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Neuro > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is the definition of an epileptic seizure?

A

an intermittent stereotyped disturbance of consciousness, behaviour, emotion, motor function or sensation which, on clinical grounds, is believed to result from abnormal neuronal discharges
- nature of the seizure depends on which part of the brain is malfunctioning

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2
Q

Describe ILAE classification of epileptic seizures

A

Generalised seizures

  • myoclonic
  • clonic
  • absence (typical/atypical)
  • tonic
  • tonic-clonic
  • atonic

Focal seizures (aka partial seizures)

  • simple
  • complex
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3
Q

What features are suggestive of a generalised seizure?

A

History of myoclonic jerks, particularly first thing in the morning
Absences or feeling strange with flickering lights

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4
Q

What features are generally suggestive of a focal seizure?

A

History of deja vu
A rising sensation from the abdomen
Episodes where patient looks blank with lip-smacking and/or fiddling with clothes

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5
Q

What features can be used to characterise focal seizures?

A 
Aura
Motor features
Autonomic features
Degree of awareness
Degree of responsiveness
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6
Q

What investigations would be carried out to test for epilepsy?

A

EEG (for primary generalised epilepsies)

  • including hyperventilation and photic stimulation
  • may include sleep deprivation

MRI for patients under age 50 with possible focal onset seizures (to exclude other serious causes)
CT for patients over age 50 with possible focal onset seizures (to exclude other serious causes)

Video-telemetry if uncertain about diagnosis

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7
Q

Which drugs are used to treat primary generalised seizures?

A

Sodium valproate
Lamotrigine
Levetir acetam

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8
Q

Which drugs are used to treat partial, or secondary generalised seizures?

A

Lamotrigine

Carbamaz epine

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9
Q

Which drug is used to treat absence seizures?

A

Ethosuximide

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10
Q

What is status epilepticus?

A

Prolonged or recurrent tonic-clonic seizures persisting for more than 30 minutes with no recovery period between seizures
Usually occurs in patients with no previous history of epilepsy

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11
Q

Why is status epilepticus so dangerous?

A

Can be fatal, although death is usually a result of the underlying cause and not the seizure itself
Uses a huge amount of oxygen and glucose so can cause brain damage

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12
Q

What can cause status epilepticus?

A

Stroke
Tumour
Alcohol

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13
Q

Which drugs are used in the first line treatment of status epilepticus?

A

Benzodiazepines:

  • Midazolam (buccal/intranasal)
  • Lorazepam (bolus)
  • Diazepam (IV/rectal)
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14
Q

Which drugs are used in the second line treatment of status epilepticus?

A

Phenytoin

Valproate

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15
Q

Which drugs are used in the third line treatment of status epilepticus (last resort)?

A

Anaesthesic drugs + propofol or thiopentone

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16
Q

Describe the nature of non-epileptic attacks?

A

Often look bizaare and are generally motor
May resemble a swoon
May superficially look tonic-clonic but movements may be alternating (in epileptic seizures movements do not alternate)
Can be either prolonged or brief
Patient may have a history of other medically unexplained symtoms

17
Q

What are non-epileptic attacks and what causes them?

A

“Functional seizures” that are not caused by abnormal electrical activity in the brain
Are psychogenic; are caused by subconscious thoughts, emotions or stresses
History may indicate possible causes, e.g. abuse or PTSD

18
Q

What investigations might be conducted when a patient presents with a possible first seizure?

A

Blood sugar (hypoglycaemia can cause seizures)
ECG
Consider alcohol or drugs (may need a tox screen)
CT head

19
Q

List some causes of blackout

A 
Epileptic seizure
Syncope
Hypoxic seizure
Concussive seizure
Cardiac arrhythmia
Non-epileptic attack
Other (narcolepsy, movement disorder, migraine)
20
Q

How do benzodiazepines work?

A

Enhance synaptic inhibition by increasing GABA activity

21
Q

Name the major excitatory and inhibitory neurotransmitters

A

Excitatory - Glutamate

Inhibitory - GABA

22
Q

Describe the side-effects and potential complications of sodium valproate

A 
Very teratogenic
Tremor
Weight gain
Nausea
Drowsiness
Transient hair loss
Hepatitis
Pancreatitis 
Ataxia
23
Q

Describe the side-effects of lamotrigine

A

Skin rash

Difficulty sleeping

24
Q

Describe the side-effects of carbamazepine

A 
Ataxia
Drowsiness
Nystagmus
Blurred vision
Low serum sodium (inhibits Na+ channels)
Skin rash
25
Q

Describe the investigations that should be carried out for suspected first seizures (aside from standard epilepsy investigations)

A

Blood sugar test (hypoglycaemia can cause seizures)
ECG
Consider alcohol and drugs
CT head

Neuro (18 decks)

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