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neuro year 4 > epilepsy > Flashcards

epilepsy Flashcards

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1
Q

causes epilepsy

A

primary generalised epilepsy (JME), developmental (neuronal migration), hippocampal sclerosis, trauma and surgery, tumour, vascular (stroke, CVA), encephalitis/inflammatory, metabolic (low calcium, sodium), Alzheimers, drugs, alcohol

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2
Q

what drugs are implicated in epilepsy as a cause

A

ciclosporin, lidocains, quinolones, TCAs, antipsychotics

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3
Q

what can hippocampal sclerosis be due to

A

childhood febrile convulsions

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4
Q

what is JME

A

myoclonic starts in teenager can go unrecognised and later have a generalised tonic clonic. life long treatment neded. occur in the morning after waking

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5
Q

when does loss of consciousness occur

A

in complex partial and all generalised seizures

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6
Q

what are the generalised seizures

A

absence, tonic clonic, myoclonic, atonic

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7
Q

signs of temporal partial seizure

A

automaticisms- lip smacking, singing, kissing, chewing; dysphasia; memory- deja vu; emotional disturbance; abdominal rising sensation; delusional; emotional disturbance

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8
Q

signs of occipital partial seizure

A

visual- flashes, spots, lines

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9
Q

signs of parietal partial seizure

A

sensory disturbance- tingling, numbness

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10
Q

signs frontal partial seizure

A

behavioural; dysphasia; motor- peddling movement of the legs, post ictal Todds palsy

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11
Q

what is Todds palsy

A

focal weakness in a part of the body after a seizure

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12
Q

investigations

A

FBC, ESR, renal, LFT, calcium, glucose, ECG, MRI, EEG

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13
Q

management - DVLA

A

must not drive 12 months after last seizure. If it is the first seizure then 6 months off driving

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14
Q

management of a single seizure

A

no treatment unless high risk of recurrence

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15
Q

first line generalised tonic clonic

A

sodium valproate, lamotrigine

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16
Q

first line absence

A

sodium valproate, lamotrigine

17
Q

what drug should you not use in absence of myoclonic

A

carbamazepine

18
Q

first line myoclonic

A

levetiracetam, valproate, topiramate

19
Q

first line partial with or without 2ary generalisation

A

carbamazepine, lamotrigine

20
Q

side effects sodium valproate

A

Valproate; Appetite incr- weight gain; Liver failure; Pancreatitis; Reversible hair loss; Oedema; Ataxia; Teratogenecity, tremor, thrombocytopenia; Encephalopathy

21
Q

side effects carbamazepine

A

leucopenia, diplopia, rash, blurred vision

22
Q

side effects lamotrigine

A

maculopapular rash (stevens jonhson), diplopia, photosensitivity, blurred vision, tremor, anaemia

23
Q

side effects levetiracetam

A

psych side effects- depression, agitation; D&V, dyspepsia, drowsy, diplopia, blood dyscrasia

24
Q

side effects phenytoin

A

decr intellect, depression, coarse facial features, acne, gum hypertrophy

25
Q

which drugs interfere with contraception

A

hepatic enzyme inducing AEDs- carbamazepine, phenytoin, phenobarbital

26
Q

what is status epilepticus

A

continuous seizures lasting >30mins.

27
Q

why could status happen in a patient with pre existing epilepsy

A

recent medication reduction or withdrawal, progressive disease, metabolic, intercurrent illness

28
Q

why could status happen in someone with no Hx epilepsy

A

metabolic- decr glucose, Na, incr Ca; alcohol; toxicity; CVS; SAH; SOL; cerebral infection;; febrile illness

29
Q

complications of status- cerebral

A

oedema, incr ICP, haemorrhage, infarction, damage 2ary to hypoxia, seizure, metabolic

30
Q

complications of status- systemic

A

DIC, severe dehydration, metabolic acidosis, hypothermia, pancreatitis, renal and hepatic failure

31
Q

complications of status- cardioresp

A

arrhythmias, resp failure, shock, cardiac arrest, hyper/hypotension, pulmonary oedema, PE, aspiration pneumonia

32
Q

management of status- early treatment

A

IV lorazepam 2-4mg, rectal diazepam

33
Q

management of status- when seizure duration >10mins

A

IV phenytoin (phenobarbital if already on phenytoin)

34
Q

if doesn’t respond to phenytoin (status)

A

general anaesthetic, transfer to ITU, midazolam, thiopental

35
Q

how can you differentiate a real seizure and a pseudoseizure

A

real seizure- increase in prolactin. do EEG

neuro year 4 (19 decks)

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