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Phase 2 > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

Define epilepsy

A

Occasional, sudden, excessive, rapid and local discharges of grey matter
Recurring tendency to seizures

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2
Q

What is the prevalence of epilepsy?

A

1% population

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3
Q

What is the underlying mechanism in epilepsy?

A

Local loss of membrane potential homeostasis starts at focal point
Relatively small number of neurones form generator site
Neurones heavily depolarise, hyperactivity spreads via synaptic transmission to other neurones

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4
Q

How do voltage gated Na+ channel blockers work?

A

Target high-frequency firing neurones, as they only get access to their binding sites during depolarisation
Once the neurone membrane potential is back to normal, the blocker detaches from the binding site

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5
Q

What is a partial seizure?

A

Focal onset

Features refer able to a part of one hemisphere

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6
Q

What is the difference between simple and complex partial seizures?

A

Complex = awareness impaired, post-Ictal symptoms

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7
Q

What are primary generalised seizures?

A

Simultaneous onset of electrical discharge throughout the cortex
No localising features

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8
Q

What are the different types of primary generalised seizures?

A 
Absence
Tonic-clonic
Myoclonic
Atonic
Infantile spasms
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9
Q

What are absence seizures?

A

Brief pauses in activity, then carries on

Presents in childhood

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10
Q

What is aura?

A

Part of the seizure
Patient aware of it
May be a strange feeling in the gut, deja vu, strange smells or flashing lights

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11
Q

What are common post ictal symptoms?

A 
Headache
Confusion
Myalgia
Sore tongue
Temporary weakness
Dysphasia
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12
Q

What are the causes of epilepsy?

A

2/3 idiopathic
Cortical scarring, SOL, stroke
Sarcoidosis
SLE

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13
Q

Give some non-epileptic causes of seizure

A

Trauma, stroke, haemorrhage, raised ICP, alcohol / benzo withdrawal
Metabolic disturbance: hypoxia, sodium, glucose, uraemia
Liver disease
Infection
Drugs: TCAs, cocaine, tramadol
Pseudo seizures

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14
Q

What are the 3 key questions in diagnosing epilepsy?

A

Are these really seizures?
What type of seizure is it?
Any triggers?

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15
Q

How do you assess a first ever seizure?

A

Is it really their first?
Was the seizure provoked - think about non-epileptic causes
Prompt investigation

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16
Q

What counselling is appropriate for seizures?

A

Dangers of swimming, driving, heights, bathing
Employment, sports, insurance, conception
DVLA must be informed, can’t drive until seizure free for 1 year

17
Q

How do you manage an acute seizure?

A 
Seizure lasting more than 5 mins or more than 3 in 1hr
Buccal midazolam or rectal diazepam
IV lorazepam if IV access
Protect from injury
Maintain airway
18
Q

What are first line treatments for tonic-clinic seizures?

A

Sodium valproate

Lamotrigine

19
Q

What are first line for absence seizures?

A

Sodium valproate

Lamotrigine

20
Q

What medication is first line for partial seizures?

A

Carbamazepine

21
Q

How are epilepsy medications managed?

A

1 drug if possible
Slowly build up doses until seizures controlled
Changing: start 2nd until max dose reached, then withdraw old drug

22
Q

How does carbamazepine work?

A

Voltage gated sodium channel blocker

NB also CYP inducer

23
Q

What are the side effects of carbamazepine?

A 
Leukopenia
Diplopia
Blurred vision
Impaired balance
Drowsiness
24
Q

What is the mechanism of action of Lamotrigine?

A

Voltage gated sodium channel blocker

25
Q

What are the side effects of Lamotrigine?

A 
Maculopapular rash
Diplopia
Blurred vision
Tremor
Vomiting
Agitation
Aplastic anaemia
26
Q

How does levetiracetam work?

A

Inhibits presynaptic calcium channels reducing neurotransmitter release

27
Q

What are the side effects of levetiracetam?

A 
Psych eg depression
D & V
Dyspepsia
Drowsiness
Diplopia
Blurred vision
28
Q

How does phenytoin work?

A

Voltage gated sodium channel blocker

NB CYP inducer

29
Q

What are the side effects of phenytoin?

A

Decreased intellect
Depression
Gum hyper trophy
Polyneuropathy

30
Q

How does phenytoin toxicity present?

A 
Nystagmus
Diplopia
Tremor
Dysarthria
Ataxia
31
Q

How does sodium valproate work?

A

Increases GABA-mediated inhibition of AP transmission by inhibiting activation of GABA and stimulating GABA synthesis
ALSO VGSC blocker

32
Q

What are the side effects of sodium valproate?

A 
Increased appetite
Liver failure
Pancreatitis
Reversible hair loss
Oedema
Ataxia
Teratogenic
Tremor
Thrombocytopenia
Encephalopathy
33
Q

What AED is best in women of childbearing age?

A

Lamotrigine

34
Q

What is the risk of feral abnormality in epilepsy?

A

5%

35
Q

What AEDs might affect the pill?

A

Carbamazepine

Phenytoin

36
Q

What is the criteria for stopping AEDs?

A

Normal CNS exam
Normal IQ
Normal EEG
Seizure free for >2 yrs

37
Q

What are the components of a good epilepsy review?

A 
Seizure control
Daily life
DVLA
First aid for carer / relatives
Medications
Women of childbearing age

Phase 2 (21 decks)

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