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Neurology Week 3 2018/19 > 8: Epilepsy - seizures, syndromes and differentials > Flashcards

8: Epilepsy - seizures, syndromes and differentials Flashcards

1
Q

What are the differences between a faint (syncope) and a seizure?

A

Syncope:

Startled look, falls to the ground, unresponsive but little/no movement, awakens and is quickly back to normal

Seizure:

Abnormal vocalisations / sensations / movements +/- loss of consciousness, slow to recover

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2
Q

When taking a funny turn history, ask what happened ___, ___ and ___ the event.

A

before, during and after

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3
Q

___ accounts are helpful for determining the cause of a collapse.

A

Eyewitness

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4
Q

What should you ask about the onset of a funny turn?

A

What were you doing at the time?

How did you feel?

What did you look like?

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5
Q

If a patient is having recurring events, what could you ask them to give you?

A

Video

Eyewitness account

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6
Q

What are some risk factors for epilepsy?

A

Birth / developmental problems

Hx head injury, tumours

Hx seizure (including febrile!)

Fx epilepsy

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7
Q

Can people with a diagnosis of epilepsy drive?

A

No

A person with active epilepsy needs to stop driving and inform the DVLA

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8
Q

An epilepsy diagnosis has consequences for a patient’s ___.

A

occupation

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9
Q

What should you examine in a patient presenting with syncope?

A

Full cardio exam

Blood pressure

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10
Q

What are some notable drugs which may precipitate seizures?

A

Analgesics e.g tramadol

Antibiotics

Anti-emetics

Opioids

if a patient has worsening seizures, check these before adjusting anticonvulsants

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11
Q

What investigation must you get for someone with new onset seizures?

A

ECG

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12
Q

Why is obtaining an ECG important in anyone with new onset seizures?

A

Arrhythmias (e.g long QT syndrome) cause cerebral hypoperfusion, precipitating seizures

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13
Q

In which case would a patient presenting with a seizure get an immediate CT scan?

A

Serious acute underlying pathology is suspected cause

e.g head trauma, haemorrhage, stroke, tumour

Persistently low GCS after admission

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14
Q

What is an EEG?

A

Electroencephalography

like an ECG for your brain, “brain waves”

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15
Q

Are EEGs used to diagnose epilepsy?

A

No

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16
Q

What are EEGs used for?

A

Classification of epilepsy

Confirming non-epileptic attacks

Confirming non-convulsive status epilepticus

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17
Q

What are some epilepsy mimics?

A

Syncope

Non-epileptic attacks

Panic attacks

TIAs

Hypoglycaemia

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18
Q

What is epilepsy?

A

Tendency to have spontaneous, recurring epileptic seizures

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19
Q

What is an epileptic seizure?

A

UNPROVOKED abnormal discharges of electricity in the brain

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20
Q

Are the electrical discharges in an epileptic seizure excitatory or inhibitory?

A

Usually excitatory

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21
Q

What does focal epileptic seizure mean?

A

Discharge affects one area of the brain only

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22
Q

What does generalised epileptic seizure mean?

A

Discharge affects several areas of the brain

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23
Q

At what ages do patients typically develop

a) focal
b) generalised

epilepsy?

A

a) focal - older patients
b) generalised - children and teens

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24
Q

What is SUDEP?

A

Sudden death syndrome re: epilepsy

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25
Q

Patients with epilepsy are (more likely / less likely) to die than normal patients.

Why?

A

more likely

aspiration; nocturnal seizures; drink and drug problems, depression and suicide; learning difficulties

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26
Q

What is a focal seizure?

A

Discharge remains in one part of the brain

causing a focal epilepsy

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27
Q

What causes focal epilepsy?

A

Structural abnormality in one part of the brain

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28
Q

Focal epilepsy causes seizures with symptoms relating to the ___ of the brain the structural abnormally is in.

A

Area

e.g motor sensory visual memory

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29
Q

What is a generalised seizure?

A

Discharge propagating via pathways to multiple areas of the brain

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30
Q

Can focal epilepsy cause generalised seizures?

A

Yes, if discharge propagates via pathways

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31
Q

What is generalised epilepsy?

A

Structural abnormality is found ON a pathway, causing immediate generalised seizures

32
Q

Can generalised epilepsy cause focal seizures?

A

No, discharge propagates by default as abnormality is found on a cortical pathway

33
Q

What is a seizure?

what is epilepsy?

A

Seizure - abnormal discharge of electricity in the brain

Epilepsy - tendency to have recurrent seizures

34
Q

Focal and generalised epilepsy have different ___.

A

managements

i.e different drugs

35
Q

What types of focal seizure can you have?

A

Focal motor

Focal sensory

these are SIMPLE focal seizures

Focal discognitive

which is a COMPLEX focal seizure involving temporal lobe

36
Q

focal seizures - affecting one brain area unilaterally - simple (awareness maintained) and complex (lost) - can cause a secondary generalised seizure if found ON propagating pathway

generalised seizures - affecting multiple brain areas - tonic-clonic (grand mal), absence (petit mal), myoclonic (children), tonic, atonic

look at Kumar and Clark!

A
37
Q

What is the tonic phase of a grand mal seizure?

A

Sudden muscle contraction (causing fall), flexion of arms, extension of legs

Dilation of pupils

Epileptic cry caused by contraction of inspiratory muscles

lasts 10s

38
Q

What causes the tonic phase of a generalised seizure?

A

Uncoordinated discharge in both motor strips

39
Q

What is the clonic phase of a seizure?

A

1-3 min period, following tonic phase, of muscle jerking in a grand mal seizure

40
Q

Why does the clonic phase of a seizure occur?

A

Motor strip discharges become less frequent

Gradually, relaxation overcomes contraction

41
Q

What are the symptoms of a sensory seizure?

A

Abnormal sensations

somatic, olfactory, visual, taste, auditory

42
Q

What are the symptoms of a seizure affecting the temporal lobe?

A

Abnormal memories (familiar but not familiar)

Deja vu

Hallucinations

43
Q

Which population are more likely to have focal seizures?

Why?

A

Over 50s

More likely to have focal brain abnormalities

44
Q

Which population are more likely to have generalised seizures?

A

Young people (under 30)

45
Q

What is drug of choice for generalised epilepsy?

A

Sodium valproate

46
Q

Sodium valproate patients must be warned that it is ___.

A

teratogenic

47
Q

What is the alternative to sodium valproate for generalised epilepsy?

A

Lamotrigine

48
Q

Which type of generalised epilepsy affects young people and causes involuntary muscle jerks, typically brought on by alcohol excess, bright lights and sleep deprivation?

A

Juvenile myoclonic epilepsy

49
Q

What is the drug of choice for focal epilepsy?

A

Carbamazepine

50
Q

What drug can be used instead of carbamazepine for focal epilepsy?

A

Lamotrigine

51
Q

35% of patients have ___ ___ epilepsy.

A

drug resistant

52
Q

Which two antiepileptic drugs interact with one another?

A

Sodium valproate

Lamotrigine

risk of toxicity and SJS

53
Q

Which drugs are given first line for

a) focal
b) generalised seizures?

A

a) carbamazepine, lamo
b) sodium valproate, lamo

54
Q

Which drug musn’t you give in generalised, myoclonic epilepsy?

A

Carbamazepine

55
Q

What is an anti-convulsant which can be used second line in generalised epilepsy?

A

Phenytoin

56
Q

Sodium valproate is cautioned against in ___ because of its side effects.

A

women

teratogenic, interacts with the pill

57
Q

When are anticonvulsant drugs given?

A

Only if:

patient has diagnosed epilepsy

patient has had one seizure and is at high risk of more e.g head injury, brain tumour, high genetic likelihood

the patient who has one/both of the above actually wants it

58
Q

Women who are using ___ should be warned about the side effects of anticonvulsants.

What are they?

A

contraception

sodium valproate is teratogenic

reduces efficacy of OCP (increase dose) and implants, nullifies progesterone pill

also need a higher dose morning after pill

59
Q

Which supplement should all pregnant women be on?

A

Folic acid

60
Q

Women who plan to be pregnant need to know that some medication for epilepsy is ___.

A

teratogenic

61
Q

What is a neurological emergency related to epilepsy?

A

Status epilepticus

62
Q

What is status epilepticus?

A

Continuous epileptic seizures without ROC for at least 30 mins

63
Q

What is non-convulsive status epilepticus?

Which investigation would you use to confirm it?

A

Continuous motor seizures but consciousness intact

EEG

64
Q

What can precipitate status epilepticus?

A

Metabolic disorders

Infection

Head injury

big list

65
Q

Why does convulsive status epilepticus cause death?

A

Tonic phase requires huge amount of energy

Aspiration

Respiratory INSUFFICIENCY

Hyperthermia

Hypotension (vasodilation in response to hyperthermia)

Rhabdomyolysis (massive muscle damage causing AKI)

66
Q

Which lobes are most active in status epilepticus?

Why?

A

Frontal lobes

Tonic, frontal lobe is where motor strips are found

67
Q

How is a patient in status epilepticus managed initially?

A

ABCDE

68
Q

Which investigations must you do for someone in status epilepticus?

A

Bloods

CT scan

LP if still unsure

69
Q

Ten minutes into status epilepticus, what is a patient given?

A

Phenytoin

70
Q

Which drugs need to be used with care in status epilepticus?

A

Benzos

71
Q

Which class of drug are given alongside benzodiazepine in convulsive status epilepticus?

A

Anticonvulsants

72
Q

What should patients in status epilepticus be given if they have histories of

a) diabetes
b) alcohol abuse?

A

a) glucose (on the off chance this is a hypo)
b) IV thiamine (on the off chance this is B1 deficiency encephalopathy)

73
Q

Who should be called thirty minutes into status epilepticus if below and anticonvulsants have failed to resolve a seizure?

A

ICU

74
Q

Should people in non-convulsive status be given benzos?

A

Yes

problem is abnormal brain discharges, it should wake them up

75
Q

What is the only situation in which seizures are treated acutely?

A

Status epilepticus I.e after 10+ minutes of fitting

Neurology Week 3 2018/19 (10 decks)

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