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Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

How can syncope and epilepsy be differentiated?

A

In syncope, recovery is rapid.

In seizure, recovery takes minutes-hours.

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2
Q

Is examination useful in seizure?

A

No, only useful in ruling out syncope.

History is crucial.

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3
Q

What test should be performed in any individual reporting a collapse?

A

ECG - regardless of clinical suspicion.

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4
Q

Which arrhythmia commonly presents with collapse?

A

Prolonged QT syndrome

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5
Q

How long must a patient avoid driving for after a seizure?

A

6 months

If HGV driver, this is 5 years.

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6
Q

If a patient is diagnosed with epilepsy, how long are they unable to drive for?

A

Must be seizure-free for a year.

If HGV driver, 10 years seizure-free plus on no treatment during this.

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7
Q

What factors can precipitate a seizure?

A

Head injury

Hypoglycaemia

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8
Q

If seizure occurs in the context of a causative factor is it epilepsy?

A

No, epilepsy is diagnosed in seizures occurring in the absence of any other causative factor.

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9
Q

What occurs in the brain during an epileptic seizure?

A

Spontaneous discharge of electrical activity disturbing normal brain activity.

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10
Q

What is SUDEP?

A

A term used to describe sudden death in those with epilepsy.

An umbrella term.

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11
Q

In focal epilepsy, the specific area of the brain affected (and which displays symptoms) is called what?

A

The seizure focus.

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12
Q

What are the networks called that connect the different brain regions?

A

Cortical networks.

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13
Q

What type of seizure can arise from focal epilepsy?

A

Focal seizures

Generalised seizures (if affecting the cortical networks)

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14
Q

What type of seizure can arise from generalised epilepsy?

A

Generalised seizures

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15
Q

What is epilepsy?

A

The tendency to have recurring seizures.

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16
Q

What is a seizure where there is LOC called?

A

Disconscious epilepsy

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17
Q

A focal seizure, producing motor symptoms, suggests which lobe is affected?

A

Frontal lobe

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18
Q

A focal seizure, producing sensory symptoms, suggests which lobe is affected?

A

Parietal lobe

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19
Q

A focal seizure, producing psychic symptoms, suggests which lobe is affected?

A

Temporal lobe

20
Q

Can focal seizures generalise?

A

Yes, if they spread to the cortical network.

21
Q

If a focal seizure generalises, which forms result?

A

Tonic

Tonic clonic

22
Q

What are the forms of generalised seiziure?

A 
Absence
Myoclonic
Atonic
Tonic
Tonic clonic
23
Q

Which age group are affected by generalised seizures?

A

Young people

Thought to carry a genetic risk.

24
Q

Which age group are affected by focal seizures?

A

The elderly

Due to a structural abnormality.

25
Q

How is a primary generalised epilepsy treated?

A

Sodium valproate

If female and of child-bearing age, give lamotrigine (as sodium valproate is teratogenic).

26
Q

How is focal epilepsy treated?

A

Lamotrigine (or carbamazepine).

Gabapentin is 2nd line.

27
Q

In which situation is phenytoin used?

A

Acute management only as high dose can be given rapidly.

Causes hirsutism and gingival hyperplasia when used long-term.

28
Q

What are side-effects of sodium valproate?

A

Weight gain
Hair loss
Teratogenicity

29
Q

What is the main issue with carbamazepine therapy?

A

Causes severe dizziness.

30
Q

Is carbamazepine suitable in generalised epilepsy?

A

No, it worsens epilepsy in these patients.

Only suitable in focal epilepsy.

31
Q

Do anti-convulsants work alongside contraception?

A

No, they reduce effectiveness.

Avoid anti-convulsants where possible as they have many drug interactions.

32
Q

What is status epilepticus?

A

A state of recurrent epileptic seizures where there is no full recovery of consciousness.

A neurological emergency.

33
Q

After how long should a seizure be treated as status epilepticus?

A

If no spontaneous resolution following 10 minutes of fitting.

34
Q

What are potential causes of status epilepticus?

A 
Hyponatraemia
Pyridoxine deficiency
Infection
Head trauma
Subarachnoid haemorrhage
Abrupt withdrawal of anti-convulsants
35
Q

What can kill patients in status epilepticus?

A

Aspiration
Hypotension
Hyperthermia
Rhabdomyolysis

36
Q

How is status epilepticus treated?

A

Give 10mg benzodiazepines.
Check for response.
If no recovery, give again 5 mins later.
If still doesn’t resolve, give phenytoin 5 mins after that.

37
Q

What is a potential issue with giving benzodiazepines?

A

They can cause respiratory depression.

38
Q

After 1 hour of status epilepticus, what should be done?

A

Patient should be moved to ITU.

39
Q

What are non-epileptic attacks?

A

Behavioural episodes that look like seizures, caused by stress.

40
Q

How are non-epileptic attacks best treated?

A

Deal with trauma rather than treat symptoms.

41
Q

What is the most common trigger of a non-epileptic attack?

A

Sexual assault

42
Q

What occurs in a tonic clonic seizure?

A

A burst of electricity affecting the motor cortex of the frontal lobe resulting in all the muscles of the body contracting.

Proceeds to relax-jerk in a pattern.

43
Q

Do functional attacks last longer than epileptic seizures?

A

Yes, usually 10-20 mins.

44
Q

What form of activity is seen in a functional attack?

A

Prominent motor activity, or
Episodic collapse with no movement, or
Abreactive attacks

45
Q

How is a functional attack treated?

A

Remove any epilepsy medication
Reassure patient
CBT

Neurology (22 decks)

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