Epilepsy Flashcards

1
Q

Epilepsy

A

Epilepsy is a common neurological condition characterised by recurrent seizures.

It should be remembered that epilepsy is not the only reason people have seizures

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2
Q

Other than epilepsy; what are the other causes of seizures?

A

Insult to the brain, infection, trauma or metabolic disturbance, tumors

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3
Q

Febrile convulsions

A

Typically occur in children between the ages of 6 months and 5 years
Usually occur early in a viral infection as the temperature rises rapidly
Seizures are typically brief and generalised tonic/tonic-clonic in nature

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4
Q

What age do febrile convulsions usually occur?

A

Typically occur in children between the ages of 6 months and 5 years

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5
Q

Alcohol withdrawal seizures

A

Occur in patients with a history of alcohol excess who suddenly stop drinking, for example following admission to hospital

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6
Q

When do alcohol withdrawal seizures occur after stopping alcohol?

A

36 hours following cessation of drinking

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7
Q

What can be done to prevent alcohol withdrawal seizures in hospitals?

A

given benzodiazepines following cessation of drinking to reduce the risk

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8
Q

Psychogenic non-epileptic seizures

A

Previously termed pseudo seizures, describes patients who present with epileptic-like seizures but do not have characteristic electrical discharges.

Patients may have a history of mental health problems or a personality disorder

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9
Q

Partial focal seizures can be describes as either simple or complex; what is the difference between the two?

A

a. Simple: without impaired consciousness

b. Complex: with impaired consciousness

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10
Q

What are focal seizures?

A

Previously termed partial seizures

These start in a specific area, on one side of the brain

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11
Q

What are the six types of generalized seizures?

A
o	tonic-clonic (grand mal)
o	tonic
o	clonic
o	typical absence (petit mal)
o	myoclonic: brief, rapid muscle jerks
o	atonic
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12
Q

What are generalized seizures?

A

These engage or involve networks on both sides of the brain at the onset

Consciousness lost immediately.

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13
Q

How are generalized and focal/partial seizures differentiated?

A

Consciousness lost immediately in generalized, in partial consciousness may or may not be lost

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14
Q

What investigations are done following the first seizure in a patient?

A

Following their first seizure patients generally have both an electroencephalogram (EEG) and neuroimaging (usually an MRI).

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15
Q

When are epileptics drugs started in epileptic seizures?

A

Most neurologists now start antiepileptics following a second epileptic seizure.

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16
Q

What is the first line drug in generalized seizures?

A

sodium valproate

17
Q

What is the first line drug in focal seizures?

A

carbamazepine

18
Q

When can patients drive following a seizure for the first time?

A

Cannot drive for 6 months following a seizure.

19
Q

When can patients with established epilepsy drive?

A

For patients with established epilepsy they must be fit free for 12 months before being able to drive

20
Q

What epilepsy medications are tetratogenic?

A

antiepileptics are generally teratogenic, particularly sodium valproate.

21
Q

What is the mechanism of action of sodium valproate?

A

Increases GABA activity

Although the mechanism of action remains to be elucidated, valproate sodium increases concentrations of gamma-aminobutyric acid (GABA) in the brain, probably due to inhibition of the enzymes responsible for the catabolism of GABA.

22
Q

Side effects of sodium valproate

A
increased appetite and weight gain
alopecia: regrowth may be curly
P450 enzyme inhibitor
ataxia
tremor
hepatitis
pancreatitis
thrombocytopaenia
teratogenic (neural tube defects)
23
Q

Side effects of Carbamazepine

A
  1. P450 enzyme inducer
  2. dizziness and ataxia
  3. drowsiness
  4. leukopenia and agranulocytosis
  5. syndrome of inappropriate ADH secretion
  6. visual disturbances (especially diplopia)
24
Q

Mechanism of action of Carbamazepine

A

Binds to sodium channels increasing their refractory period

25
Mechanism of action of Lamotrigine
Sodium channel blocker
26
Side effects of Lamotrigine
Stevens-Johnson syndrome - The syndrome often begins with flu-like symptoms, followed by a red or purple rash that spreads and forms blisters. The affected skin eventually dies and peels off. Stevens-Johnson syndrome is a medical emergency that requires treatment in hospital, often in intensive care or a burns unit.
27
When is Lamotrigine used in epilepsy?
Used second line for a variety of generalised and focal seizures
28
Side effects of Phenytoin
``` P450 enzyme inducer dizziness and ataxia drowsiness gingival hyperplasia, hirsutism, coarsening of facial features megaloblastic anaemia peripheral neuropathy enhanced vitamin D metabolism causing osteomalacia lymphadenopathy ```
29
Mechanism of action of phenytoin
Binds to sodium channels increasing their refractory period
30
In the pre-hospital setting, an epilepsy seizure of more than 5-10 mins should be given rescue medication - what is this?
Benzodiazepines such as diazepam are typically used may be administered rectally or intranasally/under the tongue.
31
Patients with epileptic seizure of more than 10 mins not stopping despite benzodiazepines are referred to as what?
Status epilepticus. | This is a medical emergency requiring hospital treatment.
32
What is status epilepticus?
a single seizure lasting >5 minutes, or | >= 2 seizures within a 5-minute period without the person returning to normal between them
33
When patient has refractory status (seizure lasting for up to 45 minutes or more); what management is done?
General anesthesia
34
What are absence seizure features?
* absences last a few seconds and are associated with a quick recovery * seizures may be provoked by hyperventilation or stress * the child is usually unaware of the seizure * they may occur many times a day * EEG: bilateral, symmetrical 3Hz spike and wave pattern
35
Why is sodium valproate considered tetragenic?
Causes neural tube defects