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Behaviour > Epilepsy > Flashcards

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
Q

when might you consider AED withdrawal

A

after 2 years seizure free

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26
Q

what is the firstline treatment for idiopathic epilepsy

A 
sodium valproate (lamotrigine or levetiracetam in females of reproductive age)
lamotrigine may exacerbate myoclonic seizures
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27
Q

when would you consider AED treatment

A 
after 2 seizures
or after first unprovoked seizures if:
-neuro deficit
-EEG 
- risk of further seizure unacceptable
- structural abnormality on brian imaging
28
Q

what is firstline treatment for absence seizures

A

ethosuximide or sodium valproate

SV if high risk of GTC seizure

29
Q

what is firstline treatment for focal seizures

A

carbamazipine or lamotrigine

30
Q

what is firstline treatment for myoclonic seizures

A

sodium valproate

levetriractam or topiramate

31
Q

which antigens is narcolepsy strongly associated with

A

HLA-DR2 and HLA-DQBl0602

32
Q

what is SUDEP

A

non-traumatic unwitnessed death in patient with epilepsy (normal PM)
possible cuases:
- cardia arrhythmias
- perictal hypoxia
- postictal cerebral depression with hypoventilation and bradycardia

33
Q

what are the risk factors for SUDEP

A 
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
Q

how long should pts be advised to stop driving after withdrawing AED medications

A

during withdrawal and 6 months after

35
Q

what are the driving restrictions on group 2 vehicles in epilepsy

A

free of attacks and OFF treatment for 10 years

5 years after single seizure and normal investigations

36
Q

what are the driving restrictions on people with epilepsy in group 1 vehicles

A

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
Q

which are the side effects of AEDs important to consider with women

A

weight gain, acne, hair loss,
association with PCOS and VPA teratogenicity
some enzyme inducing AEDs reduce OCP levels

38
Q

on which two systems is consciousness dependent

A

the ascending reticular activating system (brainstem –> thalamus) important for AROUSAL
the cerebral cortex important for CONSCIOUSNESS

39
Q

what are the main differences between awareness and arousal

A

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
Q

which two syndromes can mimic comas

A

1) locked in syndrome

2) psychogenic coma

41
Q

what might cause locked in syndrome

A

brainstem or pontine infarct
vertical eye movements and blinking are retained
awareness and arousal are also retained

42
Q

which drug should be administered in potential status epilepticus

A

4mg lorazepam which can be repeated after 10 minutes

or 10-20mg diazepam or 10mg midazolam

43
Q

what is the definition of a coma

A

state of unrousable unresponsiveness.
unaware of external stimuli
no meaningful interaction
GCS

44
Q

why is important to have early scans in patients with a coma

A

to look for surgically reversible causes of raised ICP

45
Q

which steps should be taken in the initial management of a coma

A 
Oxygenation (+/- intubation)
correct hypo/hypertension
correct hypo/hyperthermia
glucose + thiamine
Naloxone/flumazenil
think about reversible causes
46
Q

what might low temperature suggest is the cause of a coma in a patient

A 
hypothyroid
alcohol
drugs (barbiturate or TCA overdose)
addison's
hypothermia
47
Q

what might high temperature suggest is the cause of a coma in a patient

A 
infection
drugs (cocaine, TCA, phencyclidine and salicylate intoxication)
48
Q

how might odour of breath give clues to the cause of a coma

A 
alcohol
ketosis (fruity sweat)
uraemia (dirty toilet)
acute hepatic failure (fishy/musty)
paraldehyde (onion)
organophosphates (garlic)
49
Q

how might respiratory rate give clues to the cause of a coma

A

increased: uraemia, pneumonia
decreased: opiates

50
Q

which clues might pulse rate give to the cause of a coma

A

high: infection, drugs
low: hypothyroid, drugs, cold, incr ICP

51
Q

how might blood pressure provide clues as to the cause of a coma

A

high: CVA, SAH, incr ICP, stimulant drugs, hypertensive encephalopathy
low: trauma, shock, cardiac failure, drugs

52
Q

which 4 factors MUST be corrected before performing a neurological assessment

A

hypothermia
metabolic derrangement
sedative drugs in circulation
endocrine disturbance

53
Q

which parts of a neurological assessment examine brain stem function

A 
pupils
corneal response
gag reflex
response to hypercapnia
vestibulo-ocular response
54
Q

what is the difference between locked in syndrome and persistent vegetative state

A

locked in: aware but not aroused

PVS: aroused but not aware

55
Q

what are the most common causes of PVS

A

widespread hypoxia

56
Q

in hypoxic ischaemic encephalopathy which signs at 3 days would suggest a poor outcome

A

absent corneal reflex
absent pupil reflexes
absent motor responses

57
Q

which intervention increases the prognosis in hypoxic ischaemic encephalopathy

A

therapeutic hypothermia

58
Q

does horizontal deviation of the eyes go towards or away from the hemisphere affected by seizure

A

away

59
Q

what is a decorticate response

A

slow flexion of the elbow, wrist and fingers

60
Q

what is a decerebrate response

A

adduction and internal rotation of the shoulder, arm extension, and wrist pronation with fist formation

61
Q

skin bullae in a coma patient may be indicative of what?

A

barbiturate poisoning

62
Q

profuse sweating in a coma patient may be indicative of what?

A

cholinergic poisoning
neuroleptic malignant syndrome
serotonin syndrome

63
Q

How would you calculate the penetrance of a characteristic?

A

(N clinical)/(N mutation) x 100

64
Q

how is penetrance different to expressivity?

A

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
Q

what is anticipation in the context of neurogenetics

A

the tendency of AD to get more severe and develop earlier

Behaviour (10 decks)

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