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Nervous System > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

what is the differential diagnosis for blackout?

A 
> syncope
> first seizure
> hypoxic seizure
> concussive seizure
> cardiac arrhythmia
> non-epileptic attack
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2
Q

what do you need to get from the history from the patient?

A 
> what were they doing
> any warning signs
> what were they doing the night before
> how did the feel afterwards
> injury or incontinence?
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3
Q

what information do you need from witnesses?

A 
detailed observations before and during the attacks: 
> responsiveness
> colour
> breathing
> vocalisation
> behaviour following the attacks
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4
Q

what information is relevant or important in the history?

A 
> age
> sex
> head injury, birth trauma and febrile convulsions
> past psychiatric history
> alcohol and drug abuse
> family history
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5
Q

what is the most common cause of syncope?

A

vasovagal syncope

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6
Q

what prodromes syncope?

A 
> light headed
> nausea
> hot/sweating
> tinnitus
> tunnel vision
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7
Q

what are the trigger warnings for vasovagal syncope?

A 
> prolonged standing
> standing up quickly
> trauma
> venepuncture
> watching medical procedures
> micturition
> coughing
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8
Q

what features of syncope differ from seizures?

A 
> happens in upright posture
> pallor is uncommon
> there is gradual onset
> injury is rare
> incontinence is rare
> rapid recovery
> precipitants common
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9
Q

how do seizures differ from syncope?

A 
> any posture
> pallor uncommon
> sudden onset
> injury is quite common
> incontinence common
> slow recovery
> precipitants rare
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10
Q

when do hypoxic seizures occur?

A

when individuals are kept upright in a faint, there may be a succession of collapses then seizure like activity may occur

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11
Q

when do concussive seizure occur?

A

after a blow to the head

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12
Q

can seizures cause cardiac arrhythmias?

A

yes

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13
Q

what should you consider in a family history of sudden death and when collapse occurs during exercise?

A

> functional cardiac problems (long QT syndrome)

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14
Q

describe non-epileptic attacks

A 
> commoner in women
> may be frequent
> prolonged
> superficially resemble generalised tonic-clonic seizure
> may resemble a swoon
> involves bizarre alternating movements
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15
Q

what might be found in the history of a patient with non-epileptic attacks?

A

> history of other unexplained symptoms

> may have a history of abuse

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16
Q

what investigations would you carry out for a possible first seizure?

A

> blood sugar
ECG
consider drugs and alcohol
CT head (criteria)

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17
Q

what advice should be given to the patient with a first seizure?

A

> safety information
employment (they may need to inform them)
potentially dangerous leisure activities
driving regulations

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18
Q

after their first seizure how long until a patient can drive again if their investigations are normal and they have no further events?

A

6 months

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19
Q

when can a patient drive a HGV or PSV after their first seizure?

A

after 5 years if their investigations are normal, they have no further events and the are not on any anti-epileptic medication

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20
Q

when is epilepsy normally diagnosed?

A

after a second unprovoked attack (sometimes on taking the history after a first seizure if it is clear they have undiagnosed epilepsy)

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21
Q

in epilepsy what might occur in the morning?

A

myoclonic jerks

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22
Q

what features in a history would be suggestive of primary generalised epilepsy?

A

> myoclonic jerks

> absences/feeling strange with flickering lights

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23
Q

what features of a history is suggestive of focal onset epilepsy?

A

> deja vu sensation from the abdomen

> episodes of blank look with fiddling

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24
Q

what is epilepsy?

A

a condition in which seizures recur, usually spontaneously

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25
Q

what is 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 neural discharges

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26
Q

what is the incidence of epilepsy?

A

50-120 per 100000 per year

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27
Q

what shaped curve is seen in epilepsy?

A

j shaped

28
Q

what is the prevalence of epilepsy?

A

5-8 per 1000

29
Q

name some generalised seizures

A 
> tonic-clonic seizures
> myoclonic seizures
> clonic seizures
> tonic seizures
> atonic seizures
> absence seizures
30
Q

describe a tonic-clonic seizure

A

there is a tonic stage where they can stop breathing then they enter the clonic stage and begin to breath again

31
Q

describe an atonic seizure

A

the patient can rapidly collapse to the floor, resulting in injury though there is quick recovery

32
Q

describe an absence seizure

A

children will frequently drift away then come back, they can grow out of it

33
Q

what are focal seizures characterised by?

A

> aura
motor features
autonomic features
degree of awareness or responsiveness

34
Q

what can focal seizures evolve into?

A

generalised convulsive seizure

35
Q

describe primary generalised epilepsy

A 
> no warning
> <25 years
> history of absences and myoclonic jerks, and GTCS
> generalised abnormality on EEG
> family history?
36
Q

describe focal/partial epilepsies

A 
> aura
> any age
> cause can be any focal brain abnormality
> focal abnormality on the EEG
> MRI may show the cause
37
Q

what focal epilepsies may become secondarily generalised?

A

simple partial and complex partial seizures

38
Q

what can you get the patient to do when carrying out an EEG for primary generalised epilepsies?

A

> hyperventilate
photic stimulation
sleep deprivation

39
Q

when would you carry out a MRI for epilepsy?

A

patients under the age of 50 with possible focal onset seizures

40
Q

what could you carry out if you were uncertain of the diagnosis?

A

video telemetry

41
Q

what is the first line treatment for primary generalised epilepsies?

A

> sodium valproate
lamotrigine
levetiracetam

42
Q

what is the first line treatment for partial and secondary generalised seizures?

A

> lamotrigine

> carbamazepine

43
Q

what is the first line treatment for absence seizures?

A

ethosuximide

44
Q

what is the first line treatment for status epilepticus?

A

> lorazepam

> midazolam

45
Q

what is the second line treatment for status epilepticus?

A

> valproate

> phenytoin

46
Q

what is the second line treatment for generalised seizures?

A

> topiramate

> zonisamide

47
Q

what does carbamezapine make worse?

A

myoclonic jerks

48
Q

what is sodium valproate, topiramate and leviteracetam a second line treatment for?

A

partial seizures

49
Q

what are the side effects of sodium valproate?

A 
> tremor
> weight gain
> ataxia
> nausea
> drowsiness
> transient hair loss
> pancreatitis
> hepatitis
50
Q

what are the side effects of carbamazepine?

A 
> ataxia
> drowsiness
> nystagmus
> blurred vision
> low serum sodium levels
> skin rash
51
Q

what are the side effects of lamotrigine?

A

> skin rash

> difficulty sleeping

52
Q

what are the side effects of levetiracetam?

A

> irritability

> depression

53
Q

what are the side effects of topiramate?

A

> weight loss
word finding problems
tingling of the hands and feet

54
Q

what are the side effects of zonisamide?

A

> bowel upset

> cognitive problems

55
Q

what is the side effect of lacosamide?

A

dizziness

56
Q

what is the side effect of pregabilin?

A

weight gain

57
Q

what are the side effects of vigabatrin?

A

> behavioural problems

> visual field defects

58
Q

when can patients hold a group one licence after a year?

A

> if they have been seizure free for a year

> if they have only had seizures arising from sleep for a year

59
Q

when must a patient wait three years before they can drive again?

A

> if they have ever had a daytime seizure then the pattern becomes nocturnal

60
Q

when can epileptic patients hold a HGV or PSV licence?

A

if they have been seizure free for 10 years and are not on antiepileptic medication

61
Q

what is status epilepticus?

A

prolonged or recurrent tonic-clonic seizures persisting for more than 30 minutes with no recovery period between seizures

62
Q

in what patients does status epilepticus normally occur?

A

in patients with no previous history of epilepsy (stroke, tumour, alcohol)

63
Q

what is the first line treatment for TCSE?

A

> midazolam: buccal/intranasal repeated after 10 mins if necessary
lorazepam: 4mg bolus repeated once after 10mins
diazepam: 10-20mg IV or rectally repeated after 15mins if necessary

64
Q

what is the second line treatment for TCSE?

A

> phenytoin

> valproate

65
Q

what is the third line treatment of TCSE?

A

anaesthesia usually with propofol or thiopentone. this shuts down brain activity, they are loaded with anticonvulsants then woken up in 24 hours

66
Q

in what groups is mortality from TCSE the greatest?

A

in the very young and old

67
Q

what is reported in 24% percent of children who have an episode of status?

A

neurological problems

Nervous System (45 decks)

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