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Year Two - Neurology System > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is epilepsy?

A

It is defined as a condition in which individuals have a tendency to experience recurrent seizures

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2
Q

What are seizures?

A

They are transient episodes of abnormal electrical discharges

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3
Q

What are the three pathophysiological causes of seizures?

A

Neuronal Overexcitation

Neuronal Damage

Neuronal Under Inhibition

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4
Q

What are the four abnormalities that can cause neuronal overexcitation?

A

Glutamate receptor pathologies

Sodium ion channel pathologies

Calcium ion channel pathologies

Excitatory amino acid pathologies

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5
Q

What abnormality can cause neuronal under inhibition?

A

GABA receptor pathologies

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6
Q

What are the nine causes of epilepsy?

A

VINDICATE

Vascular

Infection

Neoplasms

Drugs

Iatrogenic

Congenital

Autoimmune

Trauma

Electrolyte Imbalances

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7
Q

What is the vascular condition associated with epilepsy?

A

Stroke

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8
Q

What three infections are associated with epilepsy?

A

Meningitis

Encephalitis

HIV

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9
Q

Which neoplasms are associated with epilepsy?

A

Brain

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10
Q

Which two drugs are associated with epilepsy?

A

Alcohol

Illicit Drugs

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11
Q

Which antibiotic is known to lower the seizure threshold?

A

Ciprofloxacin

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12
Q

What is an iatrogenic cause of epilepsy?

A

Drug withdrawal

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13
Q

What three congenital conditions are associated with epilepsy?

A

Tuberous Sclerosis

Cerebral Palsy

Mitochondrial Disease

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14
Q

What are the three clinical features of tuberous sclerosis?

A

Epilepsy

Depigmented skin

Roughened patches of skin over the lumbar spine

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15
Q

What autoimmune condition is associated with epilepsy?

A

Vasculitis

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16
Q

What three electrolyte imbalances are associated with epilepsy?

A

↓Na+

↓Ca2+

↑Glucose

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17
Q

What are the two general classifications of seizures?

A

Focal

Generalised

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18
Q

What is another term for focal seizures?

A

Partial seizures

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19
Q

What are focal seizures?

A

They are defined as seizures that involve networks within a specific region of the brain, in one cerebral hemisphere

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20
Q

Which cerebral lobe is most commonly affected by focal seizures?

A

Temporal

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21
Q

What are the two subclassifications of focal seizures?

A

Simple focal seizures

Complex focal seizures

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22
Q

How do we sub classify focal seizures into simple and complex seizures?

A

It is based upon the level of awareness individuals experience during the seizure

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23
Q

What are simple focal seizures?

A

They are defined as focal seizures that don’t impair consciousness or cause postictal clinical features

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24
Q

What is the posticital phase?

A

It refers to the period of time immediately following a seizure

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25
Q

How long can the posticital phase last for?

A

It can last from seconds to days

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26
Q

What is a common posticital clinical feature?

A

Todd’s palsy

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27
Q

What is Todd’s palsy?

A

It is transient post-ictal paralysis

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28
Q

What clinical features do simple focal seizures result in - motor or non-motor?

A

Motor

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29
Q

What are the four clinical features associated with simple focal seizures?

A

Uncontrollable Fit

Jacksonian March

Hallucinations

Paraesthesia

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30
Q

What is Jacksonian March?

A

It is is defined as a phenomenon in which a seizure spreads from the distal part of the limb toward the ipsilateral face

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31
Q

What are complex focal seizures?

A

They are defined as focal seizures that impair consciousness or cause postictal clinical features

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32
Q

Describe the timeline of complex focal seizures

A

Individuals tend to experience aura features prior to the seizure onset, have no memory of the seizure itself and then experience postictal confusion

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33
Q

What clinical features do complex focal seizures result in - motor or non-motor?

A

Non-motor

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34
Q

What are the four clinical features associated with complex focal seizures?

A

Automatism

Staring Into Space

Déjà Vu

Jamais Vu

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35
Q

What is automatism?

A

It is defined as the performance of non-purposeful repetitive movements without being aware of what is happening, such as lip smacking, blinking, grunting, etc

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36
Q

In what two ways do we localise focal seizures?

A

We can look at the patient’s clinical features

We can conduct an EEG scan

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37
Q

What are the four clinical features that indicate focal seizures are localised to the frontal lobe?

A

JPJP

Jerky movements

Posturing

Jacksonian march

Posticital weakness

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38
Q

What clinical feature indicates focal seizures are localised to the parietal lobe?

A

Paraesthesia

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39
Q

What four clinical features indicates focal seizures are localised to the temporal lobe?

A

HEAD

Hallucinations

Epigastric Rising Aura/Emotional

Automatisms

Deja Vu/Dysphasia

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40
Q

What two clinical features indicates focal seizures are localised to the occipital lobe?

A

Floaters

Flashing lights

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41
Q

What are the two first line management options for focal seizures?

A

Lamotrigine

Levetiracetam

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42
Q

What are the three second line management options for focal seizures?

A

Carbamazepine

Oxcarbazepine

Zonisamide

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43
Q

What is another term for generalised seizures?

A

Complete seizures

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44
Q

What are generalised seizures?

A

They are defined as seizures that involve networks within both cerebral hemispheres – with no localising features referable to a single hemisphere

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45
Q

What are the five subclassifications of generalised seizures?

A

Generalised Tonic Clonic Seizures

Absence Seizures

Atonic Seizures

Myoclonic Seizures

Infantile Seizures

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46
Q

How do we sub classify generalised seizures?

A

In all subclassifications, generalised seizures result in a loss of consciousness

They are instead classified based upon whether they result in motor or non-motor clinical features

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47
Q

What is another term for generalised tonic clonic seizures?

A

Grand mal seizures

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48
Q

What are generalised tonic clonic seizures?

A

They are defined as those that result in motor clinical features, specifically tonic (muscle tensing) and clonic (muscle jerking) episodes

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49
Q

What usually occurs first in generalised tonic clonic seizures - the tonic or clonic phase?

A

Tonic

THEN

Clonic

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50
Q

Are generalised tonic clonic seizures motor or non-motor?

A

Motor

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51
Q

What are the five additional clinical features observed in generalised tonic clonic seizures?

A

Groaning

Eye Rolling/Deviation

Urinary Incontinence

Mouth Foaming

Tongue Biting

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52
Q

What four postictal features occur following generalised tonic clonic seizures?

A

Confusion

Drowsiness

Irritability

Depression

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53
Q

What is the first line management option for generalised tonic clonic seizures?

A

Sodium valproate

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54
Q

What are the two second line management options for generalised tonic clonic seizures?

A

Lamotrigine

Levetiracetam

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55
Q

What is another term for absence seizures?

A

Petit mal seizures

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56
Q

Are absence seizures motor or non-motor?

A

Non-motor

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57
Q

Which patient group tends to be affected by absence seizures?

A

Children

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58
Q

What are the two triggers for absence seizures?

A

Hyperventilation

Photosensitivity

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59
Q

Describe the clinical features observed during absence seizures

A

Individuals become blank, stare into space and then abruptly return to normal

During the episode they are unaware of their surroundings and become unresponsive

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60
Q

How long do absence seizures tend to last? How many times can they occur a day?

A

5-10 seconds

100 times per day

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61
Q

What is the feature of abscence seizures on EEG scans?

A

3Hz spike and wave

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62
Q

What is the first line management option for absence seizures?

A

Ethosuximide

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63
Q

What is the second line management option for absence seizures - in males?

A

Sodium valproate

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64
Q

What are the two second line management options for absence seizures - in females?

A

Lamotrigine

Levetiracetam

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65
Q

What happens to absence seizures as individuals get older?

A

They spontaneously stop

66
Q

What is another term for atonic seizures?

A

Drop seizures

67
Q

Are atonic seizures motor or non-motor?

A

Motor

68
Q

Which patient group tends to be affected by atonic seizures?

A

Children

1-5 years old

69
Q

What do atonic seizures usually indicate?

A

Lennox-Gastaut syndrome

70
Q

How does Lennox Gastaut syndrome present on an EEG?

A

Slow spike

71
Q

How do we manage Lennox Gastaut syndrome?

A

Ketogenic diet

72
Q

Describe the clinical features observed during atonic seizures

A

Individuals experience a brief lapse in muscle tone within the legs – causing the individual to suddenly collapse or fall down

73
Q

How long do atonic seizures last?

A

They usually last less than 3 minutes

74
Q

What is the first line management option used for atonic seizures?

A

Sodium valproate

75
Q

What is the second line management option used for atonic seizures?

A

Lamotrigine

76
Q

Are myoclonic seizures motor or non-motor?

A

Motor

77
Q

Which patient group tend to be affected by myoclonic seizures?

A

Children

78
Q

What do myoclonic seizures indicate?

A

Juvenile myoclonic epilepsy

79
Q

What is another term for juvenile myoclonic epilepsy?

A

Janz syndrome

80
Q

Which patient group tends to be affected by juvenile myoclonic epilepsy?

A

Female

Teens

81
Q

When does juvenile myoclonic epilepsy tend to present?

A

Morning

There are no daytime seizures

82
Q

Describe the clinical features observed during myoclonic seizures

A

Individuals experience sudden brief muscle contractions, like a sudden jump

83
Q

What is the first line management option for myoclonic seizures?

A

Sodium valproate

84
Q

What is the second line management option for myoclonic seizures?

A

Levetiracetam

85
Q

What is another term for infantile spams?

A

West syndrome

86
Q

Are infantile spasms motor or non motor?

A

Motor

87
Q

Which gender tend to be affected by infantile spasms?

A

Males

88
Q

Which age group tend to be affected by infantile spasms?

A

Those between 4 -8 months old

89
Q

What do infantile spasms indicate?

A

A secondary neurological abnormality, such as tuberous sclerosis, encephalitis or birth asphyxia

90
Q

What is a feature on clinical examination of infantile seizures?

A

Salaam attack

91
Q

What is a Salaam attack?

A

This is when individuals experience clusters of full body spasms, resulting in flexion of the head, trunk and limbs and extension of the arms

92
Q

How long do infantile seizures last? How many times can they occur a day?

A

1-2 seconds

50 times per day

93
Q

What EEG feature indicates infantile seizures?

A

Hypsarrhythmia in 2/3rd of infant

94
Q

What are the two first line management options for infantile seizures?

A

Prednisolone

Vigabatrin

95
Q

What is benign rolandic epilepsy?

A

It is a form of childhood epilepsy charactersised by partial seizures, which tend to occur during sleep

96
Q

What is a risk factor of benign rolandic epilepsy?

A

Family History

97
Q

What are the three clinical features assoacited with benign rolandic epilepsy?

A

Hemifacial Paraesthesias

Oropharyngeal Manifestations

Hypersalivation

98
Q

What are the three other common causes of seizures other than epilepsy?

A

Febrile convulsions

Alcohol withdrawal

Psychogenic non-epileptic seizures

99
Q

What are febrile convulsions?

A

They are defined as brief generalised tonic-clonic seizures that occur early in a viral infection as the temperature rises rapidly

100
Q

Which age group tend to be affected by febrile convulsions?

A

6 months - 5 years old

101
Q

When should parents be advised to call an ambulance during a febrile convulsaion?

A

When febrile convulsions last longer than 5 minutes

102
Q

What is a red flag of febrile convulsions, which should prompt referral to paediatrics?

A

Droswy > 2 hrs of seizure

103
Q

What can be administered by specialists in those with recurrent febrile convulsions?

A

Rectal Diazepam

Buccal Midazolam

104
Q

What are alcohol withdrawal seizures?

A

These are seizures that occur in patients with a history of alcohol excess who suddenly withdraw alcohol

105
Q

How soon after alcohol withdrawal does seizures onset occur?

A

36 hrs

106
Q

What drug class is administered to prevent the development of alcohol withdrawal seizures?

A

Benzodiazepines

107
Q

What is another term for psychogenic non-epileptic seizures?

A

Pseudo seizures

108
Q

What are psychogenic non-epileptic seizures?

A

They describe patients who present with epileptic like seizures that do not have characteristic electrical discharges

109
Q

Which patient group tend to be affected by psychogenic non-epileptic seizures?

A

Those with mental health problems

110
Q

What is a feature indicative of psychogenic seizure?

A

Widespread convulsions without conscious impairment

111
Q

What investigation can be used to differentiate between psychogenic non-epileptic seizures and true seizures?

A

Prolactin levels

True seizures = increased

112
Q

When do we usually initiate pharmacological management of epilepsy?

A

After the second epileptic seizure

113
Q

In which three circumstances do we initiate pharmacological management of epilepsy after the first epileptic seizure?

A

If the patient has a neurological deficit, brain imaging shows a structural abnormality

If the EEG shows unequivocal epileptic activity

If the patient/family/carers consider the risk of having a further seizure unacceptable

114
Q

In general, what anti-epileptic is used as a first line management option for generalised seizures?

A

Sodium valproate

115
Q

In general, what anti-epileptic is used as a first line management option for focal seizures?

A

Carbamazepine

116
Q

What are the two investigations used to diagnose epilepsy?

A

Electroencephalogram (EEG)

MRI Scan

117
Q

What is an EEG?

A

It involves the attachment of electrodes to the scalp in order to record electrical activity of the brain

118
Q

What EEG feature indicates epilepsy?

A

Abnormal electrical activity

119
Q

How are MRI scans used to diagnose epilepsy?

A

It is used to diagnose structural problems that may be associated with seizures and other pathologies, such as tumours

120
Q

When do we acutely manage epilepsy?

A

When seizures don’t self-terminate within 5-10 minutes

121
Q

How do we acutely manage epilepsy?

A

We administer benzodiazepines, such as diazepam

122
Q

What two routes are used to administer benzodiazepines for acute treatment of epilepsy?

A

Rectally

Intranasally

123
Q

What is the first line acute pharmacological management option of epilepsy? What dose?

A

Rectal diazepam 10mg

124
Q

What is status epilepticus?

A

This is when seizures continues for more than 5 minutes or there are more than 3 seizures in one hour despite intervention

This is a medical emergency requiring hospital treatment

125
Q

What two causes of status epilepticus must be ruled out before other causes are considered?

A

Hypoxia

Hypoglycaemia

126
Q

What are the seven management steps used to treat status epilepticus in hospital?

A

Secure Airway

Administer High Concentration O2

Assessment of Cardiac/Respiratory Function

Check Blood Glucose Levels

Insert IV Cannula

Administer IV Lorazepam 4mg (Repeat After 10 Minutes If Seizure Continues)

Administer IV Phenytoin (If Seizures Persist With Lorazepam)

127
Q

What investigation is required when starting IV phenytoin? Why?

A

Cardiac monitoring

This is due to the pro-arrythmogenic effects

128
Q

What are the two management steps used to treat status epilepticus in the community?

A

Administer Buccal Midazolam 10mg (Repeat After 10 Minutes If Seizure Continues)

Administer Rectal Diazepam (If Seizures Persist With Midazolam)

129
Q

What is sodium valporate’s mechanism of action?

A

It is involved in increasing the activity of GABA, which produces a relaxing effect on the brain

130
Q

When is sodium valproate used to manage epilepsy?

A

It is used as a first line agent in generalised seizures

131
Q

What are the five side effects of sodium valproate?

A

Weight Gain

Alopecia

Liver Damage (P450 Enzyme Inhibitor)

Tremor

Teratogenic

132
Q

What is carbamazepine’s mechanism of action?

A

It binds to sodium ion channels, which increases their refractory period

133
Q

When is carbamazepine used to manage epilepsy?

A

It is used as a first line agent in focal seizures

134
Q

What are the six side effects of carbamazepine?

A

Agranulocytosis

Leucopoenia

Aplastic Anaemia

Ataxia

Liver Damage (P450 Enzyme Inducer)

Visual Disturbances (Diplopia)

135
Q

Due to being a P450 enzyme inductor, what effect does carbamazepine have on warfarin?

A

It decreases INR

136
Q

What two seizure classifications can carbamazepine exacerbate?

A

Absence seizures

Myoclonic seizures

137
Q

What is lamotrigine’s mechanism of action?

A

It binds to and inhibits sodium ion channels

138
Q

When is lamotrigine used to manage epilepsy?

A

It is used as a second line agent for a variety of generalised and focal seizures

139
Q

What are the three side effects of lamotrigine?

A

Stevens Johnson Syndrome

DRESS Syndrome

Leukopenia

140
Q

What is ethosuximide’s mechanism of action?

A

It binds to calcium ion channels of the thalamic neurons, which decreases the electrical activity of these neurones

141
Q

When is ethosuximide used to manage epilepsy?

A

It is used as a second line agent for a variety of generalised seizures

142
Q

What are the two side effects of ethosuximide?

A

Night Terrors

Rash

143
Q

Which two anti-epileptics do we need to carefully review the patient’s other prescribed medications? Why?

A

Sodium valproate

Carbamazepine

Due to the fact that they induce/inhibit the P450 system, which can result in varied metabolism of other medications - such as warfarin and COCP

144
Q

What anti-epileptic is prescribed in females of childbearing age? Why?

A

Lamotrigine

Due to the typical teratogenic effect of antileptics, particularly sodium valproate

145
Q

What are the teratogenic effects of sodium valproate?

A

Neural tube defects

146
Q

In comparison to normal pregnancies, what should patients on anti-epileptics be aware of when trying to conceive?

A

They should receive folic acid 5mg instead of 400mcg

147
Q

In cases where pregnant patients are being administered phenytoin, what should be administered in the last month of pregnancy? Why?

A

Vitamin K

To prevent clotting disorders in the newborn

148
Q

Is breastfeeding safe in mothers taking anti-epileptics?

A

Yes

The only exception is if they are taking barbiturates

149
Q

Why is it important to discuss contraception options with epileptic patients of childbearing age?

A

This is due to the fact that the effect of anti-epileptics can reduce the effectiveness of contraceptive pills, vice versa

150
Q

What general contraceptive advice is given to those taking anti-epileptics?

A

They should use condoms in addition to other forms of contraception

151
Q

What are the three first line contraception methods advised in those administered phenytoin, carbamazepine, barbiturates, primidone, topiramate or oxcarbazepine?

A

Depo-Provera

IUD

IUS

152
Q

What are the five first line contraception methods advised in those administered lamotrigine?

A

POP

Implant

Depo-Provera

IUD

IUS

153
Q

In cases where epilepsy patients select the COCP, what dose should be administered?

A

It should contain a minimum of 30 µg of ethinylestradiol

154
Q

How long is driving suspended for group one vehicles in individuals who experience a single seizure, without an epilepsy diagnosis? What other criteria must these individuals meet? How long is driving suspended for when these criteria are not met?

A

6 months

No relevant structural abnormalities on brain imaging or EEG

12 months

155
Q

How long is driving suspended for group two vehicles in individuals who experience a seizure, without an epilepsy diagnosis?

A

5 years

156
Q

How long is driving suspended for group one vehicles in individuals who experience a seizure, with an epilepsy diagnosis?

A

12 months

157
Q

How long is driving suspended for group two vehicles in individuals who experience a seizure, with an epilepsy diagnosis?

A

10 years with no medication administration

158
Q

What criteria must be obtained before anti-epileptic drugs can be stopped?

A

In cases where individuals are seizure free for > 2 years, with AEDs being stopped over 2 - 3 years

159
Q

Can individuals drive whilst anti-epileptic drugs are being withdrawn?

A

No

This includes 6 months until after last dose

160
Q

What are the five complications associated with epilepsy?

A

Sudden Unexplained Death in Epilepsy (SUDEP)

Depression

Anxiety

Injuries

Brain Damage

161
Q

What drug is contraindicated in individuals with epilepsy?

A

Bupropion

162
Q

What condition can present similarly to epilepsy? How do we differentiate between the two?

A

Syncope

The posticital period in epilepsy is prolonged, however does not exist in syncopal episodes

In addition, syncopal episodes are usually associated with stress and reduced nutritional intake

Year Two - Neurology System (25 decks)

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