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Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is epilepsy?

A

Tendency to have seizures due to abnormal electrical activity in the brain

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2
Q

What are the features of tonic-clonic seizures?

A

Loss of consciousness
Muscle jerking (clonic)
Muscle tensing (tonic)
Tongue biting
Incontinence

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3
Q

Which phase usually comes first in a tonic-clonic seizure?

A

Tonic phase

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4
Q

What is the first line treatment of tonic-clonic seizures?

A

Sodium valproate for males
Lamotrigine or levetiracetam for females

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5
Q

What is the second line treatment of tonic-clonic seizures?

A

Lamotrigine or carbamezapine

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6
Q

How does an absence seizure present?

A

Usually children
Stare into space for a few seconds
Abruptly returns to normal
Lasts around 20 seconds

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7
Q

What is the first line management of absence seizures?

A

Ethosuximide

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8
Q

When is sodium valproate contraindicated?

A

In females of fertile age

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9
Q

What are the side effects of sodium valproate?

A

Teratogenic
Liver damage
Hair loss
Tremor
Weight gain
Oedema
Ataxia

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10
Q

What is the first line medication for focal seizures?

A

Lamotrigine or leveteracitam

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11
Q

What is the second line medication for focal seizures?

A

Carbamezapine

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12
Q

What are the features of a frontal focal seizure?

A

Jacksonian features - numbness of tingling starts isolated, and then moves to the other limbs on the same side of the body
Dysphasia
Todd’s paresis

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13
Q

What is Todd’s paresis?

A

When a seizure is followed by a brief period of paralysis

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14
Q

What are the features of a temporal lobe focal seizure?

A

Deja vu
Lip smacking
Emotional disturbance - sudden onset of fear
Hallucinations - auditory, gustatory or olfactory

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15
Q

What are the features of a parietal lobe focal seizure?

A

Sensory symptoms - tingling and numbness
Motor symptoms - from spread of seizure into pre-frontal gyrus where motor cortex is

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16
Q

What are the features of an occipital focal seizure?

A

Visual symptoms - dots and lines in the vision

17
Q

What are the features of a myoclonic seizure?

A

Sudden jerking of the limbs, face or trunk

18
Q

What is the first line medication for a myoclonic seizure?

A

Sodium valproate for males
Levetiracetam for females

19
Q

What drug worsens myoclonic seizures?

A

Carbamezapine

20
Q

What is the first line medication in hospital for status?

A

IV lorazepam

21
Q

What is status epilepticus?

A

5 or more minutes of continuous seizure

22
Q

What is the driving guidance for patients with epilepsy?

A

1 seizure - 6 months seizure free
More than 1 seizure - one year seizure free

23
Q

What are the features of an atonic seizure?

A

Sudden loss of muscle tone, which leads to a fall
No loss of consciousness

24
Q

What is the first line management of status epilepticus in the community?

A

Buccal medazolam or rectal diazepam
Repeat 15 minutes later

25
Q

What medication can worsen absence seizures?

A

Carbamezapine

26
Q

What investigations are performed to diagnose epilepsy?

A

EEG (after 2 seizures)
MRI brain
ECG
Electrolytes
Blood glucose
Blood cultures, urine cultures
Lumbar puncture

27
Q

What is juvenile myoclonic epilepsy?

A

An epilepsy syndrome characteristed by infrequent generalised seizures (often in the morning), absence seizures and sudden shock like myoclonic jerks

28
Q

When is the typical onset of juvenile myoclonic epilepsy?

A

In teenage years

29
Q

Who is juvenile myoclonic epilepsy more common in?

A

Girls

30
Q

What is benign rolandic epilepsy?

A

An epileptic syndrome characterised by either tonic-clonic seizures, or focal seizures with abnormal sensation in the face
- These seizures typically occur during sleep

31
Q

When can medication be started for seizures?

A

After a patient has had 2 seizures, and has been investigated with an EEG

32
Q

What are the fetal complications of antiepileptics in pregnancy?

A

Orofacial defects
Haemorrhagic disease of the newborn
Congenital heart defects
Spina bifida

33
Q

What are the complications of sudden withdrawal of antiepileptics?

A

Status epilepticus
Suddent unexpected death in epilepsy

34
Q

Do antiepileptic levels increase or decrease in pregnancy?

A

Decreased due to increased hepatic metabolism and increased renal clearance

35
Q

Can breastfeeding women take antiepileptics?

A

Yes

36
Q

What investigation can be used to distinguish between a true seizure and a pseudoseizure?

A

Prolactin - prolactin will be raised in a true eplipetic seizure

37
Q

What is the definition of a seizure?

A

A transient episode of abnormal electrical activity in the brain

38
Q

What general advice should be offered to parents of children with epilepsy?

A

Take caution when swimming
Take caution with heights
Shower rather than have a bath
Record any further episodes
Call 999 if a seizure lasts more than 5 minutes, or more than 2 minutes with LOC

Neurology (32 decks)

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