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Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What are RFs for epilepsy?

A 
Birth
Development
Past seizures
Head injury (inc. LOC)
FHx
Drugs 
Alcohol
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2
Q

In 1st seizure clinic is examination important?

A

No- has little/no benefit

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3
Q

What should be examined if a diagnosis of syncope is suspected?

A

CVS examination

L+S BP important

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4
Q

What Ix should be considered in fallen patient?

A

ECG- mandatory
Imaging- MRIb vs CTb
Possible EEG- 0.5-4% of interictal EEGs are abnormal

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5
Q

What fallen patients will get a CT acutely?

A 
Clinical or radiological skull fracture
Deteriorating GCS
Focal signs
Head injury with seizure
Failure to be GCS 15/15 4 hours after arrival
Suggestion of another pathology- eg SAH
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6
Q

What conditions are commonly confused with epilepsy?

A

Syncope
Non-epileptic attack disorder (pseudoseizures, psychogenic non-epileptic attacks)
Panic attacks / Hyperventilation attacks
Sleep phenomena

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7
Q

What should be explain regarding seizures/epilepsy and driving?

A

1st seizure car- 6 months, 5y for HGV/PCV
Epilepsy car- 1y or 3y during sleep, 10y off medication for HGV/PCV
Discuss SUDEP

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8
Q

What is epilepsy?

A

A tendency to recurrent, usually spontaneous, epileptic seizures

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9
Q

Why do epileptic seizures occur?

A

Abnormal synchronisation of neuronal activity- usually excitatory with high frequency action potentials, sometimes predominantly inhibitory
Interruption of normal brain activity- focally, generalised

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10
Q

How long do epileptic seizures usually last?

A

Brief- seconds to minutes

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11
Q

What neurological changes occur in epilepsy?

A

Cell numbers/types
Connectivity
Synaptic function
Voltage gated ion channel function

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12
Q

What are the contributing factors to epilepsy?

A 
Genetic
Acquired Brain
Metabolic
Toxic
Environmental
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13
Q

How common is epilepsy?

A

50-80/100000

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14
Q

At what age does epilepsy occur?

A

Any age, but most commonly infancy and old age

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15
Q

How many people die of epilepsy each year?

A

1 in 400, young adults with severe epilepsy being 1 in 100

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16
Q

Can a generalised seizure start from a focal point?

A

Yes

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17
Q

How is epilepsy classified?

A 
Epileptic Seizures (Semiology, EEG)- generalised, partial-focal site of origin
Epilepsy syndrome (seizure type, age, aetiology)
Aetiology
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18
Q

What is the classification of partial epileptic seizures?

A

Simple: without impaired consciousness
Complex: with impaired consciousness

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19
Q

What is the classification of general epileptic seizures?

A 
Absence
Myoclonic
Atonic
Tonic
Tonic clonic
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20
Q

How are epileptic seizures classified?

A

Partial
Generalised
Unclassified

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21
Q

What is the motor semiology of partial seizures?

A 
Rhythmic jerking
Posturing
Head and eye deviation
Other movements (e.g. cycling)
Automatisms (eg plucking)
Vocalisation
22
Q

What is the sensory semiology of partial seizures?

A 
Somatosensory
Olfactory
Gustatory
Visual 
Auditory
23
Q

What is the psychic semiology of partial seizures?

A 
Memories
Deja vu
Jamais vu
Depersonalisation
Aphasia
Complex visual hallucinations etc
24
Q

What predisposition to do most generalised epilepsies have?

25
What findings are usually seen on EEG in generalised epilepsy?
Spike-wave abnormalities
26
When does generalised epilepsy usually present?
Childhood and adolescence
27
What is the 1st line treatment of primary generalised epilepsy?
``` Sodium valproate (teratogen) Lamotrigine as alternative/if pregnant ```
28
What occurs in juvenile myoclonic epilepsy?
Early morning jerks | Generalised seizures
29
What are RFs for juvenile myoclonic epilepsy?
Sleep deprivation | Flashing lights
30
What is the cause of focal onset epilepsy?
Underlying structural cause
31
When does focal onset epilepsy present?
Any age
32
What occurs in focal onset epilepsy?
Frequent complex partial seizures with hippocampal sclerosis
33
What is the treatment of focal onset epilepsy?
Carbamazepine or lamotrigine (sodium valproate works well, but avoided due to S/Es)
34
What percentage of epilepsies are 'drug resistant'?
35%
35
What system is targeted by antiepileptic drugs (AEDs)?
GABA
36
What is the initial treatment for partial seizures?
``` Carbamazepine and lamotrigine first line Oxycarbazepine Levetiracetam Topiramate Sodium valproate ```
37
What are 'add on' drugs for partial seizures?
``` Gabapentin Tiagabine Pregabalin Zonisamide Vigabatrin Clonazepam Clobazam ```
38
What is the first line treatment for absence generalised seizures?
Sodium valproate | Ethosuximide
39
What is the second line treatment for absence generalised seizures?
Topiramate | Levetiracetam
40
What is the first line treatment for myoclonic generalised seizures?
Sodium valproate Levetiracetam Clonazepam
41
What is the second line treatment for myoclonic generalised seizures?
Lamotrigine | Topiramate
42
What is the first line treatment for atonic, tonic and generalised tonic clonic seizures?
Sodium valproate
43
What is the second line treatment for atonic, tonic and generalised tonic clonic seizures?
Levetiracetam Topiramate Lamotrigine
44
When is phenytoin used in seizure management?
Acutely- rapid loading possible
45
What are some S/Es of sodium valproate?
Wt gain Teratogenic Hair loss Fatigue
46
What can carbamazepine do to primary generalised seizures?
Make them worse
47
Does lamotrigine take a long time to titrate up?
Yes
48
Describe levetiracetam use
Few interactions with other medications | Well tolerated, though can cause mood swings
49
What are some S/Es of topiramate?
Sedation Dysphasia Wt loss (Not particularly well tolerated)
50
When are drugs given in seizure management?
If diagnosed as epilepsy If single seizure but high risk of recurrence Only if patient wants drug
51
What anticonvulsants induce hepatic enzymes?
``` Carbamazepine Oxcarbazepine Phenobarbitol Phenytoin Primidone Topiramate ```
52
What can the enzyme induction properties of some anticonvulsants effect, and what does this mean?
Can alter efficacy of combined oral contraceptive pill Shouldn't use POP Depot progesterone needs more frequent dosing, progesterone implants not effective Morning after pill not adequate- increase dose

Neurology (27 decks)

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