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Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

Pathophysiology of seizure?

A

Clusters of brain neurons temporarily impaired -> paroxysmal electrical discharges -> symptoms

I.e. Bunch of neurons are firing at the same time

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2
Q

2 basic concepts of causes of seizure?

A

Too much excitation or too little inhibition

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3
Q

Explain how too much excitation can lead to seizure

A

Glutamate binds to NMDA receptors to open ion channel for calcium to allow calcium in to pass on electrical message. If patient has fast/long-lasting activation of NDMA receptors then can cause too much excitation and seizure

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4
Q

Explain how too little inhibition can lead to seizure

A

GABA binds to GABA receptors which opens ion channels that let chloride in which stops electrical message. Genetic mutations can occur in GABA receptor making it dysfunctional so can’t help inhibit signals

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5
Q

Main brain excitatory neurotransmitter and receptor

A

glutamate and NMDA receptor

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6
Q

Main brain inhibitory neurotransmitter and receptor

A

GABA and GABA receptor

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7
Q

What is epilepsy?

A

Seizure disorder of recurring and unpredictable seizures

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8
Q

Most common cause of epilepsy?

A

Idiopathic

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9
Q

Epilepsy prevalence

A

About 0.5% - very common

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10
Q

70% of epilepsy cases have no identified cause but 70% are well controlled with drugs. True/false

A

True

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11
Q

At what age does epilepsy normally present?

What age groups most common in?

A

Childhood/teenage years,

Old age

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12
Q

There is no genetic component of epilepsy. True/false?

A

False - 30% of patients will have first degree relative with epilepsy

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13
Q

List 6 causes for epilepsy

A 
Trauma, 
Tumours, 
Infection, 
Vascular abnormalities e.g. stroke, 
Metabolic disturbance, 
Drugs
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14
Q

List 5 triggers that can push neuron excitation pas the seizure threshold in some patients with epilepsy

A 
Sleep deprivation, 
Alcohol (both intake and withdrawal),
Drug misuse, 
Flickering light, 
Infection/metabolic disturbance
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15
Q

Flickering lights are a trigger for only what type of epilepsy?

A

Primary generalised epilepsy only

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16
Q

Epilepsy is classified into partial and generalised epilepsy. What is the difference?

A

Partial epilepsy is focal seizures - confined to one area (hemisphere or lobe) of the brian,
Generalised epilepsy originate in the midbrain or brainstem and spread to whole brain

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17
Q

Partial seizures can be classified into simple partial & complex partial seizures. What is the main difference?

A

In simple partial seizures the patient remains conscious,

In complex partial seizures the patient has impaired consciousness

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18
Q

Simple partial seizure presentation?

A

Conscious!
Small area of brain affected so can be:
Sensory: strange sensations e.g. smell, auditory, taste
Motor: jerking movements of one limb,
Autonomic: sweating, pupil dilation, incontinence
Often aware & remembers

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19
Q

What is Jacksonian march?

A

When simple partial seizure causes jerking of one limb/muscle group which then spreads to another limb/groups

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20
Q

Complex partial seizure presentation?

A

Lose consciousness!
Often partial seizure symptoms precede as aura:
Sensory: Vertigo, auditory, visual,
Psychological: deja vu, emotional disturbance
Automatisms: lip smacking, chewing, swallowing, walking away
Impaired awareness & may not remember

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21
Q

What is Todd’s paralysis?

A

Weakness or paralysis of limbs may follow a seizure and lasts about 15hours, usually only one side

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22
Q

What are secondary generalised seizures and what type is it usually?

A

Partial seizures that spread to lower brain areas which then cause a generalised seizure, usually tonic-clonic

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23
Q

Generalised seizure types? (6)

A 
Tonic, 
Atonic, 
Clonic, 
Tonic-clonic, 
Myoclonic, 
Absence seizures
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24
Q

Petit mal AKA

A

Absence seizures

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25
Q

Grand mal AKA

A

Tonic-clonic seizure

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26
Q

Most common type of generalised seizure?

A

Tonic-clonic

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27
Q

Tonic seizure presentation

A

All muscles contract and flex so patient usually falls backwards

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28
Q

Atonic seizure presentation

A

All muscles relax and go floppy so patient usually falls forward

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29
Q

Clonic seizure presentation

A

Convulsions: Muscles contract and relax

30
Q

Tonic-clonic seizure presentation

A

Tonic phase for 10-60s - rigidity, epileptic cry, tongue biting, incontinence, hypoxia/cyanosis so no breathing
Then clonic phase for seconds-mins - convulsions, eye rolling, tachycardia, no/random breathing

31
Q

Myoclonic seizure presentation

A

Short muscle twitches so different to clonic in that it is short jerking whereas clonic is periods of jerking

32
Q

Absence seizure presentation

A

Unresponsive to stimuli but conscious, stares but only lasts around 15 seconds

33
Q

Temporal lobe seizures AKA

A

Complex partial seizure

34
Q

Absence seizures generally present at what age?

A

Childhood

35
Q

What is status epilepticus?

A

Seizure that lasts >30mins or multiple seizures in which consciousness not recovered lasting >30mins

36
Q

Why is status epilepticus a medical emergency?

A

Brain cells swell due to electrolyte imbalance and brain can herniate

37
Q

Status epilepticus treatment? Initial, 1st, 2nd and other

A

Initial: ABC, emergency bloods (BG!!) +/- CT
After 10mins of seizures:
1st: benzodiazepines, if no response to 20mg then next
2nd: phenytoin
3rd: sodium valproate, phenobarbital.
Other: glucose if any suggestion hypoglycaemia, thiamine if any suggestion alcoholism or low nutritional status

38
Q

Phenobarbital risk?

A

Can cause circulatory depression

39
Q

Phenytoin risk?

A

Can cause severe cardiac arrhythmia

40
Q

Epilepsy diagnosis need minimum of _ seizures

A

2

41
Q

List 6 systemic disorders that can cause seizures

A 
Uraemic encephalopathy, 
Hepatic encephalopathy, 
Electrolyte imbalances, 
Hypoglycaemia, 
Thiamine deficiency, 
Vitamin B12 deficiency
42
Q

Investigations for seizure

A 
ECG!!!
Bloods: electrolytes, BG, FBC, LFTs, U&Es, serum calcium, CK (will be raised in true epileptics after tonic & clonic),
MRI/CT for abnormalities,
Urinalysis, 
EEG, 
Neuro exam,
43
Q

Phenobarbital mechanism of action

A

Inhibits sodium channels so reduces action potential propagation

44
Q

Phenytoin mechanism of action

A

Inhibits sodium channels so reduces action potential propagation

45
Q

List 4 drugs that can cause epilepsy

A

Phenothiazines,
Isoniazid,
Tricyclic antidepressants,
Benzodiazepine withdrawal

46
Q

List 6 types of metabolic disorders that can cause epilepsy

A 
Uraemia, 
Hypoglycaemia, 
Hyponatraemia, 
Hypernatraemia, 
Hypocalcaemia, 
Hypercalcaemia
47
Q

Primary generalised epilepsy first line treatment and alternative

A

First line: sodium valproate

Alternative as first line teratogenic: lamtrigine

48
Q

Focal onset epilepsy treatment

A

Carbamazepine or lamotrigine

49
Q

Postictal confusion in what type of seizures

A

May happen after partial complex seizures or generalised tonic-clonic

50
Q

Why ALWAYS do ECG when seeming like seizure symptoms?

A

Could be long QT syndrome which can present like fit due to hypotension

51
Q

When is EEG helpful? (4)

A

Whether someone is non-convulsive status or septic encephalopathy (old person confused),
Determine if someone having non-epileptic attack,
Epileptic surgical evaluation,
Epilepsy classification

52
Q

Driving seizure and epilepsy rules

A

1st seizure: 6 months off road and 5 years for heavy duty vehicles
Epilepsy: can’t drive if seizure in last 1 year or changed meds in last 6 months, can drive when 1 year seizure free or 3 years during sleep only and 10 years seizure free & off medication for heavy duty vehicles

53
Q

Which epilepsy types predominantly affect young people and which type predominantly older?

A

Young: generalised, usually spike-wave abnormalities on EEG
Old: partial/focal, because due to structural brain abnormality so more likely when older

54
Q

When can focal epilepsy present in childhood?

A

Due to structural damage e.g. problem during birth or lots of febrile seizures

55
Q

Common example of focal onset epilepsy

A

Complex partial seizures with hippocampal sclerosis

56
Q

List 4 side effects of sodium valproate

A

Weight gain,
Teratogenic,
Hair loss,
Fatigue

57
Q

Carbamazepine can make ________ epilepsies worse

A

Primary generalised epilepsies

58
Q

Which 2 drugs useful for absence seizures?

A

Sodium valproate and Ethosuximide

59
Q

What are functional attacks?

A

Psychogenic non-epileptic attack - like a seizure but not actually a seizure, not consciously mediated and often related to trauma etc.

60
Q

Auras often precede seizures. True/false?

A

False - aura symptoms e.g. numbness, auditory are seizures in that area

61
Q

3 common presentations of functional attacks and usual duration

A
  1. Attack with lots of motor activity
  2. Episodes of collapse with no movement
  3. Abreactive attacks e.g. fear, gasping & hyperventilation
    Duration prolonged e.g. 10-20mins
62
Q

List 4 anti-convulsant drugs that induce hepatic enzymes

A

Carbamazepine, phenytoin, phenobarbitol, topiramate

63
Q

Women and anti-convulsants that induce hepatic enzymes considerations?

A

Can alter efficacy of combined oral pill so need dose adjustment,
Shouldn’t use progesterone only pill, depot or implants due to not being effective,
Morning after pill not adequate so need higher dose,

64
Q

Older adults and anti-convulsants that induce hepatic enzymes considerations?

A

Can affect antihypertensive, cholesterol lowering, warfarin and chemotherapy efficacy

65
Q

3 types of status epilepticus?

A

Generalised convulsive status epilepticus,
Non convulsive status, (conscious but confused and altered state)
Epilepsia partialis continua (continual focal seizures)

66
Q

List 6 precipitants of status epilepticus

A 
Severe metabolic disorders, 
Infection,
Head trauma, 
Sub-arachnoid haemorrhage, 
Abrupt withdrawal of anti-convulsants, 
Treating absence seizures with carbamazepine
67
Q

List 4 methods of death due to convulsive status that happen even before brain neuronal death.

A

Respiratory insufficiency and hypoxia, (due to choking)
Hypotension,
Hyperthermia,
Rhabdomyloysis
(Last 3 due to constant squeezing muscle complications)

68
Q

When ICU for status?

A

If no response to drugs or if GCS really low (think benzo resp depression)

69
Q

Partial status epilepticcus AKA non convulsive status diagnosis and treatment?

A

EEG to confirm diagnosis and then status treatment

70
Q

Mechanism of action of benzodiazepines

A

Enhance GABA receptor

71
Q

Child patient having fall to floor seizure indicates _____ whereas adult having fall to floor seizure indicates ____

A

Child indicates generalised atonic seizure whereas adult indicates non-epileptic attack

Neurology (34 decks)

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