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Nervous System > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

what are the different causes of a blackout?

A 
Syncopy
First seizure
Hypoxic seizure
Concussive seizure
Cardiac arrhythmia
Non-epileptic attack (eg narcolepsy)
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2
Q

what is syncope?

A

Vasovagal syncope is the most common cause of fainting

caused by a fall in blood pressure

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3
Q

what are the early symptoms of syncope?

A

Light-headed, nausea
Hot, sweating
Tinnitus
Tunnel vision

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4
Q

what are the triggers of Vasovagal syncope?

A 
Prolonged standing
Standing up quickly
Trauma
Venepuncture
Watching/experiencing medical procedures
Micturition
Coughing
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5
Q

what are the symptoms of syncope?

A 
upright posture
pallor common
gradual onset
injury rare
incontinence rare
rapid recovery
precipitants common
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6
Q

what are the symptoms of seizures?

A 
any posture
pallor uncommon
sudden onset
injury quite common
incontinence common
slow recovery
precipitants rare
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7
Q

what are hypoxic seizures?

A

Occur when individuals are kept upright in a faint
Patient may have a succession of collapses
Seizure-like activity may occur

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8
Q

what are concussive seizures?

A

After any blow to the head

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9
Q

what can cause cardiac arrythmias?

A

seizures

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10
Q

describe non-epileptic attacks

A 
women>men
Can be frequent
May look bizarre
May have history of abuse
May resemble a generalised tonic-clonic seizure
May resemble a “swoon”
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11
Q

what are Features suggestive of primary generalised Epilepsy?

A

History of myoclonic jerks, esp in morning

absences or feeling strange with flickering lights

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12
Q

what are Features suggestive of focal onset Epilepsy?

A

History of “deja vu”, rising sensation from abdomen, episodes where look blank with lip-smacking, fiddling with clothes

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13
Q

what is Epilepsy?

A

is a condition in which seizures recur, usually spontaneously

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14
Q

what are focal seizures characterised by?

A

aura, motor features, autonomic features and degree of awareness or responsiveness
(May evolve into a generalised convulsive seizure)

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15
Q

describe Primary generalised epilepsies

A 
No warning
< 25 years
May have history of absences and myoclonic jerks as well as GTCS e.g in juvenile myoclonic epilepsy
Generalised abnormality on EEG
May have family history
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16
Q

describe Focal/Partial epilepsies

A

May get an “aura”
Any age – cause can be any focal brain abnormality
Simple partial and complex partial seizures can become secondarily generalised
Focal abnormality on EEG
MRI may show cause

17
Q

what can an EEG show?

A

primary generalised epilepsies including hyperventilation and photic stimulation: sometimes sleep deprivation

18
Q

what can an MRI show?

A

patients under age 50 with possible focal onset seizures: CT usually adequate to exclude serious causes over this age

19
Q

what investigation is done if uncertain about diagnosis?

A

Video-telemetry - much longer recording than a standard EEG

20
Q

what is the first line treatment of primary generalised epilepsies?

A

Sodium Valproate, Lamotrigine, Levetiracetam

21
Q

what is the second line treatment of generalised epilepsies?

A

Topiramate
Zonisamide
(carbamazepin)

22
Q

what is the first line treatment of partial and secondary generalised seizures?

A

Lamotrigine or Carbamazepine

23
Q

what is the second line treatment of partial seizures?

A
  • Sodium valproate
  • Topiramate
  • Leviteracetam
24
Q

what are the side effects of Sodium Valproate?

A

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

25
Q

what are the side effects of Carbamazepine?

A

ataxia, drowsiness, nystagmus, blurred vision, low serum sodium levels, skin rash.

26
Q

what are the side effects of Lamotrigine?

A

skin rash, difficulty sleeping

27
Q

what are the side effects of Levetiracetam?

A

irritability, depression

28
Q

what are the side effects of Topiramate?

A

weight loss, word-finding difficulties, tingling hands and feet

29
Q

what are the side effects of Zonisamide?

A

bowel upset, cognitive problems

30
Q

what is Status Epilepticus?

A

Prolonged or recurrent tonic-clonic seizures persisting for more than 30 minutes with no recovery period between seizures

31
Q

when does Status Epilepticus usually occur?

A

in patients with no previous history of epilepsy (stroke, tumour, alcohol)

32
Q

what is the first line treatment of tonic-clonic seizures?

A

Midazolam
Lorazepam
Diazepam

33
Q

what is the second line treatment of tonic-clonic seizures?

A

Phenytoin

Valproate

34
Q

what is the third line treatment of tonic-clonic seizures?

A

Anaesthesia usually with propofol or thiopentone

35
Q

when is mortality of tonic-clonic seizures greatest?

A

very young and very old (29% of those < 1 year)

90% of deaths are a result of the underlying cause

Nervous System (37 decks)

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