232 Epilepsy Flashcards
What is the function of the cingulate gyrus?
Part of the limbic system - learning, memory and emotion
What is the septal area?
Considered pleasure zone in animals - reward and reinfocement Connections with the hippocampus etc - part of limbic system
Which part of the brain is important in spatial memory and learning?
Hippocampus
Which area of the brain is associated with fear and emotion?
Amygdala
Name 2 personality traits associated with Geschwind syndrome (7 listed)
Hypergraphia Hypo sexuality Emotional viscosity/stickiness Turbulent emotions Mood swings Psychotic and quasi psychotic phenomena Hyper-religiosity
Where in the brain is epilepsy most common?
Temporal lobes
What is the difference between a simple partial seizure and complex partial seizures?
Complex = LOC
What kind of seizure is characterised by lip smacking and swallowing?
Complex partial seizure originating from the temporal lobe.
What are of the brain would cause a ‘jacksonian march’ epileptic seizure?
Frontal lobe
What is a generalised epileptic seizure?
Tonic clonic seizure
Which limbs are affected predominantly in a tonic clonic seizure?
Upper limbs
Which type of epileptic seizures often begin in childhood/adolescence and show a 3 per second generalised spike and wave pattern on EEG with an immediate recovery
Absent
When do myoclonic seizures normally happen?
In the morning
What kind of seizures are associated with Lennox-Gastaut syndrome?
Atonic/tonic
What are the 3 gold standard investigations following a seizure?
ECG EEG Imaging
Name 2 causes of epilepsy in young infants (4 listed)
Perinatal intracranial trauma/hypoxia Congenital abnormalities Infection Metabolic disturbances
Name 2 causes of epilepsy in adults
Following injury as children Brain tumours
What is the most common cause of epilepsy in the >50s?
CV events
Name 3 rarer causes of epilepsy
Tay Sachs Neurofibromatosis PKU Tuberous sclerosis
Name 2 anti-epileptic drugs (4 listed)
Carbamazepine Sodium valproate Lamotrigine Leviteracetam
Which AED inhibits sustained repetitive firing at Na channels? - carbamazepine - sodium valproate - lamotrigine - leviteracetam
Carbamazepine
Which AED inhibits voltage gated Na channels and can cause a rash? - carbamazepine - sodium valproate - lamotrigine - leviteracetam
Lamotrigine
Which AED is the most teratogenic? - carbamazepine - sodium valproate - lamotrigine - leviteracetam
Sodium valproate
Which AED is thought to increase GABA as well as inhibiting Na channels? - carbamazepine - sodium valproate - lamotrigine - leviteracetam
Sodium valproate
Which AED is thought to stimulate SV2A, inhibiting neurotransmitter release? - carbamazepine - sodium valproate - lamotrigine - leviteracetam
Leviteracetam
What is the first line treatment for epilepsy in a woman of childbearing age with a generalised epilepsy?
Lamotrigine
What is the first line treatment for a partial/focal epilepsy?
Carbamazepine
Which AED can the OCP and warfarin affect?
Carbamazepine
What is the initial treatment for early status epilepticus?
ABCs IV lorazepam
What is the drug of choice for treatment of established status epilepticus?
IV phenytoin
What is the treatment for non convulsive status epilepticus?
benzos
What are roving eye movements in a coma a sign of?
Intact brainstem
What could papilloedema in a comatose patient indicate?
Raised ICP SAH
What does horizontal deviation of the eyes indicate? (choice of 2)
Ipsilateral frontal lobe damage Contralateral pontine damage
What is the oculocephalic response?
Turning the head and eyes are like ‘dolls eyes’…
What is the diagnosis if the pupils are non-responsive to light?
Large brainstem lesion
Name 2 drugs which may make the pupils react to light despite there being a big brainstem lesion during coma (4 listed)
Atropine Cocaine Ecstatsy Aphetamines
What is the most common outcome of coma other than death?
Minimally conscious state
What is most likely outcome of a coma (other than death) caused by: 1. Hypoxia 2. Cerebrovascular 3. Drug OD
- Persistent vegetative state 2. Persistent vegetative state 3. Good recovery
What is the best treatment for hypoxic ischaemic encephalopathy?
Therapeutic hypothermia
Name 3 signs of brainstem death
Absent pupil response Absent corneal response Absent vestibulo cochlear reflex Absent cough Absent motor response to pain No respiratory response to hypercapnia
