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Neurology > 1(E): Epilepsy > Flashcards

1(E): Epilepsy Flashcards

1
Q

Define epilepsy

A
  1. Two or more unprovoked seizures occurring more than 24-hours apart
  2. One seizure with probability of second-seizure more than general recurrence risk (60%) after two unprovoked seizures
  3. Epilepsy syndrome
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2
Q

What is epilepsy

A
  • Recurrent tendency to spontaneous, intermittent. abnormal electrical activity in part of the brain manifesting as seizures
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3
Q

What are convulsions

A

Motor signs of electrical discharge

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4
Q

What is the main cause of epilepsy

A

Idiopathic

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5
Q

What are other causes of epilepsy

A 
Genetic 
TBI 
Infection 
Alcohol-related 
SOL
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6
Q

What are seizure-triggers

A

Sleep deprivation
Alcohol
Stress
Flashing-lights

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7
Q

What are 4 risk factor for epilepsy

A
  • FH
  • Hypoxic-Ischemic
  • Meningitis or Encephalitis
  • TBI
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8
Q

What investigations should those with epilepsy first receive

A

EEG

MRI

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9
Q

If someone is having a seizure in public what should be done

A

ACTION first-aid

Assess danger
Cushion head 
Time 
Identity bracelet 
Over - recovery position 
Never put object in their mouth
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10
Q

What are criteria for calling an ambulance

A
  • First seizure
  • Persists beyond 5 minutes
  • Two episodes without regaining consciousness
  • Difficultly breathing
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11
Q

When are seizures treated medically

A

Persist beyond 5-minutes.

3 or more seizures in 24-hours

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12
Q

What is first-line for seizure management in the community

A

Buccal midazolam

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13
Q

If buccal midazolam is unavailable, what is given

A

Rectal diazepam

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14
Q

What benzodiazepine is preferred where possible

A

IV lorazepam

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15
Q

When are anti-epileptic medications started

A

After second-seizure

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16
Q

What is first-line for generalised tonic-clonic seizures

A

Sodium valproate

17
Q

What is first-line for absence seizures

A

Ethosuximide, Sodium Valproate

18
Q

What is first line for myoclonic seizures

A

Lamotrigine, Valproate, Clonazepam

19
Q

What is first line for focal seizures

A

Carbamazepine

20
Q

When is surgery for epilepsy indicated

A

Hippocampal resection - if tubero sclerosis (associated with infantile spasms)

21
Q

What other surgical procedures can be ordered for epilepsy

A

DBS

Vagal nerve stimulation

22
Q

Describe interaction between anti-epileptics and contraception

A

Anti-Epileptics affect CYP450 and may alter efficacy of contraceptives. Lamotrigine does not affect CYP450 - but does reduce effectiveness of oestrogen-containing contraceptives

23
Q

What medication should women of child-bearing age not be on

A

Sodium Valproate

24
Q

What is least teratogenic medication

A

Carbamezapine

25
Q

What are pregnant women often put on and why

A

Lamotrigine - little teratogenic effects. More effective and tolerable than carbamazepine.

26
Q

What does valproate cause in-utero

A

NTD

27
Q

What does phenytoin cause in-utero

A

Cleft-Palate

28
Q

Describe epilepsy and driving

A

Individual should not drive for 12-months following their last seizure

29
Q

Explain driving following a seizure

A

6-months off driving, unless 20% recurrence risk of another seizure then 12-months

30
Q

Explain when epilepsy is resolved

A
  • Out of age-range for epilepsy syndrome

- Seizure free 10-years, 5 of which are medication free

31
Q

What is a complication of epilepsy

A

SUDEP

32
Q

When is SUDEP more common

A

Uncontrolled epilepsy

33
Q

What causes SUDEP

A

Nocturnal hypoxia or systole

34
Q

What orthopaedic complication are those with seizures at increased risk of

A

Fracture

35
Q

What psychiatric complication are those with epilepsy at risk of

A

Neurpsych assessment

36
Q

What contraceptives should be given in epilepsy

A

IUD

Depo provea injection

37
Q

What is problem with depo provea injections and epilepsy

A

Depo provea does not protect against bone health - and these individuals are at increased risk of fractures.

Neurology (26 decks)

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