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YR6: NEURO > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is epilepsy?

A

a tendency to recurrent seizures, defined by:
>,2 unprovoked seizures occurring >24h apart.
OR
1 unprovoked seizure + high risk of subsequent seizure (>, 60% over the next 10y)
OR
Dx of an epilepsy syndrome.

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2
Q

What is reflex epilepsy?

A

Epilepsy in which seizures are consistently provoked by a certain trigger (e.g., lights, music, hormonal changes during menstrual cycle).

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3
Q

What is a seizure?

A

excessive +/or hypersynchronous activity of cortical neurons that results in transient neurological Sx

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4
Q

What is convulsive status epilepticus?

A

a prolonged convulsive seizure lasting >,5 mins
OR
recurrent seizures one after the other without recovery in between

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5
Q

What are the 2 broad types of seizure?

A

Focal: originate in 1 hemisphere. Retained or impaired awareness.
Generalised: originate bilaterally. Motor or Non-motor.

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6
Q

Give 3 causes of insult to the brain that can provoke one-off seizures

A

Infection e.g. meningitis, encephalitis
Trauma
Metabolic disturbance

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7
Q

List 3 conditions associated with epilepsy

A

Cerebral palsy
Tuberous sclerosis
Mitochondrial diseases

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8
Q

Give 3 causes of recurrent non-epileptic seizures

A

Febrile convulsions
Alcohol withdrawal seizures
Psychogenic non-epileptic seizures

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9
Q

Describe epidemiology of febrile convulsions

A

6 months- 5y
~3% of children will have at least 1 febrile convulsion

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10
Q

Describe febrile convulsions

A

usually early in a viral infection as temp rises rapidly
Seizures typically brief + generalised tonic/ tonic-clonic in nature

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11
Q

In which patients do alcohol withdrawal seizures occur?

A

Those with hx of alcohol excess who suddenly stop drinking
e.g. on admission to hospital

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12
Q

Describe pathophysiology of alcohol withdrawal seizures

A

Chronic alcohol consumption enhances GABA mediated inhibition in the CNS + inhibits NMDA-type glutamate receptors.
Withdrawal is thought to be lead to the opposite (decreased inhibitory GABA + increased NMDA glutamate transmission)

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13
Q

When is peak incidence of alcohol withdrawal seizures?

A

~36h

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14
Q

What are psychogenic seizures?

A

aka. pseudoseizures
Epileptic-like seizures but no characteristic electrical discharges
May have a hx of MH problems or personality disorder

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15
Q

What is the most common form of epilepsy?

A

Temporal lobe epilepsy

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16
Q

Give 4 features of temporal lobe seizures

A

+/- impaired awareness
Aura in most
Typically last 1 minute
Automatisms common

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17
Q

Describe the aura in temporal lobe seizures

A

Typically a rising epigastric sensation
also psychic or experiential phenomena, e.g. déjà vu, jamais vu
less commonly hallucinations (auditory/gustatory/olfactory)

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18
Q

What automatisms may be seen in temporal lobe epilepsy?

A

Lip smacking
Grabbing
Plucking

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19
Q

Give 4 features of frontal lobe seizures

A

Motor: Head/ leg movement
Posturing
Jacksonian march
Post-ictal weakness

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20
Q

What is Jacksonian march?

A

Spreading of paresthesia/ uncontrolled motor activity from one part of the body to adjacent areas, usually distally to proximally

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21
Q

Describe parietal lobe seizures

A

Sensory: paraesthesia

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22
Q

Describe occipital lobe seizures

A

Visual: floaters/ flashes

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23
Q

Which type of focal seizure is most likely to cause impaired awareness?

A

Temporal lobe seizure

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24
Q

How can focal aware seizures progress?

A

May spread from one hemisphere to both
= focal to bilateral tonic-clonic seizure

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25
What occurs in focal to bilateral tonic-clonic seizures?
Starts as unilateral, localised focal Sx Progresses to loss of consciousness + motor Sx (tonic-clonic seizure)
26
What are the 2 subtypes of generalised seizure?
Motor: visible physical movement Non-motor: 'absence', no physical movement
27
Give 3 features common to generalised seizures
Involve both hemispheres Start with loss of consciousness Amnesia of the event
28
List 5 types of generalised motor seizure
Tonic-clonic Tonic Clonic Myoclonic Atonic
29
What occurs in a typical absence seizure?
Interrupted motion/ activity, blank stare, unresponsiveness Usually <10s Subtle automatisms common Sudden onset + stop
30
What are absence seizures also known as?
Petit mal
31
Describe the post-ictal phase of absence seizures
Consciousness returns rapidly without any impairment Amnesia is common
32
What occurs in a tonic-clonic seizure?
aka 'grand mal' Loss of consciousness 1. Tonic stage- generalised muscle contraction + increased sympathetic tone 2. Clonic stage- rhythmic muscle twitching Bladder/ bowel incontinence Usually lasts 1-3 mins
33
List 3 manifestations of increased sympathetic tone in the tonic phase of a TC seizure
Dilated, unresponsive pupils Increased HR Increased BP
34
List 6 manifestations of generalised muscle contraction in the tonic phase of a tonic-clonic seizure
Rotated eyes Apnoea Tongue biting Pooled oral secretions Cyanosis Loud moan
35
List 6 post-ictal S/S of TC seizures
Unresponsiveness Confusion Aphasia Fatigue Muscle flaccidity + pain Headache
36
What occurs in a clonic seizure?
Loss of consciousness Bilateral rhythmical jerking movements
37
What occurs in a tonic seizure?
Loss of consciousness Muscle stiffening (extension or flexion of head, trunk, extremities)
38
What occurs in a myoclonic seizure?
+ve myoclonus: sudden jerk like muscle twitching -ve myoclonus: brief loss of muscle activity during tonic contraction Nonrhythmic (jerks occur at different intervals) + irregular (asymmetric + may change laterality)
39
What occurs in an atonic seizure?
aka "drop seizure/ attack" Sudden loss of muscle tone: sudden head drop/ collapse Lasts <15s
40
What investigations are used for epilepsy?
EEG MRI
41
Describe acute management of epileptic seizures
Most terminate spontaneously <5 mins: start timer, protect from injury, monitor >5 mins: Administer Benzodiazepines
42
What benzodiazepines are used in the acute management of seizure?
In community: Buccal midazolam (or Rectal Diazepam) If IV access: IV Lorazepam or Diazepam
43
Describe management of status epilepticus
1. A-E 2. PR Diazepam or Buccal Midazolam (if pre-hospital) or IV Lorazepam 3. Repeat benzo after 5-10 mins 4. IV Phenytoin/ Levetiracetam/ Sodium Valproate 5. Expert advice: Phenobarbital or GA
44
What should be taken into account when considering second line agent in status epilepticus?
Levetiracetam may be quicker to administer + have less adverse effects
45
When is treatment started for epilepsy?
Most: following 2 seizures Start after 1 if certain criteria met
46
In which circumstances should anti epileptics be started following first seizure?
Neurological deficit Structural abnormality on brain imaging Unequivocal epileptic activity on EEG Pt/ family consider risk of having a further seizure unacceptable
47
Describe drug choice for generalised tonic clonic seizures
M: Sodium Valproate F: Lamotrigine or Levetiracetam
48
When may sodium valproate be prescribed first line in females?
<10s who are unlikely to need Tx when old enough to have children Women unable to have children
49
Describe drug choice for focal seizures
1st: Lamotrigine or Levetiracetam 2nd: Carbamazepine, Oxcarbazepine or Zonisamide
50
Describe drug choice for absence seizures
1st: Ethosuximide 2nd: M: Sodium Valproate F: Lamotrigine or Levetiracetam
51
Which drug may exacerbate absence seizures?
Carbamezapine
52
Describe drug choice for myoclonic seizures
M: Sodium valproate F: Levetiracetam
53
Describe drug choice for tonic or atonic seizures
M: Sodium valproate F: Lamotrigine
54
What is the MOA of Sodium Valproate?
Inhibits GABA activity
55
List 9 side effects of sodium valproate
Vomiting Alopecia + Ataxia Liver toxicity Pancreatitis + decreased platelets Rash Obesity Appetite increase Teratogenic + Tremor Enzyme inhibitor (p450)
56
What is the MOA of Carbamezapine?
Binds to Na+ channels increasing refractory period
57
List 6 side effects of carbamazepine
SIADH: hyponatraemia + water retention Leukopenia + Agranulocytosis Enzyme inducer (p450) Ataxia Teratogenic VIsual disutrbance, esp. diplopia
58
What is the MOA of Lamotrigine?
Na+ channel blocker
59
Name a side effect of lamotrigine
Stevens-Johnson Syndrome
60
What is the MOA of Phenytoin?
Binds to Na+ channels increasing their refractory period
61
List 9 side effects of phenytoin
P450 inducer Hirsuitism Enlarged gums (gingival hyperplasia) Nystagmus Yellow-brown skin (melasma) Teratogenic Osteopenia Inhibited folate absorption (megaloblastic anaemia) Neuropathy
62
Describe driving regulations for epileptic patients
Can't drive for 6 months following a seizure. If established epilepsy, must be fit free for 12 months
63
List 4 forms of epilepsy seen in children
Infantile spasms (West's syndrome) Lennox Gastaut syndrome Benign rolandic epilepsy Juvenile myoclonic epilepsy (Janz syndrome)
64
What occurs in West's syndrome? Describe the nature of these
Brief spasms beginning in first few months of life Flexion of head, trunk, limbs → extension of arms (Salaam attack); last 1-2s, repeat up to 50x
65
Give 3 features of prognosis West's syndrome
Progressive mental handicap Usually 2nd to serious neurological abnormality (e.g. TS, encephalitis, birth asphyxia) or may be cryptogenic Poor prognosis
66
What is seen on EEG in West's syndrome?
EEG: hypsarrhythmia
67
What is Lennox Gastaut syndrome thought to be? When does it present? How?
May be extension of infantile spasms (50% have hx) onset 1-5y atypical absences, falls, jerks
68
What is seen on EEG in Lennox-Gastaut syndrome?
EEG: slow spike
69
Give 2 features of prognosis in Lennox Gastaut syndrome
90% moderate-severe mental handicap ketogenic diet may help
70
What occurs in Benign rolandic epilepsy?
paraesthesia (e.g. unilateral face) Seizures characteristically occur at night
71
In which group is juvenile myoclonic epilepsy more common?
Teens, esp. girls
72
Describe the nature of juvenile myoclonic epilepsy
1. Infrequent generalized seizures, often in morning 2. Daytime absences 3. Sudden, shock-like myoclonic seizure
73
Juvenile myoclonic epilepsy usually has a good response to what?
Sodium valproate
74
What are primary epilepsy syndromes?
idiopathic generalised epilepsy Temporal lobe epilepsy Juvenile myoclonic epilepsy
75
What should you establish from the history prior to the seizure?
Rapidity of onset? Duration of episode Alteration of consciousness? Tongue-biting/ incontinence? Rhythmic synchronous limb jerking? Post-ictal period? Drug hx (alcohol, recreational drugs)
76
What bloods should be taken in epilepsy?
``` FBC U+E LFTs Glucose Calcium Magnesium ABG Toxicology screen Prolactin: transient increase shortly after seizures ```
77
What investigation can help confirm the diagnosis of epilepsy?
EEG: to confirm dx + classify the epilepsy Ictal EEGs are particularly useful
78
What other investigations are performed when diagnosing epilepsy?
CT/ MRI: to exclude structural, space-occupying + vascular lesions. LP to identify infectious aetiology HIV serology
79
What is included in the conservative approach of Patient Education for preventing seizures?
Avoid triggers Use seizure diaries Supervised swimming/ climbing Anti-epileptic drugs can have teratogenic effects (consider pregnancy) Drug interactions (e.g. AEDs can reduce effectiveness of OCP)
80
List 3 complications of epilepsy
Fractures (Tonic-clonic seizures) Behavioural problems Sudden Death in Epilepsy
81
What is the prognosis in epilepsy?
50% remission at 1 year
82
What surgical approaches can be used in epilepsy?
Removal of definable epileptogenic focus Vagus nerve stimulator

YR6: NEURO (47 decks)

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