Epilepsy Flashcards
What is a seizure?
1 - temporary disruption in brain function caused by abnormal firing of neurons
2 - temporary loss of consciousness
3 - temporary paralysis
4 - temporary contraction of all skeletal muscle
1 - temporary disruption in brain function caused by abnormal firing of neurons
- neurons can fire when they shouldn’t
- neurons don’t fire when they should
- together causes dysfunction
A seizure is a temporary disruptions of brain function, caused by uncontrolled synchronous, paroxysmal excessive neuronal activity. It can present as a stereotype disturbance of consciousness, behaviour, emotion, motor function and/or sensation, which depends on which part of the brain is affected. How long do they generally last?
1 - seconds to minutes
2 - minutes to hours
3 - hours to days
4 - can be all of the above
4 - can be all of the above
When defining the term epilepsy we need to understand 2 terms; seizure and unprovoked. In relation to epilepsy what does unprovoked mean?
1 - cause of seizure is known
2 - cause of seizure is unknown
3 - cause of seizure or the precipitating factor is unknown
4 - all of the above
3 - cause of seizure or the precipitating factor is unknown
- no medically reversible cause (alcohol, blood glucose) can be identified
What is a provoked seizure?
1 - cause of seizure is known
2 - cause of seizure is unknown
3 - cause of seizure is identified but not the precipitating factor
4 - cause of seizure or the precipitating factor is known
4 - cause of seizure or the precipitating factor is known
- diabetes, neurological disorder, alcohol withdrawal
Epilepsy is chronic condition where the occurence of recurring and unpredictable seizures, where neurons in the brain fire when they shouldnt. How many unprovoked (no known cause or precipitatking factor) seizures need to occur before a patient is diagnsoed with epilepsy?
1 - 1
2 - >2
3 - >4
4 - >10
2 - >2
- MUST be separated by >24 hours
What % of the population are affected by epilepsy?
1 - 0.1 - 1%
2 - 10-15%
3 - 15-30%
4 - 30-50%
1 - 0.1 - 1%
Which 2 of the following are said to be the cause of seizures?
1 - too much neuronal excitation
2 - toxicity of neurotransmitters
3 - lack of neurotransmitters
4 - too much inhibitory neurotransmitter stimulus
1 - too much neuronal excitation
- increased glutamate binding NMDA receptors
4 - too much inhibitory neurotransmitter stimulus
- too much GABA binding GABA receptors
Even in patients with a diagnosis of epilepsy, who are typically well controlled, they can still experience seizures. Which of following are causes of seizures in patients who are well controlled?
1 - inconsistent use of anti-epileptic medication
2 - lifestyle changes (increased stress, sleep deprivation, alcohol use)
3 - new medications / supplements interacting with anti-seizure medication
4 - estrogen supplements increase metabolism of lamotrigine (lowering serum levels) and pregnancy
5 - Infection
6 - all of the above
6 - all of the above
- inconsistent use of anti-epileptic medication is typically the most common cause
Epilepsy is a chronic condition of recurrent seizures, where >2 unprovoked seizures is diagnostic that have occured >24 hours appart. Are the seizures always of the vigorous shaking kind?
- no
- seizures can be brief and nearly undetectable symptoms to periods of vigorous shaking and convulsion
- all depends on part of brain affected
In epilepsy we know that seizures are caused by abnormal firing of the neurons in the brain. Which part of the brain is generally affected in up to 60% of cases?
1 - frontal
2 - parietal
3 - occipital
4 - temporal
4 - temporal
- presents with lots of symptoms, including epigastric rising, olfactory/gustatory hallucinations, autonomic, affective, deja-vu; motor arrest and absence prominent (>30 seconds), automatisms, automatic speech, contralateral dystonia
What is an automatism?
1 - voluntary movements following a seizure
2 - involuntary movement following a seizure
3 - coordinated involuntary motor activity
4 - voluntary coordinated movement
3 - coordinated involuntary motor activity
- typically occur during the seizure
- typically associated with amnesia and impaired awareness
Automatisms are coordinated involuntary motor activity that typically occur during the seizure and are typically associated with amnesia and impaired awareness. Anywhere can be affected, but which 2 of the following body parts are most commonly affected?
1 - mouth
2 - feet
3 - abdomen
4 - hands
1 - mouth
- chewing or lip smacking
4 - hands
- picking or fidgeting
There are different things that can occur in seizures. Which of the following is the definition of prodrome?
1 - drowsy, confused, psychotic. Bitten tongue, lost continence
2 - feeling, sensations, changes in behaviour hours or days before the event
3 - actual event (may need witness description)
4 - immediately prior (not always present)
2 - feeling, sensations, changes in behaviour hours or days before the event
- a lot of the time it can be family or friends who aware of the changes
There are different things that can occur in seizures. Which of the following is the definition of preictal/aura ?
1 - drowsy, confused, psychotic. Bitten tongue, lost continence
2 - feeling, sensations, changes in behaviour hours or days before the event
3 - actual event (may need witness description)
4 - immediately prior (not always present)
4 - immediately prior (not always present)
There are different things that can occur in seizures. Which of the following is the definition of Ictal?
1 - drowsy, confused, psychotic. Bitten tongue, lost continence
2 - feeling, sensations, changes in behaviour hours or days before the event
3 - actual event (may need witness description)
4 - immediately prior (not always present)
3 - actual event (may need witness description)
- typically associated with amnesia
There are different things that can occur in seizures. Which of the following is the definition of post-ictal ?
1 - drowsy, confused, psychotic. Bitten tongue, lost continence
2 - feeling, sensations, changes in behaviour hours or days before the event
3 - actual event (may need witness description)
4 - immediately prior (not always present)
1 - drowsy, confused, psychotic. Bitten tongue, lost continence
Some patients may experience a preceding prodrome that can last hours to days prior to a seizure, typically of the temporal lobe causing a change in mood or behaviour. They can also experience an aura. Typically what do patients with an aura experience?
1 - strange feeling in the gut
2 - deja vu
3 - strange smells
4 - flashing lights
5 - all of the above
5 - all of the above
Does a aura suggest a focal/partial or generalised seizure?
- focal seizure
In epilepsy we know that seizures are caused by increased glutamater (excitatory) or GABA (inhibitory) that causes abnormal firing of the neurons in the brain. In up to 60% of cases it generally affected the temporal lobe, but can also spread/occur where?
- frontal
- can affect both hemispheres
- parietal and occipital (rare)
- where seizures occurs affects how the patient presents
In epilepsy, seizure can last for longer periods. If the seizure lasts >5 minutes in duration, what is this called?
1 - status epilepticus
2 - status provoctus
3 - status criticalis
4 - partial epilepticus
1 - status epilepticus
- latin for continous state of seizure
Status epilepticus is when a seizure lasts longer >5 minutes in duration. Why is this serious?
1 - can increase risk of subsequent seizures
2 - increases risk of drug toxicity
3 - increases risk of self harm
4 - medical emergency
4 - medical emergency
- typically tonic-clonic affecting both hemispheres
- can lead to permanent brain damage and death
- mortality is between 10-15%
Due to the seriousness of Status epilepticus, what medication can patients often be given to try and stop the seizure?
1 - typical psychotics
2 - benzodiazepines
3 - antiepileptics
4 - antidepressants
2 - benzodiazepines
- increases effects of GABA to try and control patients seizure
- administered by intravenously, mucosal or rectal
What is the 1st line treatment for status epilepticus?
1 - diazepam
2 - carbamazepine
3 - lorazepam
4 - phenytoin
3 - lorazepam
- can also try diazepam rectally
- can also try midazolam buccal
Lorazepam is the 1st line treatment for status epilepticus. However, if a patient continues to have seizures, what medication should they be given?
1 - diazepam
2 - carbamazepine
3 - lorazepam
4 - phenytoin
4 - phenytoin
- need to monitor BP and ECG
If a patient has been given lorazepam, and then phenytoin and the patient remains in status epilepticus for 60-90 minutes, what should the next treatment option be?
1 - double lorazepam and phenytoin dosages
2 - give rectal diazepam
3 - consider anaesthesia (propofol)
4 - all of the above
3 - consider anaesthesia (propofol)
- patient will also need to be intubated with continuous EEG monitoring in ICU
In a patient with status epilepticus, organise the emergency management of the patient from the below options:
1 - thiamine and glucose administered if malnourished
2 - IV access and bloods taken
3 - anaesthesia (propofol) with continuous EEG in ICU
4 - open and secure airway
5 - Oxygen @ 100% + suction as required
6 - lorazepam given as IV bolus
7 - correct hypotension as required
4 - open and secure airway
5 - Oxygen @ 100% + suction as required
2 - IV access and bloods taken
6 - lorazepam given as IV bolus
1 - thiamine and glucose administered if malnourished
7 - correct hypotension as required
3 - anaesthesia (propofol) with continuous EEG in ICU
What is the term given in epilepsy when a seizure affects both hemispheres?
1 - unprovoked
2 - generalised
3 - systemic
4 - central
2 - generalised
Can partial / focal seizures develop into generalised seizures?
yes
- called a secondary generalised seizure
A generalised seizure is when both hemispheres are affected. There are subcategories of generalised seizures. Which of the following is NOT a form of generalised seizure?
1 - tonic
2 - atonic
3 - complex partial
4 - clonic
5 - tonic-clonic
6 - myoclonic
7 - absence
3 - complex partial
- tonic = stiff and flexed, patients fall backwards
- atonic = relaxed, patients fall forwards
- clonic = violent convulsions
- tonic-clonic = mixture
- myoclonic = small muscle twitches
- absence = patient spaces out
A generalised seizure is when both hemispheres are affected. There are subcategories of generalised seizures. Which of the this subcategories is most common?
1 - tonic
2 - atonic
3 - clonic
4 - tonic-clonic
5 - myoclonic
6 - absence
4 - tonic-clonic
- phases of violent convulsions mixed with relaxed muscles
What is the 1st line treatment for a patient having myoclonic seizures (range from muscle twitches to whole body spasms that can be brief)?
1 - Carbamazepine
2 - Phenytoin
3 - Diazepam
4 - Levetiracetam
5 - Sodium Valproate
5 - Sodium Valproate
- 2nd line is Levetiracetam
In a generalised (affecting the the whole brain) tonic-clonic seizure, there is a tonic phase (stiffening of the body) followed by a clonic phase (violent/jerking of the body). In the image below which is tonic and which is clonic?
A = tonic
- tonic (stiff) phase due to prolonged depolarization due to loss of GABA inhibition
- affected tissue cannot relax
B = clonic
- clonic (jerk) phase due to some neuronal repolarization
- following inactivity all tissues are stimulated quickly at one
What is the 1st line medication for a patient who is having generalised tonic-clonic seizures?
1 - Carbamazepine
2 - Phenytoin
3 - Diazepam
4 - Levetiracetam
5 - Sodium Valproate
5 - Sodium Valproate
- 2nd line could be Carbamazepine or Levetiracetam
What is an absence seizure?
1 - a seizure where patients lose consciousness
2 - a seizure where patients lose awareness of their surrounding for a period of time
3 - a seizure that has a stiff followed by involuntary actions
4 - combination of all of the above
2 - a seizure where patients lose awareness of their surrounding for a period of time
- looks like patient may be day dreaming
- dysfunction between cortex and thalamus
What is the 1st line medication for a patient who is having absence seizures?
1 - Carbamazepine
2 - Phenytoin
3 - Diazepam
4 - Levetiracetam
5 - Sodium Valproate
5 - Sodium Valproate
In all types of generalised seizures do patients lose consciousness?
- yes
- can be brief or for prolonger periods
If a seizure affects both sides of the hemisphere this is called a generalised seizure. Which of the following can occur during a generalised seizure?
1 - loss of awareness
2 - synchronous movements
3 - eyes remain open
4 - all of the above
4 - all of the above
In epilepsy seizures can be focal, affecting one specific location such as a lobe or one hemisphere, also called partial seizures of generalised where the the whole brain is affected. In focal / partial seziures they can be simple of complex partial seizures. Which of these does the patient typically remain concious?
- simple partial seizures
- patient is typically aware of what is happening and will remember
In epilepsy seizures can be focal, affecting one specific location such as a lobe or one hemisphere, also called partial seizures of generalised where the the whole brain is affected. In focal / partial seziures they can be simple of complex partial seizures. In simple partial seizures the patient is generally concious, is aware and will remember what happened. Which of the following typically occur during a simple partial seizures?
1 - strange sensations (smells, tastes etc..)
2 - jerking of muscles
3 - jacksonian march
4 - all of the above
4 - all of the above
- jacksonian march = small jerking of muscles spreads to surrounding areas increasing the jerking movements
In epilepsy seizures can be focal, affecting one specific location such as a lobe or one hemisphere, also called partial seizures of generalised where the the whole brain is affected. In focal / partial seziures they can be simple of complex partial seizures. In complex partial seizures the patient is generally unconcious. Which of the following typically occur during a complex partial seizures?
1 - loss of consciousness
2 - impaired awareness
3 - memory may be impaired
4 - all of the above
4 - all of the above
What is the 1st line medication for a focal (partial) epileptic seizure?
1 - Carbamazepine
2 - Phenytoin
3 - Diazepam
4 - Levetiracetam
5 - Sodium Valproate
1 - Carbamazepine
- Levetiracetam and Sodium Valproate could also be given