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Stage 3: EJR - LTC > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What 2 types of focal onset seizures are there

A
  1. simple partial
  2. complex partial

the above 2 may then develop into secondary generalised tonic clonic

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2
Q

What 3 types of generalised seizures are there

A
  1. generalised tonic clonic
  2. absence
  3. myoclonic
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3
Q

Difference between simple and complex partial seizures

A

Simple: awareness not affected (often referred to as aura)

Complex: loss of awareness

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4
Q

What are common seizure automatisms that one should ask witnesses about

A
  • lip smacking/ licking

- fidding with things eg clothes

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5
Q

What question should you ask to find out if a person really was confused after they woke up

A

Ask about next memory of waking up

If passers-by fussing over them = syncope

If in ambulance with paramedics = like seizure (will take longer to recover)

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6
Q

Symptoms of focal epilepsy in occipital lobe

A

Visual disturbance

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7
Q

Symptoms of focal epilepsy in parietal lobe

A

Unusual sensations throughout body, lasting a few seconds

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8
Q

Symptoms of focal epilepsy in frontal lobe

A

Starts with thumb twitching on 1 side. Spreads to arms, trunk, leg.

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9
Q

Symptoms of focal epilepsy in pre-frontal lobe

A

Patient going into weird stretched postures

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10
Q

Symptoms of focal epilepsy in medial temporal lobe

A
  • Fear/panic
  • Epigastric rising sensation (like dip in roller coaster)
  • Olfactory hallucinations
  • Deja vu
  • Impaired awareness
  • Automatisms
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11
Q

Common cause of focal epilepsy in medial temporal lobe

A

Hippocampal sclerosis

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12
Q

How to differentiate generalised tonic clonic vs secondary generalised seizure

-type of symptoms

A

generalised tonic clonic: tonic clonic movements start immediately

secondary generalised: will start off with focal symptoms (1 sided) before becoming full on tonic clonic

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13
Q

How to differentiate absence vs complex partial seizure

-age of onset

A

Absence: childhood onset (never onset in adulthood)

Complex partial: onset at any age

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14
Q

How to differentiate absence vs complex partial seizure

-presence of aura

A

Absence: no aura

Complex partial: often has aura

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15
Q

How to differentiate absence vs complex partial seizure

  • duration of seizure
  • presence of confusion after
A

Absence: rarely last >10s, no post-ictal confusion

Complex partial: Usually lasts at least 30s, presence of post-ictal confusion

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16
Q

How to differentiate absence vs complex partial seizure

-presence of photosensitivity

A

Absence: may have photosensitivity

Complex partial: never photosensitive

17
Q

Important differential diagnosis to epilepsy in someone with seizures

A

Non-epileptic attack disorder (NEAD)

aka dissociative/ pseudo/ functional seizures

18
Q

How to differentiate Non-epileptic attack disorder (NEAD) from epilepsy

A

In NEAD, EEG will have absence of epileptic neuronal activity

19
Q

What features of a seizure would suggest NEAD over epilepsy

A
  • Sobbing (in usual seizure, people are too unaware to show emotion)
  • Normal/ rapid breathing (no hypoxia)
  • Asynchronous limb convulsions (tonic clonic seizures are synchronous)
20
Q

Why must an ECG be done in patients who have had a seizure

A

Severe cardiac syncope can progress to anoxic seizures

21
Q

What 3 features on ECG may indicate severe cardiac syncope

A
  1. Heart block (any kind)
  2. Evidence of ischaemia/ previous MI
  3. Prolonged QT interval (torsade du pointes)
22
Q

Risk of recurrence of seizure after the first one

A

40-50%

23
Q

Which 2 drugs are used to treat generalised epilepsy

A
  1. Sodium valproate (most effective)

2. Lamotrigine (first line for women. Less effective but less teratogenic than valproate)

24
Q

Which 2 drugs are used to treat focal epilepsy

A
  1. Carbamazepine
  2. Lamotrigine

Both equally effective but Lamotrigine better tolerated

25
Q

Main side effects of sodium valproate

A
  • Tremor, parkinsonism
  • Weight gain
  • Teratogenic
26
Q

Main side effects of carbamazepine

A
  • Ataxia (not good for elderly, causes fall risk)
  • Rash
  • CYP450 inducer
27
Q

Main side effects of lamotrigine

A

Rash (leading to Steven Johnson’s)

28
Q

Main side effects of levetiracetam

A

Irritability and depression

29
Q

When would you give benzodiazepines to an epileptic patient

A

When they are in status epilepticus

30
Q

Definition of status epilepticus

A

Seizure lasting >5min

or 2 or more seizures within 5min (without patient returning to normal between them)

31
Q

Risk factors for epilepsy

A
  • Genetics (parent or siblings with epilepsy)
  • Head trauma
  • Infections: meningitis, encephalitis, AIDS
  • Alzheimer’s, stroke, brain tumours
  • Birth complications, infections during pregnancy

Stage 3: EJR - LTC (14 decks)

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