Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is epilepsy?

A
  • Seizure = transient occurrence of signs and symptoms due to abnormally excessive or synchronous neuronal activity within the brain
  • Epilepsy = repeated seizures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How are seizures classified?

A
  • Generalised = both hemispheres
  • motor (movement) – stiffening (tonic) and jerking (clonic)
  • non motor – a.k.a ABSENCE seizures – there are changes in sensations, emotions, thinking or experiences known as aura
  • Focal = one hemispheres
  • aware (simple)
  • unaware (complex)
  • Focal to bilateral = one hemisphere then progresses to both hemispheres
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the prevalence of epilepsy in the UK?

A

456,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What proportion of people will have 1 seizure in their lifetime?

A

1 in 20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What % of the epilepsy population have learning disabilities?

A

25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What % of the treatment resistant epilepsy population have learning disabilities?

A

60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the geographical distribution of epilepsy?

A

Higher prevalence in HICs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the aetiology of seizures?

A

VITAMINS
Vascular – stroke, hypertension

Infections – meningitis, encephalitis

Toxins – alcohol overdose, medications (antidepressants, antipsychotics)

AV malformations + space occupying lesions + Autoimmune (e.g., vasculitis)

Metabolic – hypoglycaemia, hypo/hypernatremia, hypocalcaemia + Multiple Sclerosis

Idiopathic

Neoplasms

Stress – trigger and predisposing factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the clinical features of a tonic clonic (i.e., grand mal) seizure?

A

Limb contraction

Limb extension

Arching of back

Ictal cry due to chest contraction

Usually lasts 2-3 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the clinical features of a tonic seizure?

A

Sustained contraction

Cyanosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the clinical features of a clonic seizure?

A

Jerking movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the clinical features of a myoclonic seizure?

A

Feature muscle spasms either in select muscle groups or across the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the clinical features of absence seizures (i.e., petit mal)?

A

May have little or no motor involvement

Usually lasts 10 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the clinical features of a atonic seizure?

A

Bilateral loss of muscle activity > 1s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is status epilepticus?

A

Either:
- Seizure lasts more than 5 mins
- 2 or more seizures without return to consciousness
- 3 or more tonic-clonic seizures within a 1-hour timeframe

MEDICAL EMERGENCY

Airway management

Medications – benzodiazepine, phenytoin and phenobarbital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the post-ictal phase? What are its features?

A

Follows seizures

Lasts mins to hours

Confusion

Tiredness

Headache

Speech difficulty

Psychosis (in 10%)

Amnesia

17
Q

What assessments and investigations can you do for someone that presents with a seizure?

A
  1. History – seizure & post-ictal phase, drug/alcohol use
  2. Physical exam – tongue biting, injuries: shoulder dislocation
  3. Blood tests – blood sugars, U&Es (to check electrolyte levels)
  4. Imaging – CT, MRI (recommended in the 1st instance of a seizure to exclude structural causes)
  5. Lumbar puncture
  6. EEG – (when an organic cause has not been identified, Epilepsy syndrome investigation
  7. Prolactin
18
Q

How would you manage someone presenting with a seizure?

A

Start the stopwatch/timer (if it hasn’t already been started)

A-E assessment

Secure environment by removing any hazardous materials

Airway management by placing in recovery position and using airway adjuncts if airway is compromised

Medications
1. Benzodiazepines (e.g., lorazepam, diazepam) – a 2nd dose of benzodiazepine may be given after 10 minutes. If this doesn’t work proceed to step 2.
2. Barbituates, propofol
3. Phenytoin – low dose and maintenance dose

Give glucose if needed

Refer for follow up
- Specialist clinic
- Antiepileptic drugs – valproate, lamotrigine and levetiracetam

19
Q

After the initial seizure Mx, your patient has not responded and is still convulsing. What should you do in the initial 5-10 minutes if the patient has IV access?

A

Lorazepam 4mg IV bolus

Monitor and give 2nd dose after 10 minutes if seizures continue

20
Q

After the initial seizure Mx, your patient has not responded and is still convulsing. What should you do in the initial 5-10 minutes if the patient has IV access, but there is a lorazepam shortage?

A

Diazepam 10mg slow IV injection (max rate = 1mL(5mg) per minute)

Monitor and give 2nd dose after 5 minutes if seizures continue

21
Q

After the initial seizure Mx, your patient has not responded and is still convulsing. What should you do in the initial 5-10 minutes if the patient has no IV access?

A

Diazepam 10mg PR
OR
Midazolam 10mg buccal
OR
Midazolam 10mg IM (ITU only)

Monitor and give 2nd dose after 10 minutes if seizures continue

22
Q

After the initial seizure Mx, your patient has not responded and is still convulsing. What should you do in the at 10-30 minutes?

A

Established status epilepticus - risk of long-term brain damage

Call MET team (2222) - start emergency IV anti-epileptic drug (AED) therapy ASAP

Tx options:
- levetiracetam 60mg/kg IV infusion (max 4500mg)
- sodium valproate 40mg/kg IV infusion (max 3000mg)
- phenytoin 20mg/kg IV infusion (max 2000mg)

Inform the anaesthetist/request airway support if patient is still in status epilepticus after 50% of infusion has been given

23
Q

If the patient that you are treating as status epilepticus’ seizure resolves at 30 minute what should you do?

A

Reinstate existing anti-epileptic meds (via PO/IV/NG route)
- ward/on call pharmacist or on-call neurologist can advise if alternative formulations or route of administration is required

Monitor neurological observations and GCS every 30 minutes and if patient does not regain consciousness within 1-2 hours call for senior help
- continue neuro obs 4-hourly for the next 12 hours

Establish aetiology, identify and treat med complications

24
Q

If the patient that you are treating as status epilepticus’ seizure continue at 30 minute onwards what should you do?

A

Transfer to HDU/ITU

Neurology (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions