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Week 232 - Epilepsy > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

Define epileptic seizure

A

A transient event experienced by a subject as a result of a synchronous and excessive discharge of cerebral neurones

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2
Q

Define epilepsy

A

The continuous tendency to have epileptic seizures

- arises secondary to pathological process

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3
Q

Define prodrome

A

A change in behaviour noticed by patient or others which may precede the seizure

  • not part of seizure itself
  • may last hours/days
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4
Q

Define Aura

A

A strange feeling in the gut, an experience of deja-vu or strange smells/flashing lights

  • patient is aware
  • may precede other manifestations
  • implies a partial seizure quite often
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5
Q

Define post-ictal period?

A

Period following seizure where symptoms may occur

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6
Q

Describe post-ictal Sx that may occur

A

Headache, confusion, myalgia, sore tongue

Temporary weakness after focal seziure in motor cortex

Dysphasia - following temporal lobe focal seizure

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7
Q

Name two features in the history that a typical of epileptic seizures

A

Tongue biting

Slow recovery

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8
Q

Describe the two general classification categories of epileptic seizures

A

Generalised seizures

Partial seizures (focal seizures)

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9
Q

Name six types of generalised seizure

A

Absence seizures

Tonic-clonic seizures

Myoclonic

Tonic seizures

Atonic seizures (akinetic seizures)

Infantile spasms

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10
Q

At what stage of life do absence seizures usually develop?

A

Childhood

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11
Q

Describe an absence seizure

A

Loss of awareness and vacant expression for less than 10 seconds before returning abruptly to normal, continuing as if nothing has happened

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12
Q

Describe a tonic-clonic seizure

A

Often no prodrome but may have aura if secondary generalised

Tonic clonic phase

  • initial tonic stiffening followed by clonic phase with synchrounous jerking of the limbs which reduce in freq over about 2 mins until convulsion stops
  • eyes remain open, often tongue biten
  • may be incontinence of urine or faeces

Post-ictal phase

  • Period of flaccid unresponsiveness -> gradual return of awareness
  • confusion and drowsiness lasting a while
  • headache
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13
Q

Describe myoclonic seizures

A

Take the form of momentary brief contractions of a muscle or muscle groups
- sudden involuntary twitch of a finger or hand

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14
Q

Describe atonic seizures

A

Sudden loss of muscle tone causing a fall (no LoC)

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15
Q

What is commonly associated with infantile spasms?

A

Tuberous sclerosis

- genetic disease that causes beningn tumours to grown in the brain and other vital organs

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16
Q

What is a primary generalised seizure?

A

Simultaneous involvement of both hemispheres - always associated with LoC and LoA

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17
Q

What is partial seizure?

A

Electrical discharge constricted to a limited part of cortex of one cerebral hemisphere

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18
Q

Describe a simple partial seizure

A

Partial seizure without loss of awareness
- e.g. one limb jerking

Originates in motor cortex, can spread to involve the entire hemisphere

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19
Q

Describe a complex partial seizure

A

Partial seizure with loss of awareness
- usually arise from temporal lobe (60%) or frontal lobe

Post-ictal confusion is common with temporal lobe seizures
- rapid recovery in frontal lobe

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20
Q

What is a secondary generalisation seizure?

A

Electrical disturbance from partial seizures spreads widely causing a generalised seizure
- typically convulsive

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21
Q

What are the features of temporal lobe seizures?

A

Automatisms - complex motor phenomena with impaired awareness and no afterward recollection

Abdominal rising sensation or pain

Dysphasia

Memory phenomena

Emotional disturbance - due to hippocampal involvement

Uncal involvement - hallucinations of taste or smell

Delusional behaviours

22
Q

Give an example of automatisms involved in temporal lobe epilepsy

A

Primitive oral - lip-smacking, chewing

Manual movements - fumbling, fidling, grabbing

Complex actions - singing, kissing,…

23
Q

What are the features of frontal lobe seizures?

A

Motor features - posturing, versive movements of head and eyes

Jacksonian march

Motor arrest

Subtle behavioural disturbance

Dysphasia or speech arrest

Post-ictal Todd’s palsy (motor weakness)

24
Q

What are the features of occipital lobe seizures?

A

Visual phenomena - spots, lines, flashes

25
Q

What are the features of parietal lobe seizures?

A

Sensory disturbance - tingling, numbness, pain (rare)

Motor Sx - due to spread to the pre central gyrus

26
Q

What are the differential diagnosis of epilepsy?

A 
Syncope
Non-epileptic attacks
Panic attacks
Sleep disorders - prasomnias or narcolepsy
Migraine
TIA
Hypoglycaemia
27
Q

What is the main aetiology of seizures?

A

Idiopathic = 2/3 of all seizures

28
Q

Give examples of structural causes of epilepsy

A

Cortical scarring - head injury years prior to onset

Developmental

  • cortical dysgenesis
  • dysembryoblastic neuroepithelial tumour

Space-occupying lesions - malignancy

Stroke

Hippocampal sclerosis - after a febrile convulsion

Vascular malformations

29
Q

Give examples of other epileptic causes of seizures

A

Tuberous sclerosis

Sarcoidosis

SLE

Polyarteritis nodosa

30
Q

Give examples of non-epileptic causes of seizures

A

Trauma

Stroke

Haemorrhage

Raised ICP

Alcohol/Benzodiazepines

Metabolic disturbance

Liver disease

Infections

Raised temperature

Drugs - tricyclics, cocaine, tramadol, theophylline

Pseudoseizures

31
Q

Ix for epilepsy

A

ECG - rule out cardiac cause

EEG - useful in context of suspected seizure, may localise seizure
- video EEG =gold standard

Cerebral Imaging

  • may find a cause of the epilepsy
  • important for treatment and prognosis
32
Q

What are the most likely epilepsy causes in infants?

A

Developmental malformations

Perinatal injuries

Infections

33
Q

What are the most likely epilepsy causes in children/adolescents?

A

Idiopathic generalised epilepsy

34
Q

What are the most likely epilepsy causes in young adult onset?

A

Idiopathic generalised epilepsy

Various - head injury, alcohol, vascular malformations, hippocampal sclerosis

35
Q

What are the most likely epilepsy causes in 30-50 yrs old?

A

Brain tumours

36
Q

What are the most likely epilepsy causes in over 50s?

A

Cerebrovascular disease

Mass lesions such as neoplasms

37
Q

Name some specific syndromes related to idiopathic generalised epilepsy

A

Juvenile Myoclonic Epilepsy

Childhood absence epilepsy

38
Q

Describe hippocampal sclerosis

A

Damage and scarring of the hippocampus and surrounding cortex

  • main pathological substrate of causing temporal lobe epilepsy
  • main cause of localisation-related epilepsy

Usually visible on MRI

One of the most common causes of refractory epilepsy, in which may indicate surgical resection of damaged temporal lobe

39
Q

What is the main risk factors of developing hippocampal sclerosis?

A

Childhood febrile convulsions

40
Q

Give three examples of genetic/developmental brain disorders that cause can epilepsy?

A

Neuronal migration defects during brain development

Dysplastic areas of cerebral cortex

Hamartomas (benign local malformation resmbling neoplasm)

41
Q

What is a major cause of seizures in countries India and South American countries?

A

Neurocyticercosis

- since pork tapeworm is endemic

42
Q

How can alcohol cause seizures?

A

Chronic alcohol use

  • during heavy dirnking seassion
  • period of withdrawal
43
Q

Which metabolic abnormalities can cause seizures?

A

Hypoglycaemia
Hypocalcaemia
Hyponatraemia

Acute hypoxia

Uraemia, hepatic encephalopathy

Porphyria (abnormal haemoglobin metabolism)

44
Q

What is the first line treatment for GTC seizures?

A

Sodium valproate or Lamotrigine

45
Q

What is the first line treatment for absence seizures?

A

Sodium valproate, Lamotrigine or Ethosuximide

46
Q

What is the first line treatment for GTC seizures?

A

Sodium valproate or Lamotrigine

- avoid carbamazepine

47
Q

What is the first line treatment for partial seizures?

A

Carbamazepine

48
Q

Define Status epilepticus

A

Seizure(s) lasting for 30 mins without regaining consciousness in between

49
Q

What is the mortality of status epilepticus?

A

20%

50
Q

Describe the treatment of status epilepticus

A

Treat if seizure lasting longer than 5 mins

General measure

  • A,B,C,D,E
  • IV access
  • Administer O2
  • Check U+Es, Ca, Mg, ABGs, ECG +/- antiepileptic drug levels
  • IV glucose +/- thiamine

Specific measures:
If early then - IV Lorazepam 4mg every ten mins (or diazepam, buccal midazolam)

If established then - IV phenytoin 15mg/kg at 50mg/min and monitor obs

If refractory - transfer to ITU, continue same treatment
- look for cause

51
Q

What does Non-convulsive status epilepticus usally respond well to?

A

Benzodiazepines

52
Q

What is SUDEP?

A

Sudden unexplained death in epilepsy

Week 232 - Epilepsy (3 decks)

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