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Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

Definition of epilepsy

A

Sudden paroxysmal uncontrolled synchronous discharge of cerebral neurons which produces symptoms either visible to patient or observer

Excludes gradual onset and discharge without symptoms

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2
Q

Prevelance

A

0.7-0.8% - higher in developing countries

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3
Q

Most common epilepsy causes in children

A

Perinatal problems, genetic or congenital disorders

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4
Q

Most common epilepsy causes in adults

A

Trauma, alcohol abuse, drugs, brain infection

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5
Q

Most common epilepsy causes in elderly

A

Cerebrovascular disease and mass lesions

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6
Q

Pre and perinatal risk factors x4

A

Intrauterine infections (including rubella, toxoplasmosis) maternal drug abuse, irradiation in early gestation, severe perinatal trauma or anoxia

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7
Q

Trauma/surgery and epilepsy

A

Highest risk with depressed skull fracture, penetrating injury or intracranial haemorrhage

Can be early or late when chronic epilepsy is most common

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8
Q

Metabolic causes of epilepsy x5

A

Electrolyte: Hyponatraemia, hypocalcaemia, hypomagnesaemia and hypoglycaemia

Uraemia
Hepatic failure
Acute hypoxia
Porphyria

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9
Q

Main pathological cause of temporal lobe epilepsy

A

Hippocampal sclerosis -childhood febrile convulsions are big risk factor - can treat surgically if medical not effective

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10
Q

Drugs which increase risk of epilepsy - 6x medication

3 x poisoning

A

Phenothiazines, tricyclics, MAO inhibitors, amphetamines, lidocaine and nalidixic acid

Lead, CO, Mercury

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11
Q

Infectious/inflammatory causes of epilepsy x6

A 
Encephalitis
Meningitis 
Tuberculomas 
Cerebral abscess
Neurosyphilis

Neurocysticercosis - tapeworm - in countries where it is epidemic - major cause of epilepsy

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12
Q

Circulatory cause of epilepsy

A

Anoxic encephalopathy due to cardiac arrest or respiratory arrest

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13
Q

Seizure triggers

A

Photosensitivity, stress, sleep deprivation

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14
Q

Partial (focal) seizure definition

A

Electrical discharge limited to one region of cortex. Simple = no LOA, Complex = LOA

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15
Q

Generalised seizure definition

A

Simultaneous involvement of both hemispheres always associated with LOC or LOA

Focal can become secondary generalised

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16
Q

Features of absence seizures

A

Age of onset typically 4-12 - rarely beyond adolescence

Family history in 40% of patients

30% get TC in adolescence

Loss of awareness and vacant expression for

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17
Q

Tonic Clonic seizures features

A

Prodrome - no warning or may be an aura including tingling

Sudden LOC and drop to ground
Epileptic cry

Tonic - body stiff, elbows flexed, arms extended, eyes open, jaw clenched, pupils dilated - about 10 seconds - associated with rapid neuronal discharge

Clonic - neuronal discharge slows, jerking of limbs, increasing size but decreasing frequency, eyes open and roll backwards, might bite tongue and have urinary/faecal incontinence - lasts about 1-2mins

Post-ictal phase - flaccid unresponsiveness, confusion and drowsiness (15mins-1hour), headache, feel exhausted for days after including muscle ache due to CPK

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18
Q

What are myoclonic jerks?

A

Momentary brief contractions of a muscle or muscle group - commonest disorder = benign juvenile myoclonic epilepsy - onset in puberty - typically in the morning and affecting the upper limb.

Family hx may be present as is hereditary

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19
Q

What are tonic seizures?

A

Stiffening of the body - sustained muscle contraction - no jerking afterwards just LOC

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20
Q

Atonic seizures?

A

Sudden collapse with loss of muscle tone and LOC

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21
Q

Frontal Lobe Seizures?

A

eg. Focal motor seizure - Jacksonian march from mouth or hand quite rare

Sometimes followed by Todd’s paralysis - local temporary paralysis of limbs

22
Q

What is an adversive seizure ?

A

Conjugate gaze deviates away from epileptic focus and head turns away too with some frontal seizures

23
Q

What happens in supplementary motor cortex seizures?

A

Can get more complicated stereotyped movements eg. cycling motion

24
Q

Occiptal lobe seizures?

A

Uncommon - elementary visual hallucinations

25
Q

Parietal lobe seizures?

A

Sensory cortex therefore paraesthesia or tingling in extremities or face

26
Q

Features of complex partial seizure (temporal lobe seizure)?

A

Start with aura - rising epigastric feeling and nausea with a wide range of sensory disturbances:

  • memory
  • visceral (olfactory or gustatory eg. lip smaking)
  • visual
  • affective/emotional disturbance

Followed by period of complete or partial loss of awareness (1-2mins vs 10secs of absence seizure)

Loss of awareness occurs with automatisms and speech arrest

May be followed by a short-period of post-ictal confusion and headache

27
Q

Causes of epilepsy.

A

50% cryptogenic, 10-20% genetic, 30-40% structural or metabolic

28
Q

What are febrile convulsions?

A

Not typically epilepsy but are epileptic seizures

Can be simple or complex

29
Q

Incidence of febrile convulsions and prognosis?

A

Affect 3% of between ages of 6 months and 6 years

Only 5% go on to have epilepsy

30
Q

Medications which lower seizure threshold x2

A

Anti-malarials and antidepressants

31
Q

Clinical discriminator between epilepsy and syncope x4 and 2 which occur in both

A

Injury and urinary incontinence occur in both

Prolonged recovery period, bitten tongue and stereotyped attacks = epilepsy

Colour change - pallor = syncope and cyanosis = epilepsy

32
Q

EEG findings in epilepsy

A

50% presenting with epilepsy will have normal EEG inter-ictal

If drug induced sleep EEG, sleep-deprived EEG or prolonged/ambulatory EEG then 85% show activity

33
Q

Recurrence risk after first seizure

A

70-80% will have 2nd seizure and highest risk during first 6months - majority who have second will continue to have seizures if not treated

34
Q

Epilepsy and psychiatric illness

A

Same risk of psychiatric disease as other illnesses but increased risk of psychosis

35
Q

Tonic-clonic drug treatment

A

1st line
- Sodium valproate
then 2nd
- Lamotrigine and Carbamazepine

Others

  • Oxcarbamazepine
  • Levetiracetam (Keppra)
36
Q

Focal first line drugs

A
  • Carbamazepine or Lamotrigine

Then

  • Levetiracetam
  • Sodium valproate
  • Oxcarbamazepine
37
Q

Myoclonic drugs

A

1st - valproate
2nd - clonazepam, lamotrigine

but not carbamazepine, gabapentin, phenytoin or oxcarbamazepine as these can make it worse (same as absence)

38
Q

Absence treatment

A

1st line - Sodium valproate and ethosuximide

2nd - lamotrigine

not carbamazepine, gabapentin, oxycarbazepine, phenytoin etc

39
Q

Juvenile myoclonic treatment

A

Sodium valproate

40
Q

Two other treatment options - not drugs

A

Surgery

neurostimulation (vagal nerve or trigeminal - works in 10%)

41
Q

Status epilepticus definition

A

Medical emergency
Continued seizure for 30mins or more - or two without recovery of consciousness

Can be convulsive, absence or focal

42
Q

Prognosis and incidence of status epilepticus

A

Mortality 10-15%

50% occur with no previous history of seizures

43
Q

Treatment of status epilepticus

A

Early: O2 and monitoring, lorazepam IV, midazolam buccal or diazepam rectal

Established (30-90mins):
Phenytoin IV or fosphenytoin

If ongoing:
Phenobarbitol or valproate

Last line: Paralyse and ventilate

44
Q

SUDEP

A

Sudden unexplained death in epilepsy

Night time seizure could cause heart arrhythmia which will result in patient not waking up

More common in uncontrolled epilepsy & alcohol drinking

45
Q

Valproate side effects

A 
Valproate 
Appetite increase and weight gain
Liver failure
Pancreatitis 
Reversible hair loss (curly when grows back)
Oedema
Ataxia
Teratogenicity, thrombocytopenia, tremor
Encephalopathy (ammonia increase)
46
Q

Lamotrigine side effects

A

Maculopapular rash - in 10%
1 in 1000 develop stevens-johnson syndrome /toxic epidermal necrolysis

Also diplopia, blurred vision, tremor, agitation vomiting, aplastic anaemia

47
Q

Phenytoin side effects

A

No longer first line for epilepsy because of toxicity

Nystagmus, diplopia, tremor, dysarthria, ataxia

48
Q

Keppra/levetiracetam side effects

A

Psychiatric common - depression and agitation

49
Q

Carbamazapine side effects

A

Leucopenia, diplopia, blurred vision, imbalance, drowsiness, rash

50
Q

Tonic and atonic seizure treatment

A

Valproate first line

2nd lamotrigine

not carbmazepine etc

51
Q

Management of essential tremor

A

Propanolol first line

Primidone

Neurology (10 decks)

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