Epilepsy Flashcards
Epilepsy?
Recurring unprovoked seizures , 1 in 100-200
Acute symptomatic seizures are provoked by?
Acute insults such as infection, stroke, metabolic disturbance, alcohol withdrawal
1 in 20
Idiopathic generalised seizures are provoked by?
Sleep deprivation
Induced by hyperventilation and o photosensitivity testing
Juvenile myoclonus epilepsy accounts for how much of all epilepsy?
3-12%
Clinic phase normally lasts?
1-3 minutes
Tonic phase contains?
Continuous muscle spasm, fall, cyanosis, incontinence, tongue biting
Absences last?
5-20 seconds
Absences are characterised by?
3hz spike and a wave
Difference between simple and complex partial seizure?
Simple- focal seizure with awareness
Complex- focal seizure with reduced awareness
Which lobe experiences partial seizures the most?
Temporal
What is common cause for temporal lobe seizures?
Hippocampal sclerosis
Risk factor for later epilepsy?
7% have febrile convulsions
Hippocampal sclerosis?
Severe neuronal cell loss and gliosis in hippocampus
Todds paresis?
Weakness or paralysis in part or all of the body after a seizure
Temporal lobe epilepsy signs and symptoms?
Hallucinations of taste, speech, smell visual distortion
Heart rate changes
Fear elation
Automatism- semi purposeful limb movements
Oral automatism- lip smacking
Frontal lobe seizure?
10-30 seconds Rapid recovery, Predominantly nocturnal Forced head Eye deviation to contra lateral side Thrashing Jacksonian spread Fencing posture
Parietal lobe epilepsy?
Positive sensory symptoms
Tingling pain
Distortion of body shape and image
Jacksonian march
Occipital epilepsy?
Visual hallucinations
Amaourosis- blackout or whiteout- 25%
Which antiepileptic drugs make myoclonus jerks and absences worse?
Phenytoin
Pregabalin
Gaba pectin
Carbamazepine
Who are you going to recommend a brain scan?
Jacksonian motor or sensory seizures
Patients with a focal neurological deficit
Alcohol withdrawal- only if subdural haemotoma suspected
Which drug enhances slow inactivation of sodium channels?
Lacosamide
AMPA receptor antagonist?
Perampanel, non competitive
Which anticonvulsants work on the presynaptic voltage gated calcium channels?
Topiramate, gabapentin, pregabalin, iamotrigine and zonisamide
Enhancers of GABA Eric synaptic transmissions?
Sodium valproate Benzo Barbiturates Tiagabine (inhibits GABA reuptake) Vigabatrin (inhibits gaba T breakdown)
How does levetiracetam work?
High affinity synaptic vesicles protein 2a ligand
Modulates glutamate release
If its a primary generalised seizure?
Sodium valproate and iamotrigine
If its a partial focal onset seizure then it is?
Carbamazepine, iamotrigine
Sodium valproate side effects?
Sedation Tremor Hair thinning Weight gain Menstrual irregularities Parkinsonism
Sodium valproate can cause what?
Impaired cognitive development 30%
Sodium valproate is an?
Enzyme inhibitor
Which enzyme induction happens due to antiepileptic drugs?
CYP3A4
Na channelopathies?
Point mutation Na channel inactivation is too slow
Reduced number of function Na in inhibitory neurons- missense mutation
GEFS plus
K channelopathies?
Benign familial neonatal convulsions
Defect in KCNQ2/3 subunit impaired activation
Action potential repolarisation impaired
When aroused neuronal activity becomes?
Desynchronised
What is the difference between spasticity and rigidity?
Spasticity- only agonist or antagonist
Characteristic posture changes
Sensitive to sensory input
Clasp knife
Rigidity Both agonist and antagonist No static postural changes Not sensitive to sensory input Cogwheel lead pipe
