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Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

List some potential causes of blackouts

A 
Syncope
First seizure
Hypoxic seizure
Concussive seizure
Cardiac arrhythmia
Non-epileptic attack e.g. narcolepsy, migraine
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2
Q

What two forms of history taking are key in assisting diagnosis of the cause of a blackout?

A

Patient history

Witness history

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3
Q

What aspects of the witness history are important when investigating a blackout?

A

Detailed descriptions of observations before and after the event - level of responsiveness, motor phenomena, pulse, colour, breathing etc.
Detailed description of behaviour follow the event

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4
Q

Describe syncope

A 
Vasovagal syncope is the most common cause of fainting
Early symptoms:
Light headed, nausea
Hot, sweating
Tinnitus
Tunnel vision
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5
Q

Give some triggers for vasovagal syncope

A

Prolonged standing
Standing up quickly
Trauma
Venepuncture

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6
Q

How does posture in differ in syncope vs seizure?

A

Syncope - upright posture

Seizure - any posture

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7
Q

How does pallor differ in syncope vs seizure?

A

Syncope - pallor common

Seizure - pallor uncommon

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8
Q

How does the rate of onset vary between syncope and seizure

A

Syncope - gradual onset

Seizure - sudden onset

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9
Q

How does incontinence differ in syncope vs seizure?

A

Syncope - rare

Seizure - common

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10
Q

How does the presence of precipitants differ in syncope vs seizure?

A

Syncope - precipitants common

Seizure - precipitants rare

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11
Q

Describe hypoxic seizures

A

May superficially resemble a generalised tonic-clonic seizure
May resemble a swoon
Occur when individuals are kept upright in a faint
Can occur in an aircraft, at the dentist
Patient may have a succession of collapses
Seizure-like behaviour may occur

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12
Q

When do concussive seizures occur?

A

After any blow to the head

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13
Q

Describe non-epileptic attacks

A

Commoner in women
Can be frequent and prolonged
May have a history of medically unexplained symptoms
May have a history of abuse

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14
Q

What are the key initial investigations for possible first seizure?

A

Blood Sugar
ECG
Consideration of alcohol and drugs
CT head - sometimes

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15
Q

Outline the driving restrictions which apply to first seizures

A

A patient may drive a car 6 months after their first seizure if the show no further signs of seizure activity
A patient may drive an HGV or PSV 5 years after their first seizure if they have no further events and are not on medication for epilepsy

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16
Q

What history feature are suggestive of epilepsy?

A

Myoclonic jerks, especially first thing in the morning, absences or feeling strange with flickering lights - in keeping with primary generalised epilepsy

History of deja vu, rising sensation form the abdomen, episodes where patient looks blank, often accompanied by lip-smacking, fiddling with clothes - suggestive of focal onset epilepsy

17
Q

Define an epileptic seizure

A

An intermittent stereotyped disturbance of consciousness, behaviour, emotion, motor function or sensation which, on clinical grounds, is believed to result from abnormal neuronal discharges

18
Q

Define epilepsy

A

A condition in which seizures recur, usually spontaneously

19
Q

List the seven classifications of seizures

A 
Generalised
Tonic-clonic
Myoclonic
Clonic
Tonic
Atonic
Absence
Focal
20
Q

How are focal seizures characterised?

A

Aura
Motor features
Autonomic features
Degree of awareness/responsiveness

21
Q

What type of EEG abnormality is seen with primary generalised seizures?

A

Generalised abnormality

22
Q

What type of EEG abnormality is seen with focal/partial seizures?

A

Focal abnormality

23
Q

Is there a relationship between epilepsy and learning difficulties?

A

Yes - many patients who suffer from epilepsy also have some form of learning disability

24
Q

Give some investigations for epilepsy

A

EEG for primary generalised epilepsies including hyperventilation and photic stimulation
MRI for patients under 50 with possible focal onset seizures
Video-telemetry in uncertain

25
Q

Give some first line treatments for epilepsy

A

Sodium valproate, lamotrigine, levitiracetam for primary generalised epilepsies

Lamotrigine or carbamazepine for partial and secondary generalised seizures

Ethosuximide for absence seizures

Lorazepam, diazepam, midazolam - first line status epilepsies
Phenobarbitone and phenytoin - second line for status epilepsies

26
Q

Give some side effects of sodium valproate

A

Tremor, weight gain, ataxia, nausea, drowsiness, transient hair loss, pancreatitis, hepatitis

27
Q

Give some side effects of carbamazepine

A

Ataxia, drowsiness, nystagmus, blurred vision, low serum sodium levels, skin rash

28
Q

Give some side effects of lamotrigine

A

Skin rash, difficulty sleeping

29
Q

Give some side effects of levetiracetam

A

Irritability, depression

30
Q

Give some side effects of topiramate

A

Weight loss, word-finding difficulties, tingling in hands and feet

31
Q

Give some side effects of zonisamide

A

Bowel upset, cognitive functions

32
Q

Give aside effect of locasamide

A

Dizziness

33
Q

Give some side effects of vigabatrin

A

Behavioural problems and visual field defects

34
Q

Give a side effect of pregabilin

A

Weight gain

35
Q

Describe the driving relations which relate to recurrent epilepsy

A

Can hold car license if seizure free for 1 year

Can hold HGV or PSV license of if seizure free for 10 years and not on any anti-epileptic medication

36
Q

Describe status epilepsy

A

Prolonged or recurrent tonic-clonic seizures persisting for more than 30 minutes with no recovery period between seizures
9000 to 14000 cases in UK pa
Usually occurs in patients with no previous history of epilepsy
Mortality 5-10%

37
Q

Give the treatment for tonic-clonic status epilepsy

A

First line:
Midazolam
Lorazepam
Diazepam

Second line:
Phenytoin
Phenobarbitone
Valproate

38
Q

Describe the outcome of tonic-clonic status epilepsy

A

Mortality greatest in the very young and very old, around one third of patients die before 1 year of age

Neurology (42 decks)

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