Epilepsy Flashcards

1
Q

Epilepsy definition

A

a condition characterised by an increased susceptibility to spontaneous epileptic seizures

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2
Q

Epileptic seizure definition

A

transient episode of abnormal neurological function caused by sudden excessive or hypersynchronous cortical neuronal activity

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3
Q

What are the 2 main seizure types?

A

focal (partial)
generalised

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4
Q

Where does a focal seizure affect?

A

affects on hemisphere

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5
Q

Name some subtypes of generalised seizures

A

absence (petit mal)
myoclonic
tonic
clonic
tonic clonic (grand mal)
atonic

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6
Q

Describe absence seizures (petit mal)

A

sudden onset
behavioural arrest
unresponsive
staring
minor blinking
duration = seconds
quick recovery
characteristic EEG

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7
Q

Describe myoclonic jerk seizures

A

brief jerks
usually involving upper limbs
may affect limbs and trunk
may show diurnal variation

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8
Q

Myoclonic seizure EEG sign

A

4-6 irregular polyspike wave

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9
Q

Describe tonic seizures

A

sudden onset
muscle contraction - limbs, axial muscles
consciousness usually impaired
may result in forceful sudden falls
common during sleep

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10
Q

Describe atonic seizures

A

sudden onset
loss of muscle tone
consciousness usually impaired
lasts 1-2 seconds
may result in sudden falls

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11
Q

What are some alternative diagnoses to seizures?

A

syncope
non-epileptic attack disorder
transient ischaemic attack
narcolepsy
cataplexy
transient global amnesia

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12
Q

Describe some differences between syncope and seizure

A

syncope:
- prodromal symptoms
- pallor
- fall
- hypotonia
- brief duration
- no post-ictal confusion

seizure:
- variable warning
- fall
- initial tonic phase
- cyanosis
- clonic jerking
- duration = minutes
- tongue biting
- incontinence
- post-ictal confusion

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13
Q

What causes epileptic seizures?

A

things that affect brain structures:
- developmental abnormalities
- brain trauma
- stroke
- tumours
- infections
- immune-mediated inflammation

things that affect the brain’s metabolic or electrophysiological function:
- alcohol withdrawal
- drugs
- hypoglycaemia
- other biochemical disturbances

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14
Q

Describe childhood absence epilepsy

A

onset in childhood
girls>boys
frequent absence seizures
characteristic EEG (generalised 3HZ spike and wave discharges, hyperventilation induced seizures)
+ve FH of epilepsy
usually remits at puberty
responds well to ethosuximide or sodium valproate

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15
Q

Describe Juvenile myoclonic epilepsy

A

age-related onset of absences, jerks, generalised tonic clonic seizures
absences begin 5-16y
myoclonic jerks follow 1-9y later
GTCS about same time as myoclonus

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16
Q

Precipitating factors of seizures in juvenile myoclonic epilepsy

A

sleep deprivation
fatigue
alcohol
emotional stress, excitement

17
Q

Juvenile myoclonic epilepsy management

A

lifestyle advice
sodium valproate
lamotrigine
clonazepam
levetiracetam

18
Q

Symptoms of seizures arising from mesial temporal lobe

A

olfactory
fear
deja vu, jamais vu, derealisation
epigastric sensation
behavioural arrest
altered awareness/consciousness
blank staring expression
lip-smacking, swallowing, chewing automatisms
post-ictal confusion, dysphasia, gradual recovery

19
Q

What drugs can be used for absence seizures?

A

1) ethosuximide
2) sodium valproate
3) lamotrigine
4) levetiracetam
5) zonisamide
6) clonazepam

20
Q

Drugs for focal seizures

A

lamotrigine
carbamazepine

21
Q

Drugs for generalised seizures

A

sodium valproate
lamotrigine

22
Q

Drugs for myoclonic seizures

A

sodium valproate
levetiracetam
topiramate
clonazepam
zonisamide

23
Q

What drugs should be avoided for myoclonic seizures?

A

carbamazepine
gabapentin
oxcarbazepine
pregabalin
vigabatrin
tiagabine

24
Q

Drugs for atonic and tonic seizures

A

sodium valproate
lamotrigine
topiramate
rufinamide (licensed for atonic seizures in Lennox Gastaut syndrome)

25
Q

List some causes of excess mortality in epilepsy

A

underlying disease (stroke, brain tumour)
suicide
seizure-related accidents (drowning)
status epilepticus
drug reactions
aspiration pneumonia
SUDEP (Sudden Unexpected Death in Epilepsy)

26
Q

Risk factors for SUDEP (Sudden Unexpected Death in Epilepsy)

A

young
generalised tonic-clonic seizures
uncontrolled epilepsy
learning disability
seizures occurring during sleep
poor adherence to antiepileptic drug regimens