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Nervous System > Epilepsy > Flashcards

Epilepsy Flashcards

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1
Q

what is epilepsy

A

a neurological condition characterised by recurrent seizures

>2 seizures

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2
Q

what conditionis commonly associated with epilepsy

A

cerebral palsy (30% have epilepsy)

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3
Q

apart from epilepsy, what are common causes of recurrent seizures

A

1 febrile convulsions
2 alcohol withdrawal seizures
3 psychogenic non- epileptic seizures

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4
Q

who do febrile convulsions usually affect

A

children

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5
Q

what is the cause of febrile convulsions

A

increased body temperature in response to viral infection

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6
Q

what are the features of febrile convulsions

A

brief

generalised tonic or tonic-clonic seizure

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7
Q

what indicates a seizure is generalised

A

immediate LOC

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8
Q

what is a tonic seizure

A

increased tone

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9
Q

what is a tonic-clonic (grand mal) seizure

A

repeated contraction-relaxation of muscles

“a convulsive seizure”

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10
Q

who do alcohol withdrawal seizures usually affect

A

alcoholics who suddenly stop drinking

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11
Q

how do alcohol withdrawal seizures occur

A

chronic alcohol consumption leads to increased GABA-mediated inhibition of CNS (similar to benzodiazepines) and inhibits NMDA-type glutamate receptors
alcohol withdrawal reverses this (decreased GABA mediated inhibition of CNS and increased NMDA glutamate transmission)

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12
Q

how are alcohol withdrawal seizures prevented

A

benzodiazepines following cessation of drinking

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13
Q

what are psychogenic non-epileptic seizures

A

AKA as pseudoseizures

epileptic like seizures without the characteristic electrical discharges

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14
Q

what are psychogenic non-epileptic seizures associated with

A

mental health problems

personality disorder

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15
Q

what are common subtypes of generalised seizures

A

1 tonic-clonic seizures (tonic phase of muscle contraction followed by repeated contraction and relaxation of muscles)
2 absence seizures (brief episode of patient appears to be ‘staring blankly’)
3 myoclonic seizures (brief, rapid muscle jerks)
4 atonic seizures (loss of muscle tone and patient falls to the ground)

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16
Q

what are common subtypes of partial seizures

A 
1 simple (no LOC)
2 complex (consciousness disturbed)
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17
Q

what symptoms are associated with seizure

A

biting tongue

incontinence of urine

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18
Q

what do seizure patients feel after a seizure

A

a postictal phase (drowsy and tired)

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19
Q

what investigations are standard for a seizure

A

EEG (electroencephalogram)

MRI

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20
Q

when are antiepileptics given

A

following a second epileptic seizure

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21
Q

what is the first line treatment for patients with generalised seizures

A

sodium valproate

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22
Q

what is the first line treatment for patients with partial seizures

A

carbamazepine!

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23
Q

what is second line treatment for generalised and partial seizures

A

lamotrigine

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24
Q

what are the guidelines for driving with epilepsy

A

no driving for 6 months following a seizure

with establised epilepsy, patient must be fit free for 12 months before driving

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25
what is the risk of sodium valproate in pregnant women
teratogenic
26
what happens when antiepileptics and the contraceptive pill are taken together
efficacy of antiepileptic and oral contraceptive pill is reduced
27
what is the MOA of sodium valproate
increases GABA activity
28
what is sodium valproates effect on P450 enzymes
P450 enzyme inhibitor
29
what is the MOA of carbamazepine
binds to Na channels increasing their refractory period
30
what is carbamazepines effect on P450 enzymes
P450 enzyme inducer
31
what is administered to a patient suffering from a seizure which fails to terminate spontaneously
benzodiazepines (diazepam)
32
what is the condition called what a patient continues to fit following administration of benzodiazepines (diazepam)
status epilepticus
33
def of seizure
paroxysmal synchronised cortical electrical discharges
34
what are the motor signs of electrical charges
convulsions
35
what are the elements of a seizure
prodrome aura post-ictally
36
what is prodrome
not part of the seizure change in mood or behaviour lasts hours/days preceding the seizure
37
what is an aura
part of the seizure | indicated by strange smells or flashing lights (which aren't really there)
38
what is the post-ictal phase
period immediately after the seizure | headache, confusion, decreased consciousness
39
what does an aura imply
focal seizure
40
aetiology
``` 1 idiopathic (majority) 2 structural 3 others ```
41
what are the structural causes of epilepsy
``` cortical scarring (head injury years before onset of epileptic seizures) space-occupying lesion stroke infection (meningitis, encephalitis) inflammation (vasculitis) ```
42
what are non-epileptic causes of seizures
trauma stroke alcohol or benzodiazepine withdrawal metabolic disturbances
43
what metabolic disturbances can cause seizures
``` hypoxia high/low Na low Ca high/low glucose uraemia ```
44
pathogenesis
seizures occur due to an imbalance between inhibitory and excitatory currents or neurotransmission in the brain triggers promote excitation of the cerebral cortex and induce a seizure however many seizures begin without an obvious trigger
45
what triggers could start an epileptic fit
flashing lights drugs sleep deprivation
46
epi
common | in children and elderly
47
history
obtain history from patient and witness of seizure ``` 1 information about the seizure -onset? duration? -LOC? incontinence or tongue biting? -limb-jerking? -post-ictal period? 2 determine whether it is a focal or generalised seizure 3 triggers? ```
48
what features are suggestive of a seizure
tongue biting | slow recovery
49
what history would be associated with a frontal lobe focal motor seizure
motor convulsion jacksonian march (spreading of focal motor seizure with no LOC) post-ictal weakness (todds paralysis) in one part of the body
50
what history would be associated with a focal temporal lobe seizure
LOC with no memory of seizure aura (fear or deja-vu) hallucinations (smell or taste something which isn't there)
51
what history would be associated with a focal frontal lobe complex partial seizure
LOC | rapid recovery
52
what is a simple seizure
a seizure which does not result in LOC
53
what history would be associated with a tonic-clonic (grand mal) seizure
LOC tonic phase (generalised muscle spasm) followed by clonic phase (repetitive synchronous jerks) associated with tonic-clonic seizures is faecal/urinary incontinence or tongue biting in the post-ictal phase there is reduced consciousness, lethargy, confusion
54
what history would be associated with a absence (petit mal) seizure
common in childhood LOC but maintenance of posture (patient stars blankly into space for seconds) no postictal phase
55
what history would be associated with a non-convulsive status epilepticus
acute confusional state
56
examination
normal between seizures
57
what is a partial seizure
focal onset (features of seizure limited to one area of the brain)
58
what is a simple partial seizure
no LOC focal motor + sensory symptoms no post-ictal symptoms
59
what is a complex partial seizure
LOC most commonly arise from temporal lobe post-ictal confusion is common with temporal lobe partial seizure
60
rapid recover from seizure suggests focal seizure in which lobe
frontal
61
what is a primary generalised seizure
silmultaneous onset of electrical discharge throughout the cortex
62
what symptoms would be seen in a partial (focal) seizure of the parietal lobe
sensory disturbances | motor symptoms
63
investigations
1 bloods -prolactin increases for a short amount of time after a 'true' seizure 2 EEG -for diagnosis 3 imaging -for structural, space-occupying + vascular lesions
64
management
1 with recurrent seizures (>2) begin medication (dependent on seizures type)
65
what medication is used for generalised tonic-clonic seizures
sodium valproate or lamotrigine are 1st line
66
what is the advantage of lamotrigine over sodium valproate
less teratogenic
67
what medication is used for absence seizures
sodium valproate or lamotrigine
68
what medication is used for tonic, atonic, myoclonic seizures
sodium valproate or lamotrigine
69
what medication should be avoided with tonic, atonic, myoclonic seizures
carbamazepine | may worsen seizures
70
what medication is used for partial seizures
carbamazepine | 1st line treatment
71
what dosages of drugs should be given
minimum dosage to control seizures | slowly build up doses over months
72
what is the procedure for changing to a different anti-epileptic drug
introduce new drug while maintaining original | withdraw the original drug once the new drug is established
73
what is status epilepticus
seizure>30mins with failure to regain consiousness
74
management of status epilepticus
resuscitate + ABCDEF IV lorazepam or PR diazepam if no change, IV phenytoin
75
what are the risks of AEDs
teratogenic | can limit effectiveness of oral contraception
76
complications
trauma from tonic-clonic seizures | sudden death in epilepsy (SUDEP)
77
what are the complications of AEDs
gingivial hypertrophy with phenytoin | neutropenia or osteoporosis with carbamzaepine
78
prognosis
remission is common

Nervous System (27 decks)

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