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Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

Define epilepsy

A

Paroxysmal electrical disturbance of cerebral neurons which may give rise to dysfunction of the motor, sensory system, behaviour, conciousness and autonomic function.

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2
Q

How would motor system seizures present (6)

A 
Tonic attack
Tonic-clonic
Myoclonic
Atonic
Disturbance of maintenance of posture with hypotonia
Automatism
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3
Q

How would sensory seizures present? (5)

A

Visual, auditory, olfactory, taste or somatosensory auras

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4
Q

How would seizures affecting behaviour present? (3)

A

Anxiety, fear, elation (rare)

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5
Q

How would seizures affecting consciousness present? (2)

A

LOC for seconds eg petit mal

10-45 minutes following grand mal seizure

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6
Q

How would seizures affecting autonomic function present? (4)

A

BP / pupillary changes, facial pallor, tachycardia

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7
Q

What is a focal seizure?

A

Limited to a part of one cerebral hemisphere , localised

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8
Q

3 types of focal seizures

A

Focal aware
Focal unaware (clouded conciousness)
With secondary generalisation (“focal to bilat”)

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9
Q

6 types of generalised seizures

A 
Absence
Myoclonic
Clonic
Tonic-clonic
Atonic
Tonic
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10
Q

Where is lesion usually in focal unaware seizure

A

Temporal or frontal lobe

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11
Q

Definition generalized epilepsy

A

Bilateral involvement of cortex at the onset. LOC. Usually no warning

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12
Q

Where does the abnormal electrical impulse probably begin in generalised seizures?

A

Diencephalon or rostral brainstem (then spreads to both hemispheres)

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13
Q

Define tonic-clonic seizure or “grand mal” seizure (stages)(6)

A
  1. Immediate LOC
  2. Tonic phase: fall and stiff. About 30 seconds, urinary incontinence can occur (EEG = spike discharges)
  3. Clonic phase: rapid, rhythmic symmetrical myoclonic jerks. About 30 seconds. (EEG - spike and slow wave pattern)
  4. Period of muscle relaxation : respiration gradually return. 30s.
  5. Period of sleep
  6. Regain consciousness with headache, tired, muscle pain, injury, confusion. = postictal period
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14
Q

Characteristics of absence/petit mal seizures (6)

A

Sudden onset
Vacant stare with disturbance of conciousness
Disruption of ongoing psychic activity
Short duration usually less than 30s, most <10s
Eyes rotate up
Normal alertness when conciousness regained
(EEG=3s spike and wave activity)

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15
Q

Myoclonus definition

A

Sudden, brief shock-like involuntary jerking movements of muscles, usually sufficient to move joint

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16
Q

Causes myoclonus (4)

A

Juvenile myoclonic epilepsy
Infantile myoclonic epilepsy (West syndrome) (trunk myoclonus with flexion-extension)
Hypoxia in liver and renal failure
Slow virus infections: subacute sclerosing panencephalitis (SSPE) caused by measles, Creutzfel t-Jacob disease

17
Q

Atonic seizure characteristics

A

“Drop attacks”

Fall to ground suddenly without warning, with or without loss conciousness (1-2s)

18
Q

Tonic seizure characteristics

A

Increase in tone in arms, legs, trunk. Often results in extension of whole body. May or may not fall.

19
Q

What is partial epilepsy?

A

Presence of aura or warning before seizure

20
Q

When is epilepsy treatment considered? (3)

A

At least 2 attacks
Unprovoked
Attacks more than 24 hours apart

21
Q

Definition status epilepticus (3)

A

Seizure longer than 30 minutes
Seizures recur without patient regaining conciousness between seizures
Frequent occurence tonic clonic seizures without clinical recovery for a period exceeding 20 minutes

22
Q

Define epilepsia partialis contua

A

Recurrent motor epileptic seizures that are focal (hands and face), which recur every few seconds or minutes for extended periods (days or years)

23
Q

Treatment status epilepticus?

A
  1. First dose benZo: lorazepam iv/ diazepam iv or rectal / midazolam IM /in/ buccal

No respond after 5 min…

  1. First dose antiepileptic (phenytoin/valproate)
  2. 2nd dose benzo
  3. 2nd dose antiepileptic (phenytoin/valproate)
  4. Anaesthetic
24
Q

Name 3 benzos that can be used to treat status epilepticus and doses

A

Lorazepam 0.1mg/kg (max 4mg)

Diazepam 0.5-2mg/kg (max 19 mg) IV
OR
RECTAL 10MG

MIDAZOLAM 10MG IM/buccal

25
Q

Dose lorazepam status epilepticus?

A

0.1 mg/kg IV

maximum 4mg

26
Q

Dose diazepam status epilepticus?

A

IV: 0.15-2mg/kg (max 10mg)
Rectal: 10 mg

27
Q

Dose midazolam status epilepticus?

A

10 mg IM/buccal

Max 20 mg

28
Q

Name a benefit and disadvantage of using lorazepam for status epilepticus

A

+ rapid onset, longer duration compared to diazepam

  • need IV access; risk injection site reaction
29
Q

Name a benefit and disadvantage of using diazepam for status epilepticus

A

+ rapid onset when given IV. Effective also as rectal if no iv access

  • risk of accumulation. Rectal route has short duration of action and less effective than other options
30
Q

Name a benefit and disadvantage of using midazolam for status epilepticus

A

+ rapid onset action. IM route has best efficacy if all the benzos with little risk accumulation

  • short duration action
31
Q

Dose phenytoin for status epilepticus

A

20 mg/kg at 50 mg/min

Max 2000mg

32
Q

Dose valproate (epilim) for status epilepticus

A

30 mg/kg at 10mg/kg/min

Max 3000 mg

Neurology (17 decks)

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