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Y3 - Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is a seizure?

A

spontaneous uncontrolled abnormal brain activity

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2
Q

What is epilepsy?

A

a tendency to have seizures. Epilepsy is a symptom, and not a true condition. Epilepsy can be diagnosed after a minimum of 2 seizures.

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3
Q

What is an ictus?

A

can refer to any acute event, in this situation, refers to the epilepsy attack itself.

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4
Q

What is prodrome?

A

a set of not specific symptoms that precede the onset of a disease, in this case, epilepsy

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5
Q

What is aura?

A

sensory disturbances that precede an attack, usually just by a few minutes. Can be visual, tactile, olfactory – pretty much any sensation.

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6
Q

What is the epidemiology of epilepsy?

A

The lifetime risk of having a seizures is about 1-2%
Prevalence of epilepsy is about 0.5% – i.e. it is very common!
70% of cases have no identified cause
70% of cases are well controlled with drug treatment
Normally presents in childhood/teenage years
5x more common in developing countries

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7
Q

What percent of patients with epilepsy will have a relative also with epilepsy?

A

30% of patients will have a first degree relative with epilepsy. But in most cases, there is no specific syndrome present

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8
Q

What can cause epilepsy?

A

Developmental abnormalities
Trauma / Surgery
Hypoxia
Pyrexia – particularly in children
Mass lesion in the skull
Drugs
CNS infection
Vascular abnormalities – particularly in the elderly; including stroke.
Metabolic disturbance

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9
Q

What is the pathology of epilepsy?

A
  1. In epilepsy there is an abnormal synchronised discharge of neurons.

Normal inhibitory mechanisms fail. Individuals are said to have a seizure threshold – this is the level of excitability at which cells will discharge uncontrollably. In epileptic patients we say that the seizure threshold is lowered, and the neurons are hyperexcitable.

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10
Q

What are the main two neurotransmitters involved?

A
  1. Glutamate (excitatory)
  2. GABA (inhibitory)
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11
Q

What are common triggers for epileptic patients?

A
  1. Sleep deprivation
  2. Alcohol (withdrawal and intake)
  3. Drug misuse
  4. Physical/mental exhaustion
  5. Flickering lights - primary generalised epilepsy only
  6. Infection/metabolic disturbance
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12
Q

What are less common triggers for epileptic patients?

A
  1. Loud noises
  2. Hot bath
  3. Reading
  4. Strange shapes
  5. Strange smells
  6. Strange sounds
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13
Q

Give 7 types of seizure:

A
  1. Generalised tonic-clonic
  2. Partial
  3. Myoclonic
  4. Tonic
  5. Atonic
  6. Absence
  7. Febrile convulsions
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14
Q

What two categories can partial seizures be broken into?

A
  1. Simple partial seizure
  2. Complex partial seizure
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15
Q

What is a simple partial seizure?

A

refers to focal seizures that remain confined to one part of the brain
- Patient remains conscious
- isolated limb jerking is common
May be isolated head turning (away from the side of the seizure)
May be isolated parasthesia – There can be any isolated motor/sensory sign
weakness of limbs may follow

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16
Q

What is Todd’s paralysis?

A

Weakness of the limbs may follow

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17
Q

What is a complex partial seizure?

A

Temporal lobe seizure

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18
Q

What are the symptoms of a complex partial seizure?

A

May impair consciousness
Déjà vu
Jamais vu – feelings of unfamiliarity
Vertigo
Visual/auditory hallucinations
Lip smacking / other motor disturbances
Tachycardia
Emotional disturbance
Automatism – patients have impaired consciousness, but motor function may still be intact, so they can often wander off.
Drowsiness and confusion after the attack

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19
Q

Give 4 features of generalised tonic-clonic seizures:

A

1) involve tonic (muscle tensing) and clonic (muscle jerking) movements
2) patient loses consciousness
3) patient may experience an aura beforehand
4) may include tongue biting, incontinence and irregular breathing

20
Q

What is the post-ictal period?

A

the altered state of consciousness after an epileptic seizure which usually lasts between 5 and 30 minutes

21
Q

Give 2 features of how partial seizures present:

A

1) they affect hearing, speech, memory and emotions
2) the patient remains awake

22
Q

What is the difference between a simple and complex partial seizure?

A

the patient remains aware during simple partial seizures but lose awareness in complex partial symptoms

23
Q

Give 4 general symptoms associated with partial seizures:

A

1) deja vu
2) strange smells, tastes, sights or sound sensations
3) unusual emotions
4) abnormal behaviours

24
Q

Describe a myoclonic seizure:

A

sudden, brief muscle contractions (like an abrupt jump or jolt) where the patient remains awake

25
Q

Describe a tonic seizure:

A

sudden onset of increased muscle tone where the entire body stiffens, often resulting in a fall

26
Q

Describe an absence seizure;

A

Patient becomes blank, stares into space and then abruptly returns to normal - the child is unaware of their surroundings and do not respond

27
Q

Describe an atonic seizure:

A

sudden loss of muscle tone causing the body to slump to the ground while the patient remains awake

28
Q

True or false: febrile convulsions are caused by epilepsy

A

false

29
Q

What are febrile convulsions?

A

tonic clonic seizures seen in children with high fevers

30
Q

What is typical during a tonic clonic seizure?

A

Often aura before attack
Tonic phase (10-60s)
Rigidity
Epileptic cry
Tongue biting
Incontinence
Hypoxia/cyanosis – no breathing during this phase
Clonic Phase (seconds-minutes)
Convulsions / limb jerking
Eye rolling
Tachycardia
No breathing / random, uncoordinated breaths

31
Q

Name two investigations used to diagnose epilepsy:

A

1) electroencephalogram
2) brain MRI

32
Q

Give 3 non-pharmaceutical interventions for epilepsy:

A

1) the DVLA should remove their drivers licence until they are seizure free for a year
2) take showers rather than baths to prevent drowning
3) have caution when working at heights or with dangerous equipment

33
Q

What drug is given to men and women who cannot have children to treat generalised tonic-clonic seizures?

A

sodium valproate

34
Q

What two drugs can be given to women who can have children to treat tonic-clonic seizures?

A

1) lamotrigine
2) levetiracetam

35
Q

What two drugs can be given to both men and women regardless of childbearing status to treat partial seizures?

A

1) lamotrigine
2) levetiracetam

36
Q

What drug is given to men and women who cannot have children to treat myoclonic, tonic and atonic seizures?

A

sodium valproate

37
Q

What drug is given to women who can have children to treat myoclonic seizures?

A

Levetriacetam

38
Q

What drug is given to women who can have children to treat tonic and atonic seizures?

A

lamotrigine

39
Q

What drug is given to treat absence seizures?

A

ethosuximide

40
Q

How does sodium valproate treat seizures?

A

it increases the activity of GABA which has a calming, neuroinhibiting effect

41
Q

Give 5 side effects of sodium valproate:

A

1) liver damage and hepatitis
2) hair loss
3) tremor
4) reduces fertility
5) highly teratogenic (neural tube defects and developmental delay)

42
Q

What is status epilepticus?

A

a medical emergency where a seizure lasts more than 5 minutes OR there are multiple seizures without regaining consciousness in between

43
Q

Describe the initial ABCDE management of status epilepticus:

A

1) give oxygen and secure airway
2) check blood glucose levels
3) gain IV access

44
Q

What is the first line drug for status epilepticus?

A

benzodiazepines

45
Q

Give 3 examples of benzodiazepines which are used to treat status epilepticus and their routes of entry:

A

1) buccal midazolam
2) rectal diazepam
3) IV lorazepam

46
Q

What is the second line drug for status epilepticus if two rounds of benzodiazepine do not work?

A

IV levetiracetam OR sodium valproate

47
Q

What is the third line management for status epilepticus if benzodiazepines and levetiracetam/sodium valproate cannot stop the seizures?

A

general anaesthesia

Y3 - Neurology (11 decks)

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