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Neurology > Epiilepsy and Seizures > Flashcards

Epiilepsy and Seizures Flashcards

1
Q

Is awareness impaired in:
Focal seizures?
Generalised seizures?

A

Focal - no impairment

Generalized - impairment

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2
Q

Focal seizures can go on to progress to secondary generalised seizures - T/F?

A

TRUE

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3
Q

What can the presence of aura’s help you decide?

A

Whether or not the pt is fit to drive

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4
Q

Focal aware seizures (SIMPLE focal seizure) have symptoms dependent on their anatomical localisation in the brain.
What kind of symptoms would be present in the parietal lobe?

A

Sensory - tingling / numbing / pain

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5
Q

where in the brain would a simple focal seizure be present if the symptoms they described:
changes in mood & behaviour
rising epigastric sensation

A

Temporal lobe

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6
Q

frontal lobe seizure symptoms

A

stiffness
twitching
spasm
spreading from distal limb to face

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7
Q

Complex focal seizures have impaired awareness - T/F?

A

TRUE

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8
Q

where do complex focal seizures most commonly arise?

A

temporal lobe

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9
Q

pathophysiology behind temporal lobe complex focal seizures

A

hippocampal sclerosis

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10
Q

3 key features of complex focal/’‘partial’’ seizures

A

aura
absence (loss of consciousness)
automatism (repetitive stereotyped movement)

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11
Q

what can happen after a seizure occurs

A

post-ictal confusion

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12
Q

is an absence seizure focal or generalized?

A

generalised

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13
Q

what happens during absence seizures

A

sudden loss of consciousness
all motor activity stopped
abrupt duration - 10 secs
pt is unaware the attack has happened and continues on as if nothing happened (no post-ictal confusion)

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14
Q

EEG characteristic in absence seizure

A

3 Hz spike wave

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15
Q

what are myoclonic seizures

A

brief contraction of one or more muscles resulting in a small twitch or severe jerk

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16
Q

what is juvenile myoclonic epilepsy

A

brief myoclonic jerks occurring 1 hour after awakening
affects mainly shoulders + arms
12-18 y/o
generalised tonic-clonic seizures also occur months/years after onset of myoclonus

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17
Q

Juvenile myoclonic epilepsy has a poor response to treatment - T/F?

A

F

complete response in 80-90% cases BUT for some lifelong therapy may be needed

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18
Q

what is a clonic seizure

A

elbows, legs and head FLEX

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19
Q

what group of individuals get clonic seizures

A

neonates & young kids

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20
Q

what is a tonic seizure

A 
brief loss of consciousness 
pt falls to ground 
EXTENSION of neck 
upturning of eyes 
back arched
21
Q

complications from tonic-clonic seizures

A

pt biting their tongue
cyanosis
incontinence

22
Q

what type of imaging can be used to help determine the type of seizures?

A

EEG (although this may show normal results)

MRI

23
Q

indications for getting an MRI for seizures

A

pt who develop epilepsy before 2 y/o

focal seizures

pt who continue to seizure despite 1st line medication

24
Q

titration of anti-epileptic drugs should start high and titrated down - T/F?

A

F

other way round

25
Q

Polytherapy is used when at least 2 drugs (used as monotherapy) have failed to control seizures

A

F

you need to use at least 3 drugs as monotherapy before you can start polytherapy

26
Q

1st line tx for tonic-clonic

A

sodium valproate

27
Q

if sodium valproate doesn’t work for tonic clonic, what can be used?

A

lamotrigine

28
Q

2nd line for tonic-clonic seizures (name 2 options)

A

levetiracetam

topiramate

29
Q

can sodium valproate be used for all generalised seizures?

A

yes - 1st line for all (tonic-clonic/absence/myoclonic)

30
Q

2nd line tx for myoclonic seizure

A

levetiracetam

31
Q

what 2 drugs can be used for focal seizures?

A

lamotrigine

carbamazepine

32
Q

if a seizure is unclassified, what drugs can be used?

A

1st line - sodium valproate

2nd line - lamotrigine & topiramate

33
Q

is toperimate ever used 1st line?

A

no - always 2nd line

34
Q

what anti-epileptic drugs work on the na+ channel?

A

carbamazepine
phenytoin
lamotrigine
sodium valproate

35
Q

S/E of carbamazepine

A

diplopia
ataxia
teratogenic
hyponatraemia

36
Q

when is phenytoin used for seizures?

A

as seizure prophylaxis

37
Q

S/E of phenytoin

A 
nystagmus 
diplopia 
sedation 
gingival hyperplasia (gum bleeding) 
peripheral neuropathy
38
Q

what is the mechanism of the anti-epileptic drug ethosuximide

A

blocks Thalamic T-type Ca2+ channels

39
Q

when is ethosuximide used?

A

1st line in absence seizures (along with sodium valproate)

40
Q

sodium valproate is teratogenic - T/F?

A

TRUE

41
Q

what is status epilepticus

A

seizures which continue for a prolonged period (5+ mins)

42
Q

1st line community treatment for status epilepticus

A

buccal/rectal midazolam

43
Q

1st line hospital treatment for status epilepticus

A

IV lorazepam

44
Q

2nd line hospital treatment for status epilepticus

A

IV phenobarbital or phenytoin

45
Q

for cars/motorcycles:

how long do you have to stop driving if a seizure occurs when awake?

A

1 year

46
Q

if a seizure occurs when you are asleep, you can still drive - T/F?

A

TRUE

BUT only if there is no awake attack for 3 years

47
Q

if a seizure occurs when awake but doesn’t affect consciousness, can you drive?

A

you can qualify for a licence if these are the only type of attack you’ve ever had and the first one was 12 months ago

48
Q

for buses/lorries:

if you have a one off seizure, you have to wait 10 years before you can drive again?

A

FALSE

You have to wait 5 years (you have to wait 10 if you have 2+ seizures or diagnosis of epilepsy)

Neurology (15 decks)

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