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Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is an ictus?

A

Sudden neurological event

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2
Q

What is a seizure?

A

Transient neurological dysfunction caused by excessive activity of cortical neutrons resulting paroxysmal alteration of behaviour and/or EEG changes.

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3
Q

What is epilepsy?

A

Tendency to repeated, spontaneous seizures

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4
Q

What are the generalised seizure types?

A
  • Tonic
  • Clonic
  • Tonic-clonic
  • Myotonic
  • Atonic
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5
Q

What are the common focal seizure types?

A
  • Dyscognitive

- Evolving to bilateral, convulsive seizure (secondary generalised).

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6
Q

What are the features of the tonic phase of a GTCS?

A

Tonic phase:

  • muscle rigidity
  • arms down
  • eyes open
  • cry
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7
Q

What is the progression of a GTCS?

A
  • Tonic phase
  • Clonic phase
  • Apnoea
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8
Q

What are the features of a GTCS?

A
  • Last 1-5mins;
  • Tonic and clonic phases
  • minor injury common (e.g. tongue biting);
  • confusion following
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9
Q

What is an absence seizure? What are its feaures?

A

Alteration of consciousness without loss of postural tone (stay upright); difficult to detect.
May have facial twitch (3Hz blinking, mouth mvt, eyes drift open).
Last 2-10s; generally in children/teens.

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10
Q

What are myoclonic seizures?

A

Brief contractions localised to muscle groups of one or more extremities, can be single or multiple.
May precede GTCS

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11
Q

What are focal seizures?

A

Single area of brain without alteration of consciousness. Features depend on location. Usually brief.

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12
Q

What are focal dyscognitive seizures?

A

Localised region with sufficient spread to impair consciousness. Bilateral temporal lobes involved.

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13
Q

What is the distinction between absence seizures and focal dyscognitive seizures?

A

Focal dyscognitive similar to absence but are:

  • longer
  • less distinct offset
  • automatisms
  • less frequent
  • may precede simple seizure
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14
Q

What are the types of genetic generalised epilepsies?

A
  • Childhood absence
  • juvenile myoclonic
  • juvenile absence
  • epilepsy with tonic clonic seizures along
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15
Q

What are genetic generalised epilepsies?

A

GTCS, absence and or myoclonic seizures with:
-no evidence of brain damage
-epileptiform discharges 3Hz or faster
-response to therapy usually good (80-85%)
(Childhood / or Juvenile Absence Epilepsy; Juvenile Myoclonic Epilepsy; Epilepsy with tonic-clonic seizures alone)

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16
Q

Onset childhood absence epilepsy?

A

4-8 years (up to 12).

17
Q

What are the types of seizure in childhood absence epilepsy? How does juvenile absence epilepsy compare?

A

-Absence (frequent, multiple per day).
-GTCS (40%; adolescence)
Juvenile absence epilepsy has its onset in adolescence (cf 4-12y for childhood)

18
Q

What are the features of juvenile myoclonic epilepsy?

A
  • Onset 12-18y
  • Seizures: myoclonus, GTCS, absence
  • Often photosensitive.
  • Sleep wake cycle.
19
Q

Is an ictal EEG useful?

A

Almost always abnormal in seizure; perfect for pseudo seizure (will appear normal despite appearance of symptoms).

20
Q

What proportion of people who have a seizure will go on to develop epilepsy?

A

~50% of people who have single seizure as an adult will never have another

21
Q

What is the role of ethosuximide?

A

Basically only absence seizures (e.g. childhood absence)

22
Q

What is important about valproate?

A

Teratogenic. Be very careful in women of childbearing age.

23
Q

In whom should carbamazepine be used with caution?

A

Asian subcontinent (HLA association with stevens johnson syndrome = toxic epidermal necrolysis).

24
Q

Features of clonic phase of GTCS?

A

Repetitive violent jerking of face and limbs, tongue biting, cyanosis, frothing, incontinence

25
Q

What is a tonic seizure characterised by?

A

Muscle rigidity in flexion or extension

26
Q

What is a clonic seizure characterised by?

A

Repetitive rhythmic jerking movements

27
Q

Features of a complex focal seizure?

A
  • Pt appears awake but w/ impairment of awareness

- Classically characterised by automatisms (chewing, lip smacking, swallowing etc)

28
Q

Ix in seizure/?epilepsy workup?

A
  • FBE / UEC / LFTs / CMP / ESR / CK
  • Fasting BSL
  • Consider tox screen, EtOH
  • CT/MRI if new seizure w/o identified cause
  • LP if fever or meningism
  • EEG
29
Q

Treatment of epilepsy?

A
  • avoid precipitants
  • anticonvulsants if indicated
  • psychosocial issues: stigma of seizures, pt/fam ed
  • safety issues: driving, swimming, operating heavy machinery
  • consider surgical Mx if focal and refractory
30
Q

What are the indication for medical therapy in management of seizures?

A
  • 2+ unprovoked seizures,
  • known organic brain disease, -EEG with epileptiform activity
  • episode of status epileptics
  • abnormal neurologic examination
31
Q

What is status epileptics?

A

Unremitting seizure of greater than 5 min; or successive seizures without a return to baseline state

32
Q

What are the complications of status epilepticus?

A
  • Anoxia
  • Cerebral ischaemia and oedema
  • rhabdomyolysis and renal failure
  • aspiration pneumonia / pneumonitis
  • death
33
Q

Initial Mx status epilepticus?

A
  • ABCs
  • Vitals
  • Fingerprick glucose (stat)
  • ECG
  • Nasal O2
  • IV NS, glucose (50mL IV) and thiamine
  • ABGs (if cyanotic)
34
Q

Medications used for seizure termination?

A

Benzodiazepines

35
Q

Medications used for acute seizure prophylaxis?

A
  • Benzos

- Phenytoin (Levetiracetam, Valproate)

36
Q

What is SUDEP?

A

Sudden Unexpected Death in Epilepsy (SUDEP)

  • 1-2/1000 pts sudden death
  • ?Cardio-resp arrest, often in sleep
  • related to seizure frequency

Neurology (38 decks)

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