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Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is epilepsy.

A

Abnormal neuronal activity, leading to seizures.
It is a recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain, manifesting as seizures.
These may take many forms, but for each individual patient they tend to be stereotyped.

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2
Q

What are most cases of epilepsy due to.

A

Idiopathic (66%, often familial).

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3
Q

What are the classes of epilepsy. (6)

A 
Partial seizures. 
Generalised seizures. 
Absence seizures. 
Tonic-clonic seizures. 
Atonic seizures. 
Myoclonic seizures.
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4
Q

What characterises a partial seizure. (2)

A

Abnormal electrical discharge originating from discrete regions of the brain.
They can be simple (patient fully conscious), or complex (decreased awareness).

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5
Q

What characterises a generalized seizure.

A

Abnormal electrical discharge involving the entire brain.

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6
Q

What characterises of an absence seizure. (3)

A

‘Petit mal’.
Sudden brief lapses of consciousness without los of postural control.
>10s.

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7
Q

What characterises a tonic-clonic seizure. (4)

A

‘Grand mal’.
Involves jerking movements.
LOC.
Post-ictal confusion and drowsiness.

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8
Q

What characterises an atonic seizure. (3)

A

Sudden loss of postural muscle tone.
Lasts 1-2seconds.
No LOC.

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9
Q

What characterises a myoclonic seizure. (2)

A

Sudden contractions of the limbs, face or trunk.

Usually followed by unconsciousness.

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10
Q

What is the main complication that can arise from epilepsy.

A

Status epilepticus.

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11
Q

What investigations should be carried out in a patient presenting with epilepsy. (10)

A 
FBC. 
UandEs. 
Calcium. 
Magnesium. 
Glucose. 
LFTs. 
Urine/serum toxins. 
EEG. 
CT/MRI brain. 
EEG.
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12
Q

What is the treatment for epilepsy.

A

Anti-epileptics.

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13
Q

What are convulsions.

A

Convulsions are the motor signs of electrical discharges.

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14
Q

What is the prevalence of active epilepsy.

A

1%.

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15
Q

What is a non-epileptic cause of seizures.

A

Metabolic abnormalities.

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16
Q

What are the main elements of a seizure. (3)

A

Prodrome.
Aura.
Post-icatal period.

17
Q

What is a prodrome. (3)

A

It rarely precedes the seizure, and it may last for hours or days.
It is not part of the seizure itself.
The patient or others notice a change in mood or behaviour.

18
Q

What is an aura. (3)

A

It is part of the seizure of which the patient is aware.
It may precede its other manifestations.
It may be a strange feeling in the gut, or an experience such as deja vu or strange smells or flashing lights.

19
Q

What does the presence of an aura imply.

A

It implies a partial (focal) seizure, often, but not necessarily, from the temporal lobe.

20
Q

What may occur post-ictally in a patient with epilepsy. (6)

A

Headache.
Confusion.
Myalgia.
Sore tongue.
Temporary weakness after a focal seizure in motor cortex (Todd’s palsy).
Dysphagia following a focal seizure in the temporal lobe.

21
Q

What are some structural causes of epilepsy. (6)

A 
Cortical scarring (post-traumatic). 
Developmental. 
Space occupying lesion.
Stroke. 
Hippocampal sclerosis. 
Vascular malformation.
22
Q

What are some other causes of epilepsy. (3)

A

Tuberous sclerosis.
Sarcoidosis.
TB.

23
Q

What are some non-epileptic causes of epilepsy. (5)

A 
Trauma. 
Stroke. 
Haemorrhage. 
Raised ICP. 
Alcohol or benzodiazepine withdrawal.
24
Q

What are some metabolic causes of epilepsy. (5)

A 
Metabolic disturbances. 
Liver disease. 
Infection (meningitis, encephalitis, syphilis, HIV). 
Raised temperature. 
Drugs (tricyclics, cocaine, tramadol).
25
Q

What are the three aspects of diagnosis epilepsy. (3)

A

Are they really seizures?
What type of seizures it is?
Are there any triggers?

26
Q

What should you assess in a first ever epileptic seizure. (3)

A

Is it really the first seizure?
Was the seizure provoked?
Investigate - bloods, drug screen, EEG.

27
Q

What should be offered to any patient after a seizure.

A

Counselling - advice about dangers, until the diagnosis is known.

28
Q

What is involved in a partial seizure in the occipital lobe.

A

Visual phenomena such as spots, lines, flashes.

29
Q

What is involved in a partial seizure in the parietal lobe. (2)

A

Sensory disturbances.

Motor symptoms.

30
Q

What is involved in a partial seizure in the frontal lobe. (5)

A 
Motor features. 
Jacksonian march. 
Motor arrest. 
Subtle behavioural disturbances. 
Dysphasia or speech arrest. 
Post-ictal Todd's palsy.
31
Q

What is involved in a partial seizure of the temporal lobe. (7)

A

Automatisms.
Abdominal rising sensation or pain.
Dysphasia.
Memory phenomena (deja vu).
Uncal involvement may cause hallucinations of smell or taste or a dreamlike state.
Hippocampal involvement may cause emotional disturbances.
Delusional behaviour.

32
Q

What do you treat generalized tonic clonic seizures with. (2)

A

Sodium valproate or iamotrigine are first line.

Then carbamazepine or topiramate.

33
Q

What do you use to treat absence seizures. (3)

A

Sodium valproate.
Iamotrigine.
Or ethusuximide.

34
Q

What do you use to treat tonic, atonic and myoclonic seizures. (2)

A

Sodium valproate or iamotrigine are first line.

Avoid carbamazepine and oxcarbazepine which may worsen seizures.

35
Q

What do you use to treat partial sseizures and secondary generalized seizures. (3)

A

Carbamazepine is first line.

Then sodium valproate, iamotrigine.

36
Q

How many drugs should you treat epilepsy with.

A

ONE.

37
Q

What is sudden unexpected death in epilepsy. (3)

A

It is more common in uncontrolled epilepsy.
It may be related to nocturnal seizure associated apnoea or asystole.
Those with epilepsy have a mortality rate 3 times greater than controls.

38
Q

What are the side effects of valproate. (8)

A 
Appetite increase, weight gain. 
Liver failure. 
Pancreatitis. 
Reversible hair loss. 
Oedema. 
Ataxia. 
Teratogenicity, tremor, thrombocytopenia. 
Encephalopathy.

Neurology (20 decks)

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