Epilepsy Flashcards
How are seizures classified?
Focal onset
- Aware vs Impaired aware
- Motor onset vs nonmotor onset
Generalised onset
- Motor vs nonmotor (absence)
Unknown onset
- Motor vs nonmotor
Young pt sleep deprived due to exams. Has GT seizure. Has generalized spike and wave pattern when drowsy on EEG. Dx?
Genetic generalized epilepsy
- can make Dx of epilepsy based on only 1 seizure because other presentation fits (ie young, sleep deprivation, typical EEG pattern)
GLUT 1 deficiency manifestations? Treatement?
GLUT 1 def in infants can cause epilepsy
GLUT 1 def in adults can cause paroxysmal exersise induced dystonia +/- epilepsy +/- haemolytic anaemia
Due to inability to get glucose in CNS
Therefore treat with ketogenic diet
What is tuberous sclerosis? Pathophys and treatment?
This is a rare AD inherited multisystem disorder that causes non cancerous tumers to grow in the brain and other organs
- many have epilepsy due to brain tumours
Due to mutations in TSC1 and TSC2 genes that lead to aberrent signalling in the mTOR pathway
Treated with mTOR inhibitors (everolimus)
What is the HLA type assoicated with antiepileptics (aromatic such as carbamazapine) assoicated SJS/TEN?
HLA B1502
- han chinese
What is the HLA type assoicated with antiepileptics (aromatic such as carbamazapine) assoicated DRESS?
HLA A 3101
Slower background rhythm (6Hz) with Biphasic waves on EEG. What condition?
diffuse encephalopathy, mild
Much slower (ie 4Hz) background waves. What condition?
moderate to severe diffuse encephalopathy
Pt with epilepsy, found to have focal slowing on his non-seziure EEG? what does this indicated?
Focal slowing indicates a focal abnoramlity in the brain, could indicate structural cause of epilepsy
What is a sharp wave discharge on EEG?
sharp wave followed by some slow waves is an epileptiform discharge
What is spike a wave pattern on EEG?
This is analogous to the sharp wave discharge but generalized
Ie spike and wave pattern = generalized epileptiform discharge
Pt has periodic lateralised epileptiform dischaerges (PLEDs). What condition?
Herpes simplex encephalitis
Looks like rhythmic period high amplitude spikes that occur more so on one side (ie lateralised to the left)
Pt has generalised periodic epileptiform dischaerges (PLEDs). What condition?
Hypoxic brain injury
What test to look as structure? and what test to look at funciton of brain in epilepsy?
MRI
PET / SPECT
What are 2 common forms of focal epilepsy?
What is the most common cause?
Mesiotemporal lobe epilepsy
Frontal lobe epilepsy
What is mesiotemporal lobe epilepsy. What type of seizure? What is the underlying pathology? Managment?
Mesiotemporal lobe epilepsy
- Common form of focal epilepsy
- Usually focal aware seizure -> focal imparied aware -> generalised tonic clonic
- Most common cause is hippocampal sclerosis characterized by neuronal loss and atrophy in the hipocampus (MRI), and PET decreased funcitoning
Cause is unknown
Management
- medicaitons
- Lifestyle modification (avoid etoh and stress)
- Psychological care
First line medicatiosn for focal seizures (ie mesiotemporal lobe epilsepsy)?
Sodium channel blocker
- carbamazapine (ETG says this)
- lamotrogine (less enzyme inducing activity)
- Oxcarbazapine
What is frontal lobe epilepsy. What type of seizure?
Frontal lobe epilepsy
- common form of focal onset seizure
- Form of seizure related to area affected. Can have sleep related hypermotor / hyperkinetic seizures
- Often short duration seizures, short post ictal period
- Caused by unilateral frontal lobe hypofunction (PET), nil structural change (MRI normal)
One form of frontal lobe epilepsy is called sleep related hyper motor epilepsy
- this is an autosomal dominant condition
What is the most common form of generalized epilepsy?
Idiopathic generalised epilepsy is most common
- Juvelinile myoclonic epilepsic is a type of idiopathic generalized epilepsy
What is juvenile myoclinic epilepsy? what are the features? managment?
- MRI normal
- PET normal
Presentation with classic triad of symptoms:
- Myoclonic jerks often in the morning. Often recalled as clumbsiness or dropping things in the morning
- generalised tonic clinic seizures, very symetrical
- Absence seizures occur in some pts
Seizures often happen when walking
Triggers:
- sleep deprivation
- stress
- alcohol in excess
managment:
- valproate in men (avoid in women because preg)
- Avoid carbamazapine, oxcarbazamine because and worsen abscense seizures
- Lifestyle care (triggers)
- psychosocial care
Common form of autoimmune epilepsy? General treatment?
faciobrachial seizures (classically associated with Lgi1-encephalitis )
- AED + immunotherapy
Treatment for abscence seizures in isolation?
Ethosuxamide
What are 4x enzyme inducing antiepileptics?
What are 1x enzyme inhibiting antiepileptics?
phenytoin
Phenibarbitone
carbamazapine/oxcarbazine
primidone
Valproate
1x example of anticonvulsant synergism?
valproate and lamotrogine
First line med in generalised epilepsy?
VPA
What are two new antiepileptics?
Perampanel
Lacosamide
Brivaracetam (new version of leviteracitam but with less neuropsychiatric side effects)
Pt on multiple other medications, which antiuepileptic to avoid?
carbamazapine (enzyme inducer)
Best drugs in preg for epi?
Lamotrogine and leviteracitam
When does SUDEP occur most commonly in the preg?
thrid tri
post partum period
Highest RF for SUDEP?
seizures from sleep
