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xB12W7 > EPILEPSY > Flashcards

EPILEPSY Flashcards

1
Q

what is a seizure

A

A sudeen surge of electrical activity in the brain sufficient to cause clinically detectable intermittent disturbance of conciousness, behaviour, emotion, motor and sensory function

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2
Q

what is epilepsy?

A

condition that affects the brain and causes frequent seizures.

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3
Q

when does epilepsy usually start?

A

in childhood or over 60

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4
Q

when taking a history about epilepsy, what should you ask?

A 
circumstances surrounding the attack
symptoms prior to the atack
sequence of events
duration
recovry time
signs during the recovery period
whether there was cyanosis, tongue biting, incontinence or injury
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5
Q

outline the pathology of epilepsy?

A

either too much excitation or too little inhibition

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6
Q

whats the main excitatory neurotransmitter?

A

glutamate

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7
Q

whats the main inhibitory neurotransmitter?

A

GABA

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8
Q

what does glutamate bind to?

A

NMDA receptors to let Ca2+ in

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9
Q

what does GABA bind to?

A

GABA receptors to let Cl- in`

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10
Q

what is a partial seizure?

A

when one hemisphere or lobe is affected

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11
Q

what is a simple partial seizure?

A

when one lobe/hemisphere is affected and the person remains conciouss
the patient usually reembers what happened

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12
Q

what is the jacksonian march?

A

a type of simple, partial seizure
it only occurs on one side of the body. It starts as tingling or twitching in a small area e.g. finger, toe, corner of mouth and then the semsation spreads to a larger area of the body

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13
Q

what is a complex partial seizure?

A

a partial seizure when the patient loses conciousness and may not remebered what happened

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14
Q

what are the symptoms of a simple partial seizure?

A 
a general strange feeling
a rising feeling in your tummy
deja vu
unusual smells or tastes
tingling in arms and legs
intense feeling of fear or joy
stiffness or twitch in parts of your body
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15
Q

what are the symptoms and signs of complex partial seizures?

A

you lose your sense of awareness and make random body movements such as smacking lips, rubbing hands, making random noises, moving arms around, fiddling, chewing or swallowing

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16
Q

what is a tonic clonic seizure?

A

aka grand mal
tonic stage - lose conciousness, body goes stiff and you may fall to the floor
clonic stage - limbs may jerk about, may lose control of bladder or bowel, may bite your tongue or inside of cheek, you may have difficulty breathing

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17
Q

what is status epilepticus?

A

if seizure lasts >5 minutes or it is ongoing without returning to normal - this is a medical emergency

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18
Q

how do you treat status epilepticus?

A

benzodiazepines

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19
Q

what is an absence seizure?

A

when you lose awareness of your surroundings for a short time, a person may stare blankly into space, look like theyre daydreaming, flutter their eyes and make slight jerking movements of their body or limbs
it mainly affects children
wh

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20
Q

what is an absence seizure?

A

when you lose awareness of your surroundings for a short time, a person may stare blankly into space, look like theyre daydreaming, flutter their eyes and make slight jerking movements of their body or limbs
it mainly affects children

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21
Q

what is a myoclonic seizure?

A

where some or all of your body suddenly twitches or jerks, like you have had an electric shock
they often happen soon after waking up
they usually last a fraction of a second but severeal can occur in a short space of time
you normally remain awake during them

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22
Q

what is a clonic seizure?

A

the body shakes and jerks for a few minutes and you might lose conciousness

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23
Q

what are tonic seizures?

A

when the muscles suddenly beome stiff and you may lsoe balance and fall backwards, often seen in children

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24
Q

what are atonic seizures?

A

when all your muscle suddenly relax so you may fall forwards. They tend to be very brief and you can usually get up again straight away

25
Q

what are some seizure triggers?

A 
stress
lack of sleep
waking up
drinking alcohol
illegal drugs
some medicines such as antidepressions, bupropion, tramadol, volatile anaesthetics, some antibiotics 
monthly periods
flashing lights
big sounds/noises
caffeiene
dehydration
26
Q

what are some common symptoms after seizures?

A

feeling tired, weak, confused, headaches, muscle pains

27
Q

what is Todd’s paralysis?

A

a neurological condition experienced by individuals with epilepsy in which a seizure is followed by a brief period of temporary paralysis on one side of the body

28
Q

what are the 3 ways in which antiepileptics work?

A

inhibiting Na+ and Ca2+ channels
enhancing synaptic inhibiting by increasing GABA activity
inhibiting synaptic excitement through decreasing glutamate activity

29
Q

what non pharmacological options are there for treating epilepsy?

A

surgery to remove the cause i.e. when the affected area of the brain is small and has no vital function
nerve stimulation of the vagys nerve to influence neurotransmitter release and reduce seizures
ketogenic diet so the body produces ketone bodies for the brain to use

30
Q

what are some side efefcts of AEDs?

A 
drowsiness
fatigue
agitation
headaches
tremors
hair loss or unwanted hair growth
swollen gums 
rashes
risk of suicidal thoughts and behaviour
31
Q

how shoudl you wean off AEDs?

A

avoid abrupt withdrawal, particularly of barbiturates and benzodiazepines as it can cause severe rebound seizures, the reduction may take several months

32
Q

whats the first line drug for tonic clonic seizures?

A

sodium valproate

33
Q

who cant take sodium valproate?

A

female patients who are pregnant or premenopausal - highly teratogenic

34
Q

whats the first line drug for absence seizures?

A

ethosuximide or sodium valproate

35
Q

whats the first line drug for myoclonic seizures?

A

sodium valproate

36
Q

whats the first line drug for tonic and atonic seizures?

A

sodium valproate - lamotrigine can be asses as adjunctive treatment

37
Q

how does sodium valproate work?

A

increases GABA concentrations in the brain

38
Q

how does carbamazepine work?

A

it enhances Na_ channel inactivation by reducing high frequency repitive firing of action potentials

39
Q

what type of seizures should carbamazepine not be used for?

A

tonic
atonic
myoclonic
absence

40
Q

how does diazepam work?

A

It increases the affinity of GABA binding to its receptor which allows Cl- in which causes hyperpolarisation

41
Q

how does lamotrigine work?`

A

selectively binds sodium channels, stabilizing presynaptic neuronal membranes and inhibiting glutamate release

42
Q

how does phenytoin work?

A

non-specific sodium channel blocker and targets almost all voltage-gated sodium channel subtypes. More specifically, phenytoin prevents seizures by inhibiting the positive feedback loop that results in neuronal propagation of high frequency action potentials

43
Q

how does gabapentin work?

A

Inhibits voltage gated Ca2+ channels

44
Q

how do we diagnose epilepsy?

A

brain imaging MRI and CT

EEG to detect brain electrical signals

45
Q

what do you give in the community for someone having a prolonged seizure?

A

buccal midazolam or rectal diazepam

46
Q

what are the 4 stages of seizures?

A

prodome stage
aura
ictal phase
post-ictal phase

47
Q

what is the prodome stage of seizures?

A

some people can tell when a seizure is on its way - they may notice mood changes, anxiety, light headidness, difficulty sleeping, diffculty focussing, behaviour changes

48
Q

what is aura stage of a seizure?

A

the early part of a seizure
symptoms may be deja vu, jamais vu, odd smells sounds and tastes, dizziness, vision difficulties, numbness, nausea, headache, panic, feeling of intense fear

49
Q

what is the ictal phase of a seizure

A

time from the first seizure to end of seizure activity
signs include loss of awareness, memory lapse, feeling confused, difficulty hearing, odd smells/sounds/tastes, difficulty speaking, saying strange words, twitching, loss of muscle control, body convulsions, trouble breathing

50
Q

what is the post ictal phase of a seizure?

A

confusion, lack of conciousness, fatigue, exhaustion, headache, loss of bladder and bowel control, fear anxiety, frustration, thirst, nausea, sore muscles

51
Q

what can cause a seizure?

A

anything that interrupts normal connections between nerve cells in the brain e.g. high fever, high or low blood sugar, acohol or drugs, brain concussion, lack of sleep, flashing lights, hyponatremia, meds such as antidepressants and halogenic anaesthetic agents, autoimmune disorders, smoking sessation, egnetic conditions etc

52
Q

if you have multiple unprovoked seizures or epilepsy, how long can you not drive for?

A

12 months if you own a car or motorcycle

10 years if you drive a bus or lorry

53
Q

if you have a singular unprovoked epielptic seizure how long can you not drive for?

A

6 months if you drive a car or motorcycle (12 if theres an underlying causative factor)
5 years if you drve a bus or lorry

54
Q

what is a non-epileptic attack disorder?

A

it looks like an epileptic seizure but is not caused by electrical activity in the brain (if its caused by a psychiatric disrder its called psychogenic non epileptic disorder)

55
Q

what would you see in frontal lobe epilepsy?

A

head and eye movement to one side, complete or partial unresponsiveness, difficulty speaking, explosive screams, swearing or laughter, abnormal body posturing

56
Q

what would you see in a parietal lobe epilepsy?

A

sensory disturbances, weakness, dizziness, hallucinations, distortions of space etc (very rare)

57
Q

what would you see in temporal lobe epilepsy

A

deja vu, jamais vu, sudden sense of fear/panic/anciety/anger/sadness/joy, rising sick feeling in the stomach, strange smells and tastes, auditory or visual hallucinations, speech arrest, motionaless stare, automatism (lip smacing, fidgeting) followed by a seizure.

58
Q

what would you see in occipital lobe epilepsy?

A

patterns, flashing lights, colours, images that appear to repeat before the eyes. This is often confused with occipital migraine. (extremely rare)

59
Q

What drug should be given to pregnant woman with epilepsy?

A

Lamotrigine and levetiracetam

xB12W7 (6 decks)

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