - Syncope

Lasting less than 15s – GTCS more likely than GTCS

Lasting for 30s to minutes – GTCS

Restricted to one limb or one side – GTCS

Pelvic thrusting – Functional GTCS (PNES)

Waxing and waning – Functional GTCS (PNES)

Epileptic (GTCSz) vs Syncope IV?
Other Aspects?
Ictal cry – GTCS

Automatisms (lip smacking, chewing, blinking) –

GTCS
Cynanotic face – GTCS, Cardiac Syncope

Eyes open – GTCS as likely as Syncope

Eyes closed – Functional TLOC (PNES)

Lateral tongue bite – GTCS

Head consistently turned to one side – GTCS more

likely than syncope