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Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is the definition of Epilepsy?

A
  • A chronic neurological disorder, characterised by recurrent seizures
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2
Q

What is the definition of a seizure?

A
  • A seizure refers to a transient neurological change due to a synchronous, hyperexcited neuronal activity in the brain
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3
Q

What is a provoked seizure?

A
  • These strokes occur at the time of acute illness
  • They include acute stroke, head trauma and hypoglycaemia)
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4
Q

What are the types of seizure that occur in Epilepsy?

A
  • recurrent, unprovoked seizures
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5
Q

What are the causes of Epilepsy?

A
  • Genetic
  • Structural (visible neurological abnormalities- cerebrovascular disease and congenital malformation)
  • Metabolic
  • Immune
  • Infectious (chronic infection predisposing to seizure - HIV)
  • Unknown
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6
Q

What is the Pathophysiology of Seizures?

A
  • Seizures develop due to an imbalance between inhibitory and excitatory signals in the brain
  • A seizure may be due to high frequency bursts of excitatory action potentials, this leads to synchronous, hyperexcitable activity
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7
Q

What are the two types of inhibitory and exhibitory signals?

A
  • Gabanergic
  • Glutamingergic
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8
Q

What are the Gabanergic signals?

A
  • inhibitory GABA receptors
  • These are ligand gated ion channels that allow the flow of the chloride ions
  • GABA is the main inhibitory neurotransmitter that binds to these receptors
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9
Q

What are the Glutaminergic signals?

A
  • Excitatory, glutamate receptors
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10
Q

What are the Risk Factors for Epilepsy?

A
  • Cerebrovascular disease
  • Head trauma
  • Cerebral infections
  • Family History
  • Premature birth
  • Congenital malformations of the brain
  • Genetic conditions associated with epilepsy
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11
Q

How are Seizures classified?

A
  • Seizure type
  • Epilepsy type
  • Epilepsy syndrome
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12
Q

What 3 classifications can the “seizure type” be split into?

A
  • Area of Onset
  • Awareness
  • Clinical Features
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13
Q

What are the Areas of Onset for Seizure type?

A
  • Focal (one hemisphere of the brain)
  • Generalised (affecting both hemispheres of the brain and associated neuronal networks)
  • Focal to bilateral tonic-clonic (focal seizure spreads to affect wider network of Neurons involving both hemispheres)
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14
Q

What is included in Awareness for seizure type?

A
  • Awareness ( fully aware of themselves and their environment throughout the seizure)
  • Impaired Awareness (any impairment of awareness during course of the seizure
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15
Q

What is included in Clinical Features of seizure type?

A
  • Motor ( Tonic (generalised muscle stiffening), Clonic (rhythmic muscle jerking), Myoclonic (brief, shock like, involuntary jerks), Atonic (loss of motor tone), spasms ( sudden Flexion/ extension movements)
  • Non- Motor ( focal onset associated with sensory, emotional, automatic or behavioural change / generalised onset with symptoms typical of an absence seizure)
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16
Q

What are the epilepsy types?

A
  • Focal Epilepsy
  • Generalised Epilepsy
  • Generalised and focal Epilepsy
  • Unknown Epilepsy
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17
Q

What is included in Epilepsy Syndrome?

A
  • Epilepsy syndrome is characterised by the recurrent propensity to a specific seizure type or series of seizure types
  • Determining an epilepsy syndrome is important to guide medical therapy with anti-epileptic drugs
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18
Q

What are examples of classic epilepsy syndrome?

A
  • West Syndrome
    -Lennox Gastaut Syndrome
  • Juvenile Myoclonic Epilepsy
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19
Q

What is important to know about the epilepsy syndromes ?

A
  • Typical age of onset
  • Specific seizure types
  • Specific EEG features
  • Additional clinical or radiological features
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20
Q

What are the clinical features of seizures?

A
  • Epilepsy is characterised clinically by seizures
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21
Q

What are the 4 stages of a Seizure?

A
  • Prodromal
  • Early- Ictal
  • Ictal
  • Post- Ictal
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22
Q

What is the Prodromal period of a Seizure?

A
  • This is a feeling/ sensation of confusion, irritability or mood disturbances that predisposes a seizure
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23
Q

What is the Early- Ictal period?

A
  • This phase is characterised by an aura, this is the earliest sign of seizure activity
  • It refers to subjective symptoms experienced by the patient including sensory, cognitive, emotional or behavioural changes
  • an aura is suggestive of a focal epilepsy which may progress to affect a wider area or develop into a focal to bilateral tonic-clonic seizure
24
Q

What is the Ictal period?

A
  • This is a highly variable stage depending on seizure type
  • A seizure is typically tonic-clonic seizure, this is characterised by stiffening and subsequent rhythmic jerking of the limbs
  • It is typically associated with urinary incontinence and tongue biting and typically lasts 1-2 minutes
25
Q

What is Status Epilepticus?

A
  • This is when a single seizure lasts greater than 30 minutes
  • Or when two seizures occur without regaining consciousness after the first
  • It can be broadly split into convulsive and non-convulsive
26
Q

What is the Post-Ictal period?

A
  • This is the recovery period when the seizure has abated
  • There may be an extended recovery period which is dependant on seizure types
  • During this period, there may be altered consciousness, confusion, memory loss, drowsiness or genera, malaise
27
Q

How do you make a diagnosis of epilepsy?

A
  • Criteria 1: more than or equal to 2 unprovoked seizures occurring more than 24 hours apart
  • Criteria 2: 1 unprovoked seizure with a probability of further seizures felt to be at a similar recurrence risk to patients with more than or equal to 2 unprovoked seizures over the next 10 years
  • Criteria 3: A diagnosed epilepsy syndrome
28
Q

What are the differential diagnoses for Epilepsy?

A
  • Syncope and anoxic seizures (transient loss of consciousness from impaired cerebral blood flow)
  • Behavioural, psychological and psychiatric ( non-epileptic seizures = pseudo seizures)
  • Sleep-related conditions
  • Paroxysmal movement disorders
  • Migraine associated disorders
29
Q

What Investigations are indicated for Epilepsy?

A
  • Neuroimaging and an EEG
  • ECG
  • Bloods: FBC,U&E, LFT, Glucose and Bone Profile
30
Q

What is an EEG?

A
  • This is a non-invasive method of assessing and recording the electrical activity of the brain
  • Epilepsy has a certain waveform that is present
31
Q

What are the 3 main uses for an EEG?

A
  • Support a diagnosis of Epilepsy
  • Assess risk of seizure recurrence
  • Determine seizure type of epilepsy syndrome
32
Q

What is Neuroimaging?

A
  • This is an MRI and a CT can be used if MRI is not available
  • This is able to look for structural abnormalities
33
Q

What are the main stages of treatment for Epilepsy?

A
  • Education and Safety
  • Treating Acute seizures
  • First Fit Clinic
  • Long term treatment with AED
34
Q

What is included in the management regarding Education and Safety?

A
  • Driving
  • Water safety - using buddy system, showers instead of baths
  • Fire Safety
  • Environmental safety
  • Care with heights, high risk recreational activities, contraception and certain medications
35
Q

What is a first fit clinic?

A
  • After an initial presentation and management of a suspected epileptic seizure the patient should go to a first fit clinic
  • This is a formal assessment (history and examination), relevant investigations (MRI, EEG)
  • As a general rule, following a single seizure patients are not routinely started on AEDs unless there is felt to be considerable risk for another seizure
36
Q

What are the options for Anti-Epileptic Drugs?

A
  • Sodium Valproate
  • Carbamazepine
  • Lamotrigine
  • Levetiracetam
  • Phenytoin
37
Q

What is the important information to note about Sodium Valproate?

A
  • Teratogenic
  • Side Effects: drug-induced liver injury, pancreatitis and increased suicide risk
38
Q

What is the important information to know about Carbamazepine?

A
  • Sodium channel antagonist
  • Increased teratogenic risk
  • Side effects: Agranulocytosis, SIADH
39
Q

What important information should you know for Lamotrigine?

A
  • Sodium channel antagonist
  • Increased teratogenic risk
  • Side effects: severe skin reactions
40
Q

What important information is needed for Levetiracetam?

A
  • Unclear mechanism
  • Side Effects: CNS disturbance, neuropsychiatric disturbance
41
Q

What important information is needed for Phenytoin?

A
  • Sodium channel antagonist
  • Teratogenic
  • Side effects: Arrhythmia with parenteral use, Gum hypertrophy and cerebella atrophy
42
Q

What information should you know about anti-epileptic drugs and pregnancy?

A
  • Sodium Valproate is highly teratogenic and therefore should not be given to women and girls of childbearing potential
  • This includes girls who are likely to need treatment into their child bearing years
43
Q

What is the general rule for medication for patients with Epilepsy?

A
  • Monotherapy at the lowest possible dose to control seizures
44
Q

What is the management for Focal Seizures?

A
  • 1st - Lamotrigine (if childbearing potential), Carbamazepine (no childbearing potential)
  • 2nd - Levetiracetam, Oxcarbazepine or Sodium Valproate
45
Q

What is the management for Generalised Tonic-Clonic Seizures?

A
  • 1st - Sodium Valproate/ Lamotrigine
  • 2nd - Clobazam, Lamotrigine, Levetiracetam or Topiramate
46
Q

What is the management for Absence Seizures?

A
  • 1st - Sodium Valproate or Ethosuximide
  • 2nd - Lamotrigine
47
Q

What is the management for Myoclonic Seizures?

A
  • 1st - Sodium Valproate
  • 2nd - Levetiracetam or Topiramate
48
Q

What is the management for Juvenile Myoclonic Epilepsy?

A
  • 1st - Sodium Valproate
  • 2nd - Lamotrigine, Levetiracetam or Topiramate
49
Q

What medications can impair the effectiveness of hormonal contraceptives?

A
  • Oxycarbazepine and Topiramate
50
Q

What are the two major complications of Epilepsy?

A
  • status epilepticus
  • SUDEP ( sudden unexplained death in epilepsy) - this is the most common cause of death in young adults with epilepsy
  • SUDEP - has been linked to uncontrolled epilepsy and nocturnal seizures
  • Seizure control is Pivotal to reduce risk
51
Q

What is the general advice for epilepsy and driving?

A
  • First Seizure (group 1)- Impaired consciousness: do not drive for six months, reapply
  • Epileptic seizure (group 1) - Impaired consciousness: do not drive for one year, reapply
  • Seizures (group 1) - no loss of consciousness (seek DVLA advice)
  • First Seizure (group 2) - do not drive for 5 years, seek DVLA advice
  • More than or equal to one seizure (group 2) - do not drive for 10 years, seek DVLA advice
52
Q

What are the features of Temporal Lobe Seizures?

A
  • May occur with/ without impairment of consciousness or awareness
  • a rising in epigastric sensation
  • a psychic/ experiential phenomena = deja vu
  • hallucinations (auditory/ gustatory/ olfactory)
  • Seizure last one minutes
  • Automatisms (lip smacking/grabbing/plucking)
53
Q

What are the features of Frontal Lobe Seizures?

A
  • Head/leg movements
  • Posturing
  • Post-ictal weakness
  • Jacksonian march
54
Q

What are the features of Parietal Lobe Seizures?

A
  • Paraesthesia
55
Q

What are the features of Occipital Lobe Seizures?

A
  • Floaters/ Flashes

Neurology (18 decks)

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