Epilepsy Flashcards

1
Q

what is part of the seizure which may be a strange feeling, deja vu, strange smells, flashing lights

A

aura- implies focal/partial seizure

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2
Q

what symptoms can you get post ictally

A

headache, confusion, myalgia, sore tongue, temporary weakness (focal seizure in motor cortex), dysphasia (impairment of communication)(if in temporal lobe)

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3
Q

what makes up 2/3 of seizures

A

idiopathic

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4
Q

structural causes of seizures

A

cortical scarring, developmental, space occupying lesions, stroke, hippocampal sclerosis, vascular malformation

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5
Q

other causes of seizures

A

tuberous sclerosis, sarcoidosis, SLE, PAN

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6
Q

non epileptic causes of seizures

A

trauma, stroke, haemorrhage, incr ICP, alcohol, benzodiazepine withdrawal

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7
Q

metabolic disturbances causes of seizures

A

hypoxia, changes in Na, calcium decr, glucose incr, uraemia, liver disease, infection, temperature, drugs, pseudoseizures

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8
Q

investigations

A

24h admission for bloods, drug screen, LP, EEG, CT/MRI

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9
Q

what are focal seizures

A

focal onset with features referable to a part of one hemisphere. often seen with underlying structural disease

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10
Q

what happens in a simple partial seizure

A

awareness unimpaired, focal motor sensory autonomic or psychic symptoms. no post ictal symptoms

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11
Q

what happens in a complex partial seizure

A

awareness impaired. may have simple partial onset - aura or impaired awareness at onset. commonly arise from temporal lobe. recovery rapid after seizures in frontal love, confusion common if temporal lobe

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12
Q

what happens in a partial seizure with secondary generalisation

A

in 2/3 patients with partial seizures, electrical disturbance spreads widely causing secondary generalised seizure- convulsive

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13
Q

what is a primary generalised seizure

A

simultaneous onset of electrical discharge throughout the cortex with no localising features referable to only one hemisphere

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14
Q

what types of seizures are primary generalised seizures

A

absence, tonic-clonic, myoclonic, atonic (akinetic), infantile spasms

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15
Q

what happens in an absence seizure

A

brief pauses. presents in childhood

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16
Q

what happens in tonic-clonic seizures

A

loss of consciousness. limbs stiffen (tonic), then jerk (clonic). can have one without the other. post ictal confusion and drowsiness

17
Q

what happens in myoclonic seizures

A

sudden jerk of limb, face or trunk. may be thrown suddenly to the ground or violently disobedient limb

18
Q

what happens in atonic seizures

A

sudden loss of muscle tone causing a fall no loss of conciousness

19
Q

what are infantile spasms commonly associated with

A

tuberous sclerosis

20
Q

what are localising features of focal seizures in the frontal lobe

A

motor features, motor arrest, behavioural differences, dysphasia or speech arrest, post ictal Todds palsy

21
Q

what are localising features of focal seizures in the parietal lobe

A

sensory disturbances- tingling, numbness, pain. motor symptoms

22
Q

what are localising features of focal seizures in the occipital lobe

A

visual phenomena- spots, lines, flashes

23
Q

what are localising features of focal seizures in the temporal lobe

A

automatisms (complex motor- impaired awareness and no recollection after); abdominal rising sensation or pain; dysphasia; memory phenomena; emotional disturbance (hippocampal involvement); hallucinations; delusional behaviour

24
Q

what is the first line of treatment for generalised tonic clonic seizures

A

sodium valproate or lamotrigine is 1st line. carbamazepine or topiramate.

25
drugs used in absence seizures
sodium valproate, lamotrigine, ethosuximide
26
what drugs may worsen seizures in tonic, atonic and myoclonic seizures
carbamazepine, oxcarbazepine
27
if drugs don't work what can be done
neurosurgical resection (70% improvement); vagal stimulation (33% improvement)
28
what is sudden unexpected death in epilepsy associated with
nocturnal seizure associated apnoea or asystole
29
doses and side effects carbamazepine
100mg/12h incr by 200mg/d every 2 weeks up to max 1000mg/12. SE: leucopenia, diplopia, blurred vision, impaired balance, dwosy, erythematous rash, SIADH
30
doses and side effects lamotrigine
monotherapy- 25mg/day, incr by 50mg every 2 weeks to max 250mg/12h. SE- maculopapular rash, diplopia, blurred vision, photosensitivity, tremor, agitation, vomiting, aplastic anaemia
31
doses and side effects phenytoin
no longer first line due to toxicity. SEs- depression, coarse facial features, acne, gum hypertrophy, hypertrophy.
32
doses and side effects sodium valproate
300mg/12h incr by 100mg every 3 days. nausea very common. SEs- VALPROATE- Valproate, Appetite incr, Liver failure, Pancreatitis, Reversible hair loss, Oedema, Ataxia, Teratogenicity Tremor Thrombocytopenia, Encephalopathy
33
what feature is important of anti epileptic drugs for pregnant women
teratogenicity. take folic acid 5mg/d. valproate in particular should be avoided