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The Nervous System: Pathology > Blackouts, First seizures and Epilepsy > Flashcards

Blackouts, First seizures and Epilepsy Flashcards

1
Q

What is the 9 different causes of a black out

A

Syncope

First seizure

Hypoxic seizure

Concussive seizure (after blow to head)

Cardiac arrhythmia

Non-epileptic attack

Narcolepsy,

Movement disorder,

Migraine

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2
Q

What is the commonest cause of fainting/syncope

A

Vasovagal syncope:

When you faint because your body overreacts to certain triggers, such as the sight of blood or extreme emotional distress causing your heart rate and blood pressure to drop suddenly

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3
Q

What is the features of syncope

A

Happens in the upright position

Pallor common

Gradual onset

Rapid recovery

Incontinence rare

Precipitants common

Injury rare

Early symptoms:
Light-headed, Nausea
Hot, sweating
Tinnitus
Tunnel vision
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4
Q

Why is injury rare in syncope and common in seizure

A

Due to gradual onset, patients can get themselves into a safe position avoiding injury, where in a seizure there is no warning do injury is more common

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5
Q

What is the features of seizures

A 
Occur in any posture
Pallor uncommon
Sudden onset
Injury quite common
Incontinence common
Slow recovery
Precipitants rare
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6
Q

What occurs in hypoxic seizures

A

Continued oxygen deprivation, e.g. when individual kept upright in a faint

Patient has succession of collapses

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7
Q

What is an example of a cardiac arrhythmia that can cause seizure

A

Long QT syndrome

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8
Q

When would long QT syndrome result in a seizure

A

Collapse occurs with exercise

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9
Q

When should you consider cardiac arrhythmias as the cause of seizures

A

When there is a family history of sudden death,

When there is a cardiac history

When collapse occurs with exercise

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10
Q

What can seizures cause over time

A

Cardiac arrhythmias

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11
Q

What is common features of non-epileptic attacks

A

Commoner in women than men

Can be frequent

May look bizarre

Can be prolonged

May have a history of other medically unexplained symptoms

May have history of abuse

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12
Q

What does a non-epileptic attack look like

A

May superficially resemble a generalised tonic-clonic seizure (rigid with jerking)

May resemble a “swoon”- flat on the ground and pale

May involve bizarre movements (thrusting of hips - sexual abuse)

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13
Q

What investigations must take place at a possible first seizure

A

Blood sugar - rule out as cause of blackout

ECG - what kind of seizure

Consideration of alcohol and drugs

CT head - see structural problems

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14
Q

After diagnosing a first seizure what needs to be discussed with the patient

A

Enquire about employment and dangerous leisure actuates

Explain driving regulations

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15
Q

What is the driving regulations put in place after a patient has their first seizure

A

Patient may drive a car after 6 months if their investigations are normal and they have had no further events

They may drive an Heavy good vehicle or Public Service Vehicle after 5 years if their investigations are normal, they have no further events and they are not on anti-epileptic medication

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16
Q

After first seizure, when would an epilepsy diagnosis be made

A

After a second unprovoked attack

Sometimes on taking the history after a first seizure, it is clear that they have undiagnosed epilepsy

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17
Q

What features in your history suggest undiagnosed primary generalised epilepsy

A

History of myoclonic jerks, especially first thing in the morning

Absences or feeling strange with flickering lights

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18
Q

What is features in your history suggesting a focal onset epilepsy

A

History of “deja vu”, rising sensation from abdomen,
Episodes where look blank with lip-smacking,
Fiddling with clothes

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19
Q

Define an epileptic seizure

A

Epileptic seizure is an intermittent stereotyped disturbance of consciousness, behaviour, emotion, motor function or sensation which, on clinical grounds, is believed to result from abnormal neuronal discharges

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20
Q

Define epilepsy

A

condition in which seizures recur, usually spontaneously

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21
Q

Where does damage occur in an epileptic seizure

A

Grey matter

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22
Q

What is the two ILAE Classifications of epilepsy

A

Generalsed seizures

Focal seizures

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23
Q

What are the 6 different types of generalise seizures

A

Tonic-clonic seizures

Myoclonic seizures

Clonic seizures

Tonic seizures

Atonic seizures

Absence seizures

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24
Q

What occurs in a tonic-clonic seizure

A

Usually begins on both sides of the brain, but can start in one side and spread to the whole brain.

A person loses consciousness, body become rigid (tonic) , and jerking movements (clonic) are seen

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25
Q

What occurs in a myotonic seizure

A

Brief shock - like jerks of a muscles and the person is usually awake and able to think clearly

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26
Q

What is seen in a tonic seizure

A

Produce constant contractions of the muscles. The person may turn blue if breathing is impaired

27
Q

What is seen in a clonic seizure

A

involve shaking of the limbs in unison

28
Q

What is seen in an absence seizure

A

Non convulsive seizure

Can be subtle, with only a slight turn of the head or eye blinking.
Lasting only a few seconds
The person often does not fall over and may return to normal right after the seizure ends

29
Q

What is focal seizures characterised by

A

According to aura:

Motor features, Autonomic features
Degree of awareness or responsiveness

30
Q

What can focal seizures progress to

A

Generalised convulsive seizures

31
Q

What can focal seizures be divided into

A

Simple e.g. hand jerk and conscious

Complex e.g. any disturbance to your conscious level
(appear confused or dazed and can not respond to questions or direction)

32
Q

What is the common presentation of primary generalised epilepsy

A

No warning

Diagnosed <25 years

History of absences and myoclonic jerks as generalised tonic-clonic seizure

May have a family history

Abnormal EEG

33
Q

What is the common presentation of a focal epilepsy

A

May get an “aura”

Any age – cause can be any focal brain abnormality

Simple partial and complex partial seizures can become secondarily generalised

Focal abnormality on EEG

MRI may show cause

34
Q

What investigation can show the cause of a focal epilespy

A

MRI

35
Q

What occurs in primary generalised epilepsy

A

Occurs in both hemispheres

due to disorder of brain function causing a group of neurones to fire in an abnormal, excessive, and synchronized manner

36
Q

What is a common pathological cause of generalised epilepsy

A

Channelopathies

Inhibitory neurons not functioning properly

so there is a constant firing of excretory neurone resulting in a wave of depolarisation across the brain

37
Q

What occurs in focal onset epilepsy

A

Disorder of brain structure usually occurring in one hemisphere of the brain

38
Q

Focal epilepsy is often preceded by certain experience known as auras, these include

A

Sensory, visual, psychic, autonomic, olfactory or motor phenomena with a degree of awareness or responsiveness

39
Q

What are the investigation used for epilepsy

A

EEG
MRI
CT (exclude other causes)
Video- telemetry

40
Q

What further processes take place with an EEG to help diagnose epilepsy

A

Hyperventilation
Photic stimulation
Sleep deprivation
- used to help trigger an primary generalised epileptic seizure

41
Q

When is an MRI investigation used in epilepsy

A

For patients under age 50 with possible focal onset seizures

42
Q

How and when would video-telemetry occur in epileptic investigations

A

If the diagnosis is uncertain
Using EEG and ECG monitoring to see how long someone is have a seizure so can differentiate between no epileptic and epileptic

43
Q

What is the first line treatment for primary generalised epilepsy

A

Sodium Valproate
Lamotrigine
Levetriacetam

44
Q

What is the first line treatment for partial and secondary generalised seizures

A

Lamotrigine

Carbamazepine

45
Q

What is the first line treatment for absence seizures

A

Ethosuximide

46
Q

What is the second line treatment for generalised epilepsy

A

Topiramate
Zonisamide

(carbamazepine)

47
Q

What is the second line treatment for partial seizures

A
  • Sodium valproate
  • Topiramate
  • Leviteracetam
  • Gabapentin
  • Pregabilin
  • Zonisamide
  • Lacosamide
  • Perampanel
  • Benzodiazepines
48
Q

What is the side effects of sodium valproate

A

tremor,
weight gain,
ataxia,
nausea, drowsiness, transient hair loss, pancreatitis, hepatitis

49
Q

Why is sodium valproate avoided during pregnancy

A

As can cause birth defects:
Delayed language development
Autism

50
Q

What is the side effects of carbamazepine

A

Ataxia, drowsiness, nystagmus, blurred vision, low serum sodium levels, skin rash

51
Q

What is the side effects of levetiracetam

A

Irritability

Depression

52
Q

What is the side effects of topiramate

A

weight loss,
word-finding difficulties,
tingling hands and feet

53
Q

What is the side effects of zonisamide

A

bowel upset, cognitive problems

54
Q

What is the contradiction in carmazepine treatment

A

Makes myoclonic jerks worse

55
Q

When can epileptic patients hold a group 1 licence

A

Once they have been seizure free for a year or have only had seizures arising from sleep for a year.

If they have ever had a day time seizure but then the pattern becomes noctural, this must be established for three years before they can drive

56
Q

When can epileptic patients hold a HGV and PSV licence

A

Have been seizure free for 10 years and are not on anti-epileptic medication

57
Q

Define status epilepticus

A

Prolonged or recurrent tonic-clonic seizures persisting for more than 30 minutes with no recovery period between seizures

58
Q

Status epilepticus usually occurs in patients with no previous history of epilepsy, so what is the potentially causes

A

Stroke
Tumour
Haemorrhage
Intoxicants (alcohol, drugs)

59
Q

Status epilepticus can be life threatening with out treatment so what is the first line treatment available

A

Midazolam: 10mg by buccal or intra-nasal route, repeated after 10mins if necessary

Lorazepam: 0.07mg/kg, usually 4mg bolus repeated once after 10 mins

Diazepam: 10 - 20mg iv or rectally, repeated after 15 mins if necessary

60
Q

What is the second line treatment of Status epilepticus if first line treatment doesn’t work

A

Phenytoin - slow infusion of 15 – 18mg/kg at 50mg/min

Valproate – 20 -30mg/kg iv at 40mg/min

Levetiracetam - IV
(near status)

61
Q

What is the third line treatment of status epilepticcus if it still isn’t under control

A

Anaesthesia usually with propofol or thiopentone

62
Q

What occurs in third line treatment of status epilepticcus

A

Shuts of brain activity, and leave for 24 hours, and administrate anticonvulsants

63
Q

What is SUDEP

A

Sudden unexpected death in epilepsy (SUDEP) is a fatal complication of epilepsy, where brain activity just flat lines

64
Q

What mechanisms are potential involved in SUDEP

A

Autonomic malfunction

  • Cardiac arrhythmias
  • Respiratory failure
    • Pulmonary dysfunction
    • Brain stem - apnea

The Nervous System: Pathology (25 decks)

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