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Medicine Y3 TCD 13-24 > 24. Epilepsy > Flashcards

24. Epilepsy Flashcards

1
Q

Define epilepsy

A

Epilepsy is an umbrella term for a condition where there is a tendency to have seizures. Seizures are transient episodes of abnormal electrical activity in the brain. There are many different types of seizures.
A diagnosis of epilepsy is made by a specialist based on the characteristics of the seizure episodes.

(A disruption in the normal balance between excitatory and inhibitory currents or neurotransmission in the brain causing hypersynchronous neuronal discharge )

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2
Q

name some causes of epilepsy

A
  • Structural: stroke, trauma, malformation of cortical development
  • Genetic: Dravet syndrome
  • Infectious: TB, cerebral malaria, HIV , zika virus  congenital
  • Metabolic: porphyria, amino-acidopathies
  • Pyridoxine deficiencies
  • Immune: anti-NMDA receptor encephalitis, anti-LG11 encephalitis
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3
Q

name some risk factors of epilepsy

A
  • Premature birth
  • Genetic conditions: Tuberous sclerosis, Neurofibromatosis
  • Brain development malformations
  • Family Hx
  • Head trauma, infections (meningitis, encephalitis) or tumours
  • Cerebrovascular disease and Stroke
  • Dementia and neurodegenerative disorders : Alzheimer’s disease  10X more likely to develop epilepsy compared to the general population
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4
Q

name some investigations you would carry out

A

All patients must be referred to a specialist for assessment and investigation in < 2 weeks

An electroencephalogram (EEG) can show typical patterns in different forms of epilepsy and support the diagnosis.

An MRI brain can be used to visualise the structure of the brain. It is used to diagnose structural problems that may be associated with seizures and other pathology such as tumours.

Other investigations can be used to exclude other pathology, particularly an ECG to exclude problems in the heart.

U&E: hyponatraemia

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5
Q

all patients with epilepsy should have a review yearly to assess what kind of things

A

o Seizure control
o Impact on QoL
o DVLA: Must inform DVLA
 1st seizure = 6 months off driving
 Can only drive if 1 year free of seizures
o Carers’ skills in managing seizures
o Contraception needs and planning pregnancy information

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6
Q

what is the difference between a focal epilepsy and a generalised epilepsy

A
  • Focal epilepsy: Localised disturbance in the cortex occurring in one hemisphere. If it remains localised, the symptoms experienced depend on which cortical area is affected. Often occurs in the temporal lobe
  • Generalised epilepsy: Both hemispheres are involved . Activity probably originating in the central mechanisms controlling cortical activation and spreading rapidly
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7
Q

name the different types of seizures

A 
generalised tonic-clonic 
focal 
absence 
atonic 
myoclonic 
infantile spasms
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8
Q

tell me about a generalised tonic-clonic seizure

  • do they experience anything beforehand
  • what happens during the seizure
  • is there any associated features
  • what happens after the seizure

(this is what most people think of with an epileptic seizure)

A
  • may experience aura
  • during seizure there is loss of consciousness and tonic (muscle tensing) and clonic (muscle jerking) episodes.
    Typically the tonic phase comes before the clonic phase.
  • there may be associated features such as tongue biting, incontinence, groaning and irregular breathing
  • there is a prolonged post-octal period where the person is confused, drowsy and feels irritable or depressed
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9
Q

what is the management of tonic-clonic seizures

A
  • First line: sodium valproate

* Second line: lamotrigine or carbamazepine

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10
Q

tell me about a focal seizure

  • where does it start
  • what does it affect
  • how does it present (remember HEAD)
A
  • start in temporal lobes
  • affect hearing, speech, memory and emotions
    o Hallucinations (auditory/gustatory/olfactory)
    o Epigastric rising/Emotional
    o Automatisms (lip smacking/grabbing/plucking)
    o Déjà vu/dysphasia
  • can also get memory flashbacks
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11
Q

what is the management of focal seizure (remember it is the reverse of tonic-clonic seizure)

A
  • First line: carbamazepine or lamotrigine

* Second line: sodium valproate or levetiracetam

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12
Q

localising features of focal seizure;

- what are the features in association with the temporal lobe

A 
automatisms
dysphasia 
deja vu 
hallucinations of smell, taste or sound 
delusional behaviour
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13
Q

localising features of focal seizure;

- what are the features in association with the frontal lobe

A
  • motor features such as posturing or peddling movements of the legs
  • motor arrest
  • subtle behavioural disturbances
  • dysphasia
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14
Q

localising features of focal seizure;

- what are the features in association with the parietal lobe

A

sensory disturbances ie tingling, numbness, pain (rare)

motor symptoms due to the spread to the pre-central gyrus

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15
Q

localising features of focal seizure;

- what are the features in association with the occipital lobe

A

visual phenomena such as spots, lines, flashes

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16
Q

tell me about absence seizures

  • which age group do they typically happen in
  • what are the features of the seizure
  • how long do the seizures last
  • what is it often mistaken as
A
  • typically happen in children
  • The patient becomes blank, stares into space and then abruptly returns to normal. During the episode they are unaware of their surroundings and won’t respond.
  • Often mistaken for daydreaming or poor concentration in school.
  • These typically only lasts 10-20 seconds. Most patients (> 90%) stop having absence seizures as they get olde
17
Q

what is the management of absence seizures

A

sodium valproate or ethosuximide

18
Q

tell me about atonic seizures

  • what are they also known as
  • describe the seizure
  • how long does it have
  • what syndrome may they be indicative of
A
  • Atonic seizures are also known as “drop attacks”. They are characterised by brief lapses in muscle tone.
  • These don’t usually last more than 3 minutes. They typically begin in childhood.
  • They may be indicative of Lennox-Gastaut syndrome.
19
Q

what is the management of atonic seizures

A
  • First line: sodium valproate

* Second line: lamotrigine

20
Q

tell me about myoclonic seizures

  • describe them
  • is the patient awake or unconscious during the attack
  • what specific type of epilepsy is it associated with
A
  • Myoclonic seizures present as sudden brief muscle contractions, like a sudden “jump”.
  • The patient usually remains awake during the episode.
  • They occur in various forms of epilepsy but typically happen in children as part of juvenile myoclonic epilepsy.
  • Can happen due to sleep deprivation
21
Q

what is the management of myoclonic seizures

A
  • First line: sodium valproate

* Other options: lamotrigine, levetiracetam or topiramate

22
Q

tell me about infantile spasms

  • what is also known as
  • what is it characterised by
A
  • This is also known as West syndrome
  • . It is a rare (1 in 4000) disorder starting in infancy at around 6 months of age.
  • It is characterised by clusters of full body spasms. There is a poor prognosis: 1/3 die by age 25, however 1/3 are seizure free.
23
Q

what is the management for infantile spasms

A
  • Prednisolone

* Vigabatrin

24
Q

sodium valproate is first line option for most forms of epilepsy except for

A

focal seizures (First line: carbamazepine or lamotrigine)

25
Q

how does sodium valproate work and what are the main side effects

A

increasing the activity of GABA, which has a relaxing effect on the brain

  • Teratogenic so patients need careful advice about contraception
  • Liver damage and hepatitis
  • Hair loss
  • Tremor
26
Q

what is carbamazepine first line treatment for

A

focal seizures

27
Q

what are the main side effects of carbamazepine

A
  • Agranulocytosis
  • Aplastic anaemia
  • Induces the P450 system so there are many drug interactions
28
Q

what are the main side effects of phenytoin

A
  • Folate and vitamin D deficiency
  • Megaloblastic anaemia (folate deficiency)
  • Osteomalacia (vitamin D deficiency)
29
Q

what are the main side effects of ethosuximide (use din absence seizures in children)

A
  • Night terrors

* Rashes

30
Q

what are the main side effects of lamotrigine

A
  • Stevens-Johnson syndrome or DRESS syndrome. These are life threatening skin rashes.
  • Leukopenia
31
Q

what is status epilepticus

A

. It is a medical emergency. It is defined as seizures lasting more than 5 minutes or more than 3 seizures in one hour.

32
Q

what is the management for status epilepticus in hospital

ABCDE approach

A

Take an ABCDE approach:
• Secure the airway
• Give high-concentration oxygen
• Assess cardiac and respiratory function
• Check blood glucose levels
• Gain intravenous access (insert a cannula)
• IV lorazepam 4mg, repeated after 10 minutes if the seizure continues
• If seizures persist: IV phenobarbital or phenytoin

33
Q

what is the management of status epilepticus in the community ie what are your medical options

A
  • Buccal midazolam

* Rectal diazepam

34
Q

remember that most of the drugs interact with the oral contraception pill except which drug

A

sodium valproate

Medicine Y3 TCD 13-24 (32 decks)

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