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Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is a seizure?

A

An abnormal discharge of electrical activity in the brain

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2
Q

What is epilepsy?

A

A tendency to recurrent, usually spontaneous, epileptic seizures

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3
Q

What are some factors that can contribute to epilepsy?

A

Genetic factors
Acquired brain conditions
Metabolic factors
Toxic factors
Environmental factors

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4
Q

Describe the aetiology of generalised epilepsy

A

Childhood - Adolescence
Usually have a genetic predisposition

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5
Q

What is an epileptic seizure?

A

An abnormal synchronisation of neuronal activity, usually excitatory with high frequency action potentials but can sometimes be predominantly inhibitory

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6
Q

What are some changes that occur in seizure?

A
  • Cell numbers/types
  • Connectivity
  • Synaptic function
  • Voltage-gated ion channel function
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7
Q

What us the usual length of a seizure?

A

Seconds to minutes

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8
Q

What are some ways in which seizures can be classified?

A

Location of onset
Awareness of seizure
Symptoms of seizure

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9
Q

How are seizures classified by location of onset?

A

Focal
Generalised

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10
Q

How are seizures classified by awareness?

A

Aware
Impaired

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11
Q

How are seizures classified by symptoms?

A

Motor
Sensory
Psychic

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12
Q

Describe the pathophysiology of focal seizure

A

1 area of the brain is structurally normal
This causes production of a seizure which stays in this area

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13
Q

How can a focal seizure generalise

A

The area of electrical activity may pass onto a pathway that runs throughout the brain, causing spread to other parts of the brain

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14
Q

What are the 3 main forms of focal seizure

A

Motor
Sensory
Psychic

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15
Q

What are the 5 main types of generalised seizure?

A

Absence
Myoclonic
Atonic
Tonic
Tonic-Clonic

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16
Q

Describe the pathophysiology of a generalised seizure

A

An abnormality occurs of a pathway that runs through the brain (Not an abnormality that spreads through the pathway), causing problems in many regions of the brain

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17
Q

Presentation - Absence seizure

A

Goes blank and unresponsive for a few seconds

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18
Q

Presentation - Myoclonic seizure

A

Sudden muscle jerks

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19
Q

Presentation - Atonic

A

Muscles suddenly relax and the person will fall over

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20
Q

Presentation - Tonic

A

Muscles go stiff and the person will fall

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21
Q

Presentation - tonic-clonic

A

Muscles stuffed and tighten rhythmically

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22
Q

What type of epilepsy is associated with hippocampal sclerosis

A

Temporal lobe epilepsy

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23
Q

What are some risk factors for juvenile myoclonic epilepsy?

A

Sleep deprivation
Flashing lights

24
Q

How will juvenile myoclonic epilepsy present?

A

Early morning jerks
Generalised myoclonic (rhythmic muscle jerks) seizures

25
Q

What are some symptoms of motor focal epilepsy?

A

Rhythmic jerking, posturing, head and eye deviation, other movements (eg cycling), automatisms (eg plucking), vocalisation

26
Q

What are some symptoms of sensory focal epilepsy?

A

Somatosensory, olfactory, gustatory, visual, auditory dysfunction

27
Q

What are some symptoms of psychic focal epilepsy?

A

Memories, déjà vu, jamais vu, depersonalisation, aphasia, complex visual hallucinations etc

28
Q

What are some important history points in epilepsy?

A

What were they doing before, during and after the event, what did they look like (Ask witnesses), what type of movements were there

29
Q

What test is always performed in suspected seizure?

A

ECG - Rule of prolonged QT syndrome

30
Q

What are the uses of EEG in epilepsy?

A

Distinguish between non-convulsive status and encephalopathy
Otherwise very unreliable

31
Q

What are some uses of CTb or MRIb in epilepsy?

A

Indicated in acute cases to rule out skull fracture, in cases of deteriorating GCS or head injury

32
Q

What anti-E drugs are good for most seizure types?

A

Lamotrigine
Levetiracetam
Valproate

33
Q

What are some anti-E medications used in focal seizures?

A

Carbamazepine
Gabapentin
Phenytoin

34
Q

What anti-E drug may worsen myoclonic seizures

A

Carbamazepine

35
Q

Drug - Absence seizures

A

Ethosuxamide
Sodium valproate

36
Q

Drug - Myoclonic seizures

A
  • Sodium valproate
  • Levetiracetam
  • Clonazepam
37
Q

Drug - Tonic, atonic, generalised tonic-clonic

A
  • Sodium valproate (1st line)
  • Levetiracitam
  • Lamotrigine
38
Q

Describe the car driving rules for seizures (Non-epilepsy)

A

1st seizure = 6 months no car-driving

39
Q

Describe the HGV driving rules for seizures (Non-epilepsy)

A

1st seizure = 5 years no HGV-driving

40
Q

Describe the car driving rules for epilepsy

A

1 year no car-driving following last seizure

41
Q

Describe the HVG driving rules for epilepsy?

A

10 years no HGV-driving following last seizure and no medication

42
Q

What are some of the pre-synaptic targets for anti-epileptic drugs?

A

Voltage-gated Na+ channels (drives APs)
Voltage-gated K+ channels (Lowers neuronal excitation)
SV2A (Neurotransmitter release)
Voltage-gated Ca2+ channels (influx drives neurotransmitter release)

43
Q

What anti-E medications target voltage-gated Na+ channels to reduce APs in the pre-synaptic neurones

A

Carbamazepine
Lamotrigine
Phenytoin

44
Q

What anti-E medication targets voltage-gated K+ channels to reduce pre-synaptic neuronal excitation?

A

Retigabine

45
Q

What anti-E medications target SV2A channels to reduce neurotransmitter release?

A

Levetiracetam

46
Q

What anti-E medications target voltage-gated Ca2+ channels to reduce neurotransmitter release?

A

Pregabalin
Gabapentin
Ethosuxamide

47
Q

What are some targets for anti-E medication in the GABA system?

A

GABA synthesis
GABA transporter (Removes GABA from synapse)
GABA transaminase (Degrades GABA)
GABA receptor (Reduces neuronal excitability)

48
Q

What anti-E medication increases GABA synthesis?

A

Sodium valproate

49
Q

What anti-E medication inhibits the GABA transporter?

A

Tiagabine

50
Q

What anti-E medications inhibit GABA transaminase?

A

Vigabatrin

51
Q

What anti-E medications increase GABA receptor presentation?

A

Benzodiazepines
Barbituates
Falbamate
Topiramate

52
Q

Side effects of phenytoin

A

Gum hyperplasia
Hair growth

53
Q

Side effects of sodium valproate

A

Weight gain
!!!!!!!!!!!!!!! Teratogenic !!!!!!!!!!!!!!!!!!!!!!!
Hair loss
Fatigue

54
Q

Side effects of levetiracetam

A

Mood swings

55
Q

Side effects of topiramate

A

Sedation
Dysphasia
Weight loss

56
Q

What anti-E medications can alter the efficacy of morning-after pill

A
  • Carbamazepine
  • Oxycarbazepine
  • Phenobarbitol
  • Phenytoin
  • Primidone
  • Topiramate
57
Q
A

Neurology (28 decks)

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