Epilepsy Flashcards
What is epilepsy?
Tendency to have seizures due to abnormal electrical activity in the brain
What are the features of tonic-clonic seizures?
Loss of consciousness
Muscle jerking (clonic)
Muscle tensing (tonic)
Tongue biting
Incontinence
Which phase usually comes first in a tonic-clonic seizure?
Tonic phase
What is the first line treatment of tonic-clonic seizures?
Sodium valproate for males
Lamotrigine or levetiracetam for females
What is the second line treatment of tonic-clonic seizures?
Lamotrigine or carbamezapine
How does an absence seizure present?
Usually children
Stare into space for a few seconds
Abruptly returns to normal
Lasts around 20 seconds
What is the first line management of absence seizures?
Ethosuximide
When is sodium valproate contraindicated?
In females of fertile age
What are the side effects of sodium valproate?
Teratogenic
Liver damage
Hair loss
Tremor
Weight gain
Oedema
Ataxia
What is the first line medication for focal seizures?
Lamotrigine or leveteracitam
What is the second line medication for focal seizures?
Carbamezapine
What are the features of a frontal focal seizure?
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
What is Todd’s paresis?
When a seizure is followed by a brief period of paralysis
What are the features of a temporal lobe focal seizure?
Deja vu
Lip smacking
Emotional disturbance - sudden onset of fear
Hallucinations - auditory, gustatory or olfactory
What are the features of a parietal lobe focal seizure?
Sensory symptoms - tingling and numbness
Motor symptoms - from spread of seizure into pre-frontal gyrus where motor cortex is
What are the features of an occipital focal seizure?
Visual symptoms - dots and lines in the vision
What are the features of a myoclonic seizure?
Sudden jerking of the limbs, face or trunk
What is the first line medication for a myoclonic seizure?
Sodium valproate for males
Levetiracetam for females
What drug worsens myoclonic seizures?
Carbamezapine
What is the first line medication in hospital for status?
IV lorazepam
What is status epilepticus?
5 or more minutes of continuous seizure
What is the driving guidance for patients with epilepsy?
1 seizure - 6 months seizure free
More than 1 seizure - one year seizure free
What are the features of an atonic seizure?
Sudden loss of muscle tone, which leads to a fall
No loss of consciousness
What is the first line management of status epilepticus in the community?
Buccal medazolam or rectal diazepam
Repeat 15 minutes later
What medication can worsen absence seizures?
Carbamezapine
What investigations are performed to diagnose epilepsy?
EEG (after 2 seizures)
MRI brain
ECG
Electrolytes
Blood glucose
Blood cultures, urine cultures
Lumbar puncture
What is juvenile myoclonic epilepsy?
An epilepsy syndrome characteristed by infrequent generalised seizures (often in the morning), absence seizures and sudden shock like myoclonic jerks
When is the typical onset of juvenile myoclonic epilepsy?
In teenage years
Who is juvenile myoclonic epilepsy more common in?
Girls
What is benign rolandic epilepsy?
An epileptic syndrome characterised by either tonic-clonic seizures, or focal seizures with abnormal sensation in the face
- These seizures typically occur during sleep
When can medication be started for seizures?
After a patient has had 2 seizures, and has been investigated with an EEG
What are the fetal complications of antiepileptics in pregnancy?
Orofacial defects
Haemorrhagic disease of the newborn
Congenital heart defects
Spina bifida
What are the complications of sudden withdrawal of antiepileptics?
Status epilepticus
Suddent unexpected death in epilepsy
Do antiepileptic levels increase or decrease in pregnancy?
Decreased due to increased hepatic metabolism and increased renal clearance
Can breastfeeding women take antiepileptics?
Yes
What investigation can be used to distinguish between a true seizure and a pseudoseizure?
Prolactin - prolactin will be raised in a true eplipetic seizure
What is the definition of a seizure?
A transient episode of abnormal electrical activity in the brain
What general advice should be offered to parents of children with epilepsy?
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
What is West syndrome?
A type of childhood epilepsy
When does West syndrome typically present?
Between 4 and 8 months
What are the features of West syndrome?
Salaam attacks - flexion of head trunk and arms, followed by extension of the arms
What is the first line therapy for West syndrome?
Vigabatrin
What features favour a pseudoseizure?
Pelvic thrusting
Family member with epilepsy
Crying after seizure
Don’t occur when alone
Gradual onset
