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Z Year3 Neuro Conditions > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is epilepsy?

A

recurrent tendency to have unprovoked seizures

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2
Q

What are seizures?

A

an abnormal paroxysmal discharge of cerebral neurons

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3
Q

What are convulsions?

A

the motor signs of electrical discharges

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4
Q

What is the main cause of epilepsy?

A

2/3 idiopathic

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5
Q

What is an acronym to remember causes of seizures?

A

VITAMINS

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6
Q

What does vitamins stand for?

A
  1. Vascular e.g. stroke
  2. Infection: brain abscess, meningitis, encephalitis
  3. Trauma + toxins
  4. Autoimmune e.g. lupus
  5. Metabolic: hyponaetraemia, hypocalcaemia
  6. Idiopathic: epilepsy
  7. Neoplasms
  8. Syncope or psychogenic siezures or eclampsia
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7
Q

What are structural causes of epilepsy?

A
  1. Cortical scarring (head injury years before)
  2. Development
  3. SOL
  4. Stroke
  5. Hippocampal sclerosis
  6. Vascular malformations
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8
Q

What are the other possible causes of epilepsy?

A
  1. Tuberous sclerosis
  2. Sarcoidosis
  3. SLE
  4. Tumours, infection, inflammation, trauma
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9
Q

What are two different types of seziures?

A
  1. Focal seizures

2. Generalised seizures

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9
Q

What are two different types of seziures?

A
  1. Focal seizures

2. Generalised seizures

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10
Q

What are different types of focal seizures?

A
  1. Without impairment of consciousness
  2. With impairment of consciousness
  3. Evolving to a bilateral, convulsive seizure
    - Can have aura in focal seizures
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11
Q

Which focal seizures have a post-ictal phase?

A

With impairment of consciousness do and without don’t

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12
Q

What are different types of generalised seizures?

A
  1. Absence seizures
  2. Tonic-clonic seizures
  3. Myoclonic seizures
  4. Atonic seizures
  5. Infantile spasms
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13
Q

What are the characteristics of absence seizures?

A
  1. <10s
  2. In childhood
  3. Loss of consciousness but maintain posture
  4. No change in muscle tone
  5. Can happen hundreds of times a day
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14
Q

What does tonic limb mean?

A

stiff

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15
Q

What does clonic limb mean?

A

jerking

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16
Q

What are the characteristrics of tonic-clonic seizures?

A
  1. loss of consciousness
  2. Limb stiffens (tonic) then jerks (clonic) may have one without other
  3. Post-ictal drowsiness and confusion
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17
Q

What are the characteristics of myoclonic seizures?

A
  1. Repetitive sudden jerk of limb, face or trunk very fast
  2. Common in puberty
  3. Usually in morning and can be triggered by lack of sleep and stress
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18
Q

What are atonic seizures?

A
  1. Sudden loss of muscle tone causing a fall
  2. No loss of consciousness
  3. Common in children
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19
Q

What are infantile seizures?

A

associated with tuberous sclerosis

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20
Q

What are different area of focal seizure?

A
  1. Temporal lobe
  2. Frontal lobe
  3. Parietal lobe
  4. Occipital lobbe
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21
Q

What are the characteristics of a temporal lobe focal seizure?

A
  1. Aura (epigastric discomfort,)
  2. Automatism: playing with fingers, lip smacking
  3. Hallucinations
  4. Emotional disturbances
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22
Q

What are characteristics of a frontal lobe focal seizure?

A
  1. Motor arrest
  2. Subtle behavioural disturbances
  3. Motor symptoms: Jacksonian march
  4. Post ictal flaccid weakness
  5. Todd’s palsy
  6. Involuntary actions (disinhibition)
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23
Q

What are characteristics of parietal lobe focal seizures?

A
  1. Sensory disturbances, tingling, numbeness, pain

2. Motor symptoms

24
Q

What are the characteristic occipital lobe focal features?

A

Visual phenomenon such as spots, lines, flashes

25
Q

What may suggest it is a focal seizure that is a secondary generalised over a generalised tonic-clonic seizure?

A
  1. history of aura
  2. turning head to one side
  3. Todd’s paralysis
26
Q

What is status epilepticus?

A

seizure lasting >5mins or repeated seizures without recovery or regain of consciousness in between

27
Q

What are some triggers for status epilepticus?

A
  1. Non-adherence to medication
  2. Alcohol abuse
  3. OD and toxicity
28
Q

What is the management of status epilepticus?

A
  1. Secure airway: 100% O2
  2. IV access and continuous monitoring: sats, BP, ECG, glucose
  3. IV lorazepam (repeat after 10 mins if seizure does not terminate or PR diazepam
  4. IV phenytoin
  5. ICU
29
Q

What are symptoms and signs of epilepsy?

A
  1. Some experience prodrome (can last hours or days)
  2. Some have aura
  3. Post-ictally may be headache, confusion or myalgia
  4. During can have tongue biting, limb jerking
30
Q

What are possible DDx for epilepsy?

A
  1. Non-epileptic attack disorder

2. Syncope

31
Q

What may suggest it is non-epileptic attack disorder: psychogenic?

A
  1. if prolonged duration
  2. abrupt termination
  3. are accompanied by closed eyes, rapid breathing – can coexist with actual epilepsy
32
Q

Why do you need to rule out provoking cause?

A

As could be seizure but not actually epilepsy

33
Q

What are some provoking causes that could cause seizure?

A

trauma, stroke, haemorrhage, metabolic disturbances

34
Q

How do you determine epilepsy and syncope?

A

syncope won’t have post-ictal phase and regain consciousness quickly

35
Q

What is needed for the clinical diagnosis of epilepsy?

A

need 2 or more UNPROVOKED seizures occurring > 24 hr apart

36
Q

How do you refer for epilepsy?

A
  • Difficult as >40 types of epilepsy

- All patients with seizure must be referred for specialist assessment and investigation in less than 2 weeks

37
Q

What is important to ask in history of epilepsy?

A
  1. Ask about witnesses
  2. Tongue biting
  3. Slow recovery
  4. Any triggers?
  5. Déjà vu feeling
    - Look for provoking cause
38
Q

What investigations do you do for epilepsy?

A
  1. EEG
  2. MRI
  3. Drug levels
  4. Drug screen
  5. Bloods
  6. Brain imaging
39
Q

Why do you do an EEG

A
  1. cannot exclude epilepsy and can give false positive

2. can show if generalised or focal

40
Q

Why may you do a brain MRI?

A

suspect structural lesion

41
Q

Why do you need to counsel a patient with epilepsy?

A

Counselling: after fit, no swimming, driving, heights until diagnosis known and then give individualised

42
Q

What is treatment for focal seizures?

A
  1. Carbamazepine

2. Lamotrigine

43
Q

What is treatment (1st and 2nd line) for generalised seizures?

A

1st line: sodium valproate

2nd line: carbamazepine

44
Q

What treatment do you use for epilepsy if pregnant?

A

AVOID SODIUM VALOPRATE as teratogenic (use lamotrigine instead)

45
Q

What are some SE of carbamazepine?

A

neutropenia and osteoporosis

46
Q

What can be a SE of lamotrigine?

A

Skin reaction (Steve Johns)

47
Q

What are other SE for AEDs?

A
  1. psychiatric (depression)

2. Weight gain

48
Q

What are the different type of mechanisms for drugs for epilepsy?

A
  1. Enhance GABA inhibition
  2. Reduce glutamate-mediated excitation (pre-synaptic)
  3. Reduce glutamate-medicated excitation (post-synaptic)
  4. Block action potential Na+ channel depolarisation
49
Q

How do you stop epileptic drugs?

A

can stop under specialised supervision if seizure free for >2 years and assessing risk and benefits

50
Q

What are possible complications of epilepsy?

A
  1. SUDEP: sudden death in epilepsy
  2. Behavioural problems
  3. Fractures (from seizure)
  4. Complications from drugs
51
Q

Where do generalised seizures arise from?

A

both cerebral hemispheres at the same time

52
Q

Where do focal seizures arise from?

A

specific areas in one cerebral hemisphere

53
Q

Can focal and generalised seizures overlap?

A

focal seizures can spread to both cerebral hemispheres, causing a generalized seizure

54
Q

How to benziodiazapines work?

A
  1. bind to the GABA-A receptors and increase channel opening frequency
  2. increased chloride conductance and neuronal hyperpolarization, leading to enhanced inhibitory neurotransmission
55
Q

What are dissociativce seizures?

A

can resemble epileptic seizures but have NO biological correlate

56
Q

When should you suspect dissociative seizures?

A
  1. Prolonged duration

2. History of abuse, psychological or emotional precipitants

57
Q

What is the management for dissociative seizures?

A

psychotherapy

Z Year3 Neuro Conditions (34 decks)

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