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Charis & Ellie VS Neuro > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is epilepsy?

A

Epileptic seizure can be defined as a sudden synchronous discharge of cerebral neurons causing symptoms or signs that are apparent either to the patient or to an observer

-Epilepsy is a tendency to recurrent, usually spontaneous epileptic seizures

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2
Q

Types of seizures?

A

-Can be classified as focal or general

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3
Q

Focal seizures?

A

-Occur in a focal region of the brain

Can be focal sensory or focal motor

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4
Q

General seizures?

A

Affect the whole brain

-Simultaneous involvement of both hemispheres, always associated with loss of consciousness or awareness

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5
Q

Types of epilepsy?

A
  • Focal epilepsy

- Generalized epilepsy

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6
Q

What is focal epilepsy?

A

Type of epilepsy where there is a seizure focus (part of brain that doesn’t work properly) that can irritate the surrounding brain
-This focus can cause a focal seizure if the irritation stays in that are or it can cause a general seizure if the abnormal electrical activity hits a cortical network allowing it to spread throughout the brain

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7
Q

What networks do generalized epilepsy work on?

A

Cortical networks

- As soon as they occur they immediately propagate around the brain and generalized seizures occur

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8
Q

Focal epilepsy can cause?

A

Focal or generalized seizures

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9
Q

Generalized epilepsy can cause?

A

Only causes generalized seizures

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10
Q

Types of general seizure?

A 
Absence
Myoclonic 
Tonic 
Atonic 
Tonic clonic
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11
Q

Absence seizures?

A
  • Loss of awareness and vacant expression <10 secs before returning abruptly to normal and continuing as though nothing happened
  • Appears like they are day dreaming
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12
Q

Myoclonic seizures?

A

Jerk movements
Momentary brief contractions of muscles or muscle groups
Eg involuntary twitch of a finger or hand

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13
Q

Tonic seizures?

A

Consists of stiffening of the body not followed by jerking

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14
Q

Atonic seizures?

A

Sudden collapse with loss of muscle tone and conciousness

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15
Q

Tonic clonic seizures?

A
  • Often no warning before these occur
  • Initial tonic stiffening is followed by the clonic phase with synchronous jerking of the limbs reducing in frequently over about 2 minutes until convulsion stops
  • May be incontinence when convulsions stop
  • Period of flaccid unresponsiveness is followed by gradual return of awareness with confusion and drowsiness lasting 15 minutes to an hour or longer

Headache is common after

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16
Q

When do primary generalized epilepsy’s present?

A

As childhood and early adult life and account for up to 20% of all patients with epilepsy

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17
Q

Brain in primary generalised epilepsy?

A

Structurally brain is normal, ion channel and NT release abnormalities are hypothesised as causes

18
Q

Primary generalized epilepsies include how many main syndromes?

A

3 main syndromes

  • Childhood absence seizures
  • Juvenile myoclonic epilepsy
  • Monogenic epilepsy
19
Q

Childhood absence epilepsy?

A

Absence seizures

Spontaneous remission by age 18 is usual

20
Q

Juvenile myoclonic epilepsy?

A
  • 10% of all epilepsies
  • Typically myoclonic jerks start in teenage years
  • Followed by generalized tonic clonic seizures
  • Can occur with lack of sleep. alcohol or strobe light or flickering lights
21
Q

Causes of monogenic epilepsies?

A

Single gene mutation in voltage gated channels

22
Q

Focal seizures often indicate what?

A

Structural cause and detailed imaging is required to identify this

23
Q

What do auras suggest?

A

Temporal lobe seizures

24
Q

Causes include for epilepsy?

A
  • Hippocampal sclerosis
  • Genetic developmental disorders
  • Trauma, hypoxia ad surgery
  • Vascular disorders
  • Infections
  • Alcohol and drugs
  • Immunological disorders
25
Q

Main risk factor for hippocampal sclerosis?

A

Childhood febrile convulsions

26
Q

Hippocampal sclerosis is usually visible on?

A

MRI

27
Q

Challenge in diagnosing epilepsy?

A

Differentiating between epilepsy and syncope?

28
Q

Epileptic seizures diagnosing factor?

A
  • May have an aura or strange feeling
  • During the seizure they have may have convulsions
  • After seizure they may have headache and confusion
29
Q

Syncope diagnosis?

A

-Lightheaded before episode

Triggered by pain, heat, prolonged unrecognized seizures

30
Q

What is it important to do after a blackout?

A
  • Blood tests
  • Check glucose
  • Serum calcium
  • Must do ECG (Rule out long QT)
  • May do brain and EEG
31
Q

What are you ruling out with an ECG after a blackout?

A

Long QT syndrome

32
Q

Driving and epilepsy?

A
  • After single seizure ptnt must be told to stop driving

- If they continue to drive the DVLA must be informed

33
Q

After a single seizure you are not allowed to?

A

Drive a motor car for 6 months or HGV for 5 years

34
Q

Diagnosis of epilepsy you are not allowed to?

A

Drive a car until you have been a year seizure free and not allowed to drive HGV until 10 years off all medication and seizure free

35
Q

If the person only ever has seizures at night and 1st seizure was 12 months ago?

A

The person can still drive OR if the person has only had night seizures for the past 3 years

36
Q

First line pharmacological treatment for tonic clonic/tonic or atonic epilepsy?

A

Sodium valproate

If that is not suitable cab give Lamotrigine
Or
Carbamazepine

37
Q

First line pharmacological management for focal epilepsies?

A

Carbamazepine if tolerated

Lamotrigine if can’t tolerate

38
Q

First line management of myoclonic seizures?

A

Sodium valproate

39
Q

Sodium valproate contrandications?

A

Highly teratogenic
Generally not offered to woman of child bearing age
unless there is no alternative

40
Q

What should be noted about AEDs?

A

Enzyme inducing and can make many forms of COCP and contraception pills ineffective

Charis & Ellie VS Neuro (49 decks)

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