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Nervous System > Epilepsy > Flashcards

Epilepsy Flashcards

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
Q

what is the risk of sodium valproate in pregnant women

A

teratogenic

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26
Q

what happens when antiepileptics and the contraceptive pill are taken together

A

efficacy of antiepileptic and oral contraceptive pill is reduced

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27
Q

what is the MOA of sodium valproate

A

increases GABA activity

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28
Q

what is sodium valproates effect on P450 enzymes

A

P450 enzyme inhibitor

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29
Q

what is the MOA of carbamazepine

A

binds to Na channels increasing their refractory period

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30
Q

what is carbamazepines effect on P450 enzymes

A

P450 enzyme inducer

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31
Q

what is administered to a patient suffering from a seizure which fails to terminate spontaneously

A

benzodiazepines (diazepam)

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32
Q

what is the condition called what a patient continues to fit following administration of benzodiazepines (diazepam)

A

status epilepticus

33
Q

def of seizure

A

paroxysmal synchronised cortical electrical discharges

34
Q

what are the motor signs of electrical charges

A

convulsions

35
Q

what are the elements of a seizure

A

prodrome
aura
post-ictally

36
Q

what is prodrome

A

not part of the seizure
change in mood or behaviour
lasts hours/days preceding the seizure

37
Q

what is an aura

A

part of the seizure

indicated by strange smells or flashing lights (which aren’t really there)

38
Q

what is the post-ictal phase

A

period immediately after the seizure

headache, confusion, decreased consciousness

39
Q

what does an aura imply

A

focal seizure

40
Q

aetiology

A 
1 idiopathic (majority)
2 structural
3 others
41
Q

what are the structural causes of epilepsy

A 
cortical scarring (head injury years before onset of epileptic seizures)
space-occupying lesion
stroke
infection (meningitis, encephalitis)
inflammation (vasculitis)
42
Q

what are non-epileptic causes of seizures

A

trauma
stroke
alcohol or benzodiazepine withdrawal
metabolic disturbances

43
Q

what metabolic disturbances can cause seizures

A 
hypoxia
high/low Na
low Ca
high/low glucose
uraemia
44
Q

pathogenesis

A

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
Q

what triggers could start an epileptic fit

A

flashing lights
drugs
sleep deprivation

46
Q

epi

A

common

in children and elderly

47
Q

history

A

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
Q

what features are suggestive of a seizure

A

tongue biting

slow recovery

49
Q

what history would be associated with a frontal lobe focal motor seizure

A

motor convulsion
jacksonian march (spreading of focal motor seizure with no LOC)
post-ictal weakness (todds paralysis) in one part of the body

50
Q

what history would be associated with a focal temporal lobe seizure

A

LOC with no memory of seizure
aura (fear or deja-vu)
hallucinations (smell or taste something which isn’t there)

51
Q

what history would be associated with a focal frontal lobe complex partial seizure

A

LOC

rapid recovery

52
Q

what is a simple seizure

A

a seizure which does not result in LOC

53
Q

what history would be associated with a tonic-clonic (grand mal) seizure

A

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
Q

what history would be associated with a absence (petit mal) seizure

A

common in childhood
LOC but maintenance of posture (patient stars blankly into space for seconds)
no postictal phase

55
Q

what history would be associated with a non-convulsive status epilepticus

A

acute confusional state

56
Q

examination

A

normal between seizures

57
Q

what is a partial seizure

A

focal onset (features of seizure limited to one area of the brain)

58
Q

what is a simple partial seizure

A

no LOC
focal motor + sensory symptoms
no post-ictal symptoms

59
Q

what is a complex partial seizure

A

LOC
most commonly arise from temporal lobe
post-ictal confusion is common with temporal lobe partial seizure

60
Q

rapid recover from seizure suggests focal seizure in which lobe

A

frontal

61
Q

what is a primary generalised seizure

A

silmultaneous onset of electrical discharge throughout the cortex

62
Q

what symptoms would be seen in a partial (focal) seizure of the parietal lobe

A

sensory disturbances

motor symptoms

63
Q

investigations

A

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
Q

management

A

1 with recurrent seizures (>2) begin medication (dependent on seizures type)

65
Q

what medication is used for generalised tonic-clonic seizures

A

sodium valproate or lamotrigine are 1st line

66
Q

what is the advantage of lamotrigine over sodium valproate

A

less teratogenic

67
Q

what medication is used for absence seizures

A

sodium valproate or lamotrigine

68
Q

what medication is used for tonic, atonic, myoclonic seizures

A

sodium valproate or lamotrigine

69
Q

what medication should be avoided with tonic, atonic, myoclonic seizures

A

carbamazepine

may worsen seizures

70
Q

what medication is used for partial seizures

A

carbamazepine

1st line treatment

71
Q

what dosages of drugs should be given

A

minimum dosage to control seizures

slowly build up doses over months

72
Q

what is the procedure for changing to a different anti-epileptic drug

A

introduce new drug while maintaining original

withdraw the original drug once the new drug is established

73
Q

what is status epilepticus

A

seizure>30mins with failure to regain consiousness

74
Q

management of status epilepticus

A

resuscitate + ABCDEF
IV lorazepam or PR diazepam
if no change, IV phenytoin

75
Q

what are the risks of AEDs

A

teratogenic

can limit effectiveness of oral contraception

76
Q

complications

A

trauma from tonic-clonic seizures

sudden death in epilepsy (SUDEP)

77
Q

what are the complications of AEDs

A

gingivial hypertrophy with phenytoin

neutropenia or osteoporosis with carbamzaepine

78
Q

prognosis

A

remission is common

Nervous System (27 decks)

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