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Epilepsy Flashcards

1
Q

which AEDs are enzyme inducers

A

arbazepine
phenytoin
topiramate

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2
Q

what might happen in an epileptic aura

A

rising epigastric sensation
olfactory and gustatory
psychic (depersonalisaton, derealisation, deja vu)
limbic (fear)

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3
Q

what are the three A’s of complex partial seizures

A

aura
arrest
automatism (tends to be ipsilateral)

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4
Q

what is JME

A

juvenile myoclonic epilepsy
myoclonic jerks develop in teenage years which are eventually followed by generalized tonic-clonic seizures
often occur in the morning after waking
triggers include: lack of sleep, alcohol and strobe lighting or flickering

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5
Q

what is an absence seizure an example of

A

a primary GENERALISED seizure

tends to occur in children

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6
Q

what is a Jacksonian seizure

A

a focal motor seizure

jerking begins in on area of the body (ie mouth or hand) and then spreads to that entire side of the body

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7
Q

what is Todd’s palsy

A

weakness of the limbs following a seizure

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8
Q

how long does the tonic phase of a tonic clonic seizure last and what happens

A 
10-60s
rigidity
epileptic cry
tongue biting
incontinence
hypoxia/cyanosis
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9
Q

how long does the clonic phase of a tonic clonic seizure last and what happens

A 
seconds to minutes
convulsions/limb jerking
eye rolling
tachycardia
stertorous breathing
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10
Q

what are automatisms

A

semi purposeful stereotyped motions such as lip smacking or dystonic limb posturing, pacing or undressing

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11
Q

what is the commonest cause of temporal lobe epilepsy

A

hippocampal sclerosis

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12
Q

which analgaesic can trigger epilepsy

A

tramadol

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13
Q

what is the threshold time for treating seizures

A

all seizures lasting more than 5 mins need treating

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14
Q

what are the main causes of death in people with epilepsy

A

accidents
status epilepticus
SUDEP

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15
Q

What’s the most likely diagnosis?
27y/o woman with an episode of LOC while standing on the bus, preceded by nausea and sweating. Witnesses reported some limb jerks with rapid recovery

A

Vasovagal syncope

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16
Q

What’s the most likely diagnosis?
70y/o lady w/BG of IHD and CVD felt disorientated and exhausted on waking one morning. Her husband reports being woken in the night by a loud noise and described rhythmic jerking movements of all 4 limbs. Her lips turned blue and she bit the side of her tongue. She was not incontinent of urine

A

Generalised TC seizure

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17
Q

What’s the most likely diagnosis?
65y/o man with sudden collapse whilst hill walking. Tried loss of consciousness with rapid recovery. PMH of T2DM, depression and IHD

A

Cardiac syncope

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18
Q

What’s the most likely diagnosis?
21 y/o lady with recurrent attacks consisting of abnormal movements of all 4 limbs. The attacks vary in description can can last up to an hour. She has a pmh of asthma and IBS

A

Non-epileptic attack

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19
Q

What’s the most likely diagnosis?
18 y/o man with a new onset of stereotyped attack preceded by an unpleasant smell, an odd sensation in his stomach and a feeling of fear and anxiety. Witness report how he loses awareness, fiddles with his clothing and smacks his lips

A

Complex partial seizure

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20
Q

A 20 y/o student is referred to a first seizure clinic following a generalised TC seizure while on a hight out. Over previous months she has noticed some involuntary jerks of her arms particularly in the morning - what should you advise her

A

she should be advised to refrain from driving and inform the DVLA

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21
Q 
Which of the following anti-epileptic drugs is associated with the greatest risk of developmental malformations to an unborn child?
lamotrigine
topiramate
sodium valproate
clobazam
carbamazepine
A

sodium valproate

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22
Q 
which of the following anti-epileptic drugs does not reduce the efficacy of the OCP:
carbamazepine
phenytoin
clobazam
phenobarbitone
topiramate
A

clobazam

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23
Q

What investigations should be carried out after first seizure

A 
ECG
EEG
Imaging (MRI brian)
avoid/remove precipitants
Safety advice
DVLA
Risk and treatment
Specialist referral
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24
Q

how many people will have a second seizure and when is the risk of this highest

A

70-80% will have a second seizure

highest risk within 6 months

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25
when might you consider AED withdrawal
after 2 years seizure free
26
what is the firstline treatment for idiopathic epilepsy
``` sodium valproate (lamotrigine or levetiracetam in females of reproductive age) lamotrigine may exacerbate myoclonic seizures ```
27
when would you consider AED treatment
``` after 2 seizures or after first unprovoked seizures if: -neuro deficit -EEG - risk of further seizure unacceptable - structural abnormality on brian imaging ```
28
what is firstline treatment for absence seizures
ethosuximide or sodium valproate | SV if high risk of GTC seizure
29
what is firstline treatment for focal seizures
carbamazipine or lamotrigine
30
what is firstline treatment for myoclonic seizures
sodium valproate | levetriractam or topiramate
31
which antigens is narcolepsy strongly associated with
HLA-DR2 and HLA-DQBl0602
32
what is SUDEP
non-traumatic unwitnessed death in patient with epilepsy (normal PM) possible cuases: - cardia arrhythmias - perictal hypoxia - postictal cerebral depression with hypoventilation and bradycardia
33
what are the risk factors for SUDEP
``` high seizure frequency AED poly therapy frequent changes in medication young age at onset me poor compliance symptomatic seizures long history of epilepsy seizures from sleep living/sleeping alone ```
34
how long should pts be advised to stop driving after withdrawing AED medications
during withdrawal and 6 months after
35
what are the driving restrictions on group 2 vehicles in epilepsy
free of attacks and OFF treatment for 10 years | 5 years after single seizure and normal investigations
36
what are the driving restrictions on people with epilepsy in group 1 vehicles
need to be seizure free for 1 year 6 months after a single seizure and normal investigations if seizures only occur in sleep after 1 year
37
which are the side effects of AEDs important to consider with women
weight gain, acne, hair loss, association with PCOS and VPA teratogenicity some enzyme inducing AEDs reduce OCP levels
38
on which two systems is consciousness dependent
the ascending reticular activating system (brainstem --> thalamus) important for AROUSAL the cerebral cortex important for CONSCIOUSNESS
39
what are the main differences between awareness and arousal
arousal refers to brainstem function and is level of consciousness/alertness awareness refers more to cortical function and is the understanding of the content of consciousness
40
which two syndromes can mimic comas
1) locked in syndrome | 2) psychogenic coma
41
what might cause locked in syndrome
brainstem or pontine infarct vertical eye movements and blinking are retained awareness and arousal are also retained
42
which drug should be administered in potential status epilepticus
4mg lorazepam which can be repeated after 10 minutes | or 10-20mg diazepam or 10mg midazolam
43
what is the definition of a coma
state of unrousable unresponsiveness. unaware of external stimuli no meaningful interaction GCS
44
why is important to have early scans in patients with a coma
to look for surgically reversible causes of raised ICP
45
which steps should be taken in the initial management of a coma
``` Oxygenation (+/- intubation) correct hypo/hypertension correct hypo/hyperthermia glucose + thiamine Naloxone/flumazenil think about reversible causes ```
46
what might low temperature suggest is the cause of a coma in a patient
``` hypothyroid alcohol drugs (barbiturate or TCA overdose) addison's hypothermia ```
47
what might high temperature suggest is the cause of a coma in a patient
``` infection drugs (cocaine, TCA, phencyclidine and salicylate intoxication) ```
48
how might odour of breath give clues to the cause of a coma
``` alcohol ketosis (fruity sweat) uraemia (dirty toilet) acute hepatic failure (fishy/musty) paraldehyde (onion) organophosphates (garlic) ```
49
how might respiratory rate give clues to the cause of a coma
increased: uraemia, pneumonia decreased: opiates
50
which clues might pulse rate give to the cause of a coma
high: infection, drugs low: hypothyroid, drugs, cold, incr ICP
51
how might blood pressure provide clues as to the cause of a coma
high: CVA, SAH, incr ICP, stimulant drugs, hypertensive encephalopathy low: trauma, shock, cardiac failure, drugs
52
which 4 factors MUST be corrected before performing a neurological assessment
hypothermia metabolic derrangement sedative drugs in circulation endocrine disturbance
53
which parts of a neurological assessment examine brain stem function
``` pupils corneal response gag reflex response to hypercapnia vestibulo-ocular response ```
54
what is the difference between locked in syndrome and persistent vegetative state
locked in: aware but not aroused | PVS: aroused but not aware
55
what are the most common causes of PVS
widespread hypoxia
56
in hypoxic ischaemic encephalopathy which signs at 3 days would suggest a poor outcome
absent corneal reflex absent pupil reflexes absent motor responses
57
which intervention increases the prognosis in hypoxic ischaemic encephalopathy
therapeutic hypothermia
58
does horizontal deviation of the eyes go towards or away from the hemisphere affected by seizure
away
59
what is a decorticate response
slow flexion of the elbow, wrist and fingers
60
what is a decerebrate response
adduction and internal rotation of the shoulder, arm extension, and wrist pronation with fist formation
61
skin bullae in a coma patient may be indicative of what?
barbiturate poisoning
62
profuse sweating in a coma patient may be indicative of what?
cholinergic poisoning neuroleptic malignant syndrome serotonin syndrome
63
How would you calculate the penetrance of a characteristic?
(N clinical)/(N mutation) x 100
64
how is penetrance different to expressivity?
penetrance is the proportion of individuals who have a mutation and exhibit clinical symptoms and expressively is the EXTENT to which the mutation is expressed
65
what is anticipation in the context of neurogenetics
the tendency of AD to get more severe and develop earlier

Behaviour (10 decks)

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