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Neurology SB > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

what is the most important tool to investigating a possible case of epilepsy

A

the history

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2
Q

what are the 2 classification of epilepsy seizures

A

generalised seizures

partial/focal seizures

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3
Q

what drugs may precipitate epileptic seizures

A
  • aminophylline
  • theophylline
  • antibiotics e.g. penicillins, cephalosporins, quinolones
  • anti-emetics e.g. prochlorperazine
  • opioids e.g. diamorphine
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4
Q

what is often a first line investigation for suspected epilepsy

A

ECG

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5
Q

who gets a CT scan 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 other pathology – eg SAH
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6
Q

when is an EEG useful

A

Classification of epilepsy
Confirmation of non-epileptic attacks
Surgical evaluation
Confirmation of non-convulsive status

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7
Q

what is the Ddx for a seizures

A 
Syncope
Non-epileptic attack disorder (pseudoseizures, psychogenic non-epileptic attacks)
Panic attacks / Hyperventilation attacks
Sleep phenomena
TIAs
Migraine
Hypoglycaemia
Parasomnias
Paroxysmal movement disorders
Cataplexy
Periodic paralyses
Tonic spasms of MS
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8
Q

what is the proposed cause of epileptic seizures

A

abnormal excessive or synchronous neuronal activity

imbalance between excitation and inhibition

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9
Q

what does symptoms in a focal seizure depend on

A

on which cortical area is affected

i.e. if temporal lobe affected then awareness of the environment becomes impaired

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10
Q

what is partial seizures further spilt into

A

simple - without impaired consciousness

complex - with impaired consciousness

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11
Q

what are the types of generalised seizures

A 
Absence
Myoclonic
Atonic
Tonic
Tonic clonic (primary generalised)
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12
Q

what type of epilepsy has the most genetic predisposition

A

generalised epilepsy

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13
Q

what is seen on an EEG in generalised epilepsy

A

generalised spike-wave abnormalities

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14
Q

what is the first line treatment for generalised epilepsy

A

Sodium valproate

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15
Q

how does treatment for generalised epilepsy differ

A

the first line is the same i.e. Sodium valproate

the second line options depend on the type of seizure i.e. tonic-clonic, absence, myoclonic

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16
Q

what is the second line treatment for tonic-clonic seizures

A

Lamotrigine or Carbamazepine

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17
Q

what is second line for absent seizures

A

Lamotrigine or Ethosuximide

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18
Q

what is second line for myoclonic seizures

A

Lamotrigine or Clonazepam

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19
Q

what is the first line treatment for PARTIAL seizures

A

Carbamazepine

20
Q

what is 2nd line for PARTIAL seizures

A

Lamotrigine or Sodium valproate

21
Q

what is 3rd line for PARTIAL seizures

A

gabapentin

22
Q

if a > 30y/o presents with epilepsy what is the most likely type

A

focal/partial seizure

23
Q

what is frequently seen in complex partial seizures

A

hippocampal sclerosis

24
Q

what are causes of partial/focal seizures

A 
tuberous sclerosis 
neurofibromatosis 
intracerebral haemorrhage
AV malformation 
cerebral infarction 
cerebral abscess
subdural empyema
HIV
vasculitis
25
Q

what are features of a tonic-clonic seizure

A
  • LOC
  • falling heavily if standing
  • breathing stop
  • central cyanosis
  • limbs stiffen (tonic) the jerk (clonic)
  • afterwards, coma like state for some minutes
  • patient may be disorientated, confused upon awakening
26
Q

what can occur during tonic-clonic seizures

A

tongue bitting
urinary incontinence
myalgia
headache

severely bitten tongue + LOC&raquo_space; think tonic-clonic

27
Q

what are features of an absence seizures

A

brief pause e.g. stop talking mid sentence then continue

present in childhood
provoked by stress or hyperventilating

28
Q

what are features of a myoclonic seizure

A

sudden jerk of a limb, face or trunk but predominating in the arm

in epilepsy, more marked in the morning, or on awakening

trigger by fatigue, alcohol and sleep deprivation

29
Q

what are atonic seizures

A

sudden, brief loss of muscle tone

causes a heavy fall but no LOC

30
Q

what are tonic seizures

A

generalised increase in tone and an associated loss of awareness
seen as epilepsy syndrome, not isolated

31
Q

what are features of a simple partial seizure

A
  • no disturbance of consciousness or awareness
  • focal motor, sensory, autonomic or psychic symptoms
  • no post-ictal symptoms
32
Q

what are features of a complex partial seizure

A
  • awareness is impaired and consciousness disturbed

- post-ictal confusion common with seizures from temporal lobe

33
Q

what area of the brain is most commonly affected in complex focal seizures

A

temporal

get faster recovery with frontal lobe seizures

34
Q

what are Sx related to a focal seizures (temporal lobe)

A

lip smacking, chewing, fumbling, fiddling, singing, kissing, abdo pain, deja vu, sudden terror/anger, aura

35
Q

what are Sx related to a focal seizures (frontal lobe)

A

peddling movement with legs, jacksonian march, speech arrest

36
Q

what are Sx related to a focal seizures (parietal lobe)

A

tinging, numbness, pain

37
Q

what are Sx related to a focal seizures (occipital lobe)

A

spots, lines, flashes in vision

38
Q

what are the 4 main epilepsy syndromes

A

Childhood absence epilepsy

Juvenile absence epilepsy

Juvenile myoclonic epilepsy

Generalised tonic-clonic seizures (GTCS) on awakening.

39
Q

EEG features of Childhood absence epilepsy

A

3/sec spike and wave

40
Q

EEG features of Juvenile absence epilepsy

A

poly-spike and wave

41
Q

EEG features of Juvenile myoclonic epilepsy

A

poly-spike and wave

photosensitivity

42
Q

EEG features of GTCS on awakening

A

spike and wave on waking and sleep onset

43
Q

what needs to be considered in ladies taking anti-convulsants

A

some induce hepatic enzymes and can alter efficacy of COCP

morning after pill also not adequate - dose needs to be increased

44
Q

what contraception should not be used in epileptic female patients

A

progesterone only pill

45
Q

what anti-convulsants induce hepatic enzymes

A

Carbamazepine

Phenytoin

46
Q

why is sodium valproate not given to young women

A

teratogenic

Neurology SB (23 decks)

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