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Neuropsyciatry > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

Seizure

A

sudden irregular discharge of electrical activity in the brain causing a physical manifestation such as sensory disturbance, unconsciousness or convulsions

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2
Q

Convulsion

A

uncontrolled shaking movements of the body due to rapid and repeated contraction and relaxation of muscles

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3
Q

Aura

A

perceptual disturbance experienced by some prior to a seizure, e.g. strange light, unpleasant smell, confusing thoughts

(not everyone w/ seizure gets Aura)

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4
Q

Epilepsy

A

neurological disorder marked by sudden recurrent episodes of sensory disturbance, LOC or convulsions, associated with abnormal electrical activity in the brain

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5
Q

What causes epilepsy? (4)

A

Increased excitatory activity

decreased inhibitory activity

Loss of homeostatic control

spread of neuronal activity

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6
Q

difference between primary and secondary causes of epilepsy

A

Primary: idiopathic

secondary: identifiable cause >> head trauma, hypoxia, tumor, stroke, infection, hypoglycemia, drugs

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7
Q

Status epilepticus

A

medical emergency.

It is defined as seizures lasting >5 mins or more than 3 seizures in one hour.

Management of status epileptics in the hospital:

Take an ABCDE approach:

  • Secure the airway
  • Give high-concentration oxygen
  • Assess cardiac and respiratory function
  • Check blood G levels
  • IV access (insert a cannula)
  1. IV lorazepam 4mg, repeated after 10 minutes if the seizure continues
  2. If seizures persist: IV phenobarbital or phenytoin
  3. If no response (‘refractory status’) w/in 45 minutes from onset induction of GA

Medical options in the community:

  1. Buccal midazolam
  2. Rectal diazepam
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8
Q

CL ASSIFICATION OF SEIZURES

A

.generalized> “matat” il bint mn il seizure

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9
Q

PARTIAL VS GENERALISED

A

P

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10
Q

PARTIAL SEIZURES

how r their consciousness levels different?

A

.

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11
Q

most common partial seizure?

symptoms?

when does it commonly occur?

A

Temporal lobe epilepsy

– 1st/2nd decade in most people, following seizure with fever or an early injury to the brain

– auras –e.g. auditory hallucination, rush of memories

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12
Q

2nd common type of partial seizure

A

Frontol lope epilepsy

Abnormal movements when motor areas affected (contralateral side)

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13
Q

GENERALISED

A

.• Tonic-clonic: 2 parts - 1st tonic (muscles Tense), 2nd clonic (Convulsions)

• Absence: ‘daydreaming’

• Status epilepticus: medical emergency

• Myoclonic: brief shock-like muscle jerks

• Atonic: ‘without tone’ – drop attack

• Tonic: increased tone (stiff)

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14
Q

Having convo, them suddenly u stop…. and carry on then like nthn happened

tx?

A

Absence

1st line: sodium valproate or ethosuximide

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15
Q

Standing 3ady tsolfeen, faj2a ogaf wa i stretch my hands out, then contnue normal

A

Tonic

increase tone in hand

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16
Q

brief shock-like muscle jerks

A

Myoclonic Chna lama ag3D >> ba3dayn faj2a y7ooshny bard😂😂

1st line: sodium valproate

Other options: lamotrigine, levetiracetam or topiramate

typically happen in children as part of juvenile myoclonic epilepsy

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17
Q

Atonic Seizures

Mx

A

They may be indicative of Lennox-Gastaut syndrome.

Management is:

1st line: sodium valproate

Second line: lamotrigine

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18
Q

Infantile spasms

A

This is also known as West syndrome.

It is a rare (1 in 4000) disorder starting in infancy at around 6 months of age.

It is characterised by clusters of full body spasms.

poor prognosis: 1/3 die by age 25, however 1/3 are seizure free. It can be difficult to treat but

first line treatments are:

  • Prednisolone
  • Vigabatrin
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19
Q

INVESTIGATIONS (3)

A

• Clinical history

  • EEG> can show typical patterns in different forms of epilepsy and support the diagnosis.
  • MRI > used to diagnose structural problems that may be associated with seizures and other pathology such as tumours.
  • ECG to exclude problems in the heart.
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20
Q

CLINICAL HISTORY

A

u wanna divide it into asking what happened (before, during ,after)

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21
Q

what is an EEG, if it is not diagnostic, why do we use it? what msut u warn the pateitn?

A

EEG (ELECTROENCEPHALOGRAM)

to supports diagnosis from the history!

patient warned that it may induce a seizure

22
Q

When should we NOT use EEG.

A

if u think from the history that its probably a syncope (risk of false positive result)

23
Q

If eeg is unclear? What do can we do?

A

– Repeated standard EEGs

– Sleep EEGs (sleep deprivation or melatonin in children/young people)

– Long-term video or ambulatory EEG (have elctrodes attached and get on w/ their daily lives

24
Q

DIFFERENTIAL DIAGNOSES

A
  • Vascular: Stroke, TIA
  • Infection: Abscess, Meningitis
  • Trauma: Intracerebral haemorrhage
  • Autoimmune: SLE
  • Metabolic: Hypoxia, Electrolyte imbalance, Hypoglycaemia, Thyroid dysfunction
  • Iatrogenic: Drugs, Alcohol Withdrawal
  • Neoplastic: Intracerebral mass
25
Q

INITIAL MANAGEMENT OF SEIZURES

A
26
Q

EPILEPSY AND DRIVING

A
  • If suffers epilepsy when awake, licence is taken away until 1 year seizure-free
  • If due to medication change: 6 months seizure-free
  • Seizures whilst asleep or don’t affect driving or consciousness – assessment of case by DVLA
  • If one-off seizure then can apply when 6 months seizure-free and assessment by DVLA
27
Q

Emergency seizure managment

A
28
Q

difference btw Delirium & Dementia

A

Delirium: Acute confuson state ( something that comes in quite suddenly) & its there bc somthing precipitated it.

ex in elderly: if they have some sort of infection, severe pain, constipation>> anything like that can set it off & they can become acutely confused!

29
Q

Difference in recovery & duration w/ syncope and epilepsy

A

Syncope: rapidly regains full lucidity (within 20-30 seconds)

Seizure: post-ictal period of confusion and/or agitation lasting several minutes to hours (often not recalled by the patient)

Syncope: <20 seconds typically

Seizure: often longer than 20 seconds

30
Q

How can we work out if the “situation” is going to become a progressive decline (like in dementia) or resolve (like in Delirium?)

A

we use the Confusion assessment method – CAM Score

(if they have any of the 4> they score a point)

(if 2 or more> most likely Delirium)

31
Q

Dementia vs delirium

A
32
Q

Dementia

A

“Progressive decline in higher cortical function leading to a globa limpairment of memory, intellect & personality which effects the individuals ability to cope with activities of daily living.”

33
Q

common types of dementias?

A
  1. Alzheimers
  2. Demetia w/ Lewy body
  3. Vascular Dementia
34
Q

INVESTIGATIONS of dementia

A
  • Full History + MMSE (collateral from family)
  • Full Neurological Examination
  • Blood tests – for reversible causes: TFTs, Vitamin B12
  • CT/MRI head
  • Memory Clinic follow up

(Minimental state examination- Give patien score out of 24, this classifies them into mild moderate or severe cognition)

Helps see rate of progression as well!

35
Q

what do u see on a CT scan w/ someone w/ Dementia?

A
36
Q

what do u see on a MRI scan w/ someone w/ Dementia?

A
37
Q

causes of Dementia?

A
38
Q

theraputic targets for antiepleptics

examples of drugs in each class

A
39
Q

3 GABA TYPE Classes & DRUGS

A
40
Q

INITIATING ANTI-EPILEPTICS, how to start, what liver interactions sould u be aware of?

A
  • Start with monotherapy and if ineffective change to monotherapy with different AED
  • First-line for generalised or tonic-clonic seizures – sodium valproate (or lamotrigine)

– If ineffective, other adjuncts considered (e.g. Levetiracetam, topiramate or sodium valproate AND lamotrigine)

• Titrate up to achieve a balance of therapeutic effect vs adverse side effects

• Beware of interactions!!!!

– Liver enzyme inducers

• Carbamazepine

• Phenyotin
– Liver enzyme inhibitors

• Sodium valproate

41
Q

if someone taking COCP, what should u do?

A

may need to increase estrogen dose to at least 50mcg & advise use of additional methods of contraception

42
Q

common ADVERSE EFFECTS and drugs causing each

A
43
Q

how to u change an epileptic?

why would u wanna change it?

A
  • Change if unacceptable side effects, failure of treatment or on inappropriate drug
  • Start at initial dose and slowly increase to middle of recommended therapeutic range
  • Then slowly withdraw old drug over about 6 weeks
44
Q

rules for cessation of antiepileptic

what is the aim?

(each drug, how much dose reduced in how many wks)

what about if they were on more than one drug?, what should be the time frame btw withdrawing one drug from the other?

what must u inform the patient?

A

Gradually taper off

Aim is to avoid withdrawal features

– Recurrent seizures
– Anxiety and restlessness

  1. Lamotrigine,carbamazepine,phenytoin,sodiumvalproate,vigabatrin – Reduce dose by 10% every 2-4 weeks
  2. Ethosuximide,barbiturates,benzodiazepines – Reduce dose by 10% every 4-8 weeks
  • If on more than one drug, withdraw from one drug at a time

– 1 month between complete withdrawal from one drug and starting withdrawal from another

45
Q

which is contraindicated in preganany? what is its effect on baby?

pregnancy dosage rules?

what should u advice her b4 getting pregnant?

A

Na Valproate

  • causes decreased SERUM FOLATE
  • craniofacial and skeletal abnormalities> Na valproate syndrome
  • developmental disorders after birth

prescribe lowest effective dose, divided throughout day, in conrolled-release tablets

start folate supplementation b4 pregnancy

46
Q

which drug must be monitored? why? howto we monitor? what r we checking for?

A
47
Q

what common congenital malformations does phenytoin cause?

A

Common congenital malformations
– Cleft lip and palate
– Congenital heart defects (septal defects)

Cardiac depressant (arrhythmias)

Toxicity !! > nausea, CNS dysfunction (confusion, nystagmus, ataxia), decreased consciousness, coma!

48
Q

how to treat partial seizures

A
49
Q

how to treat generalized seizures

A
50
Q

1st line therpay for primary generalized?

1st line therpay for partial seizures?

druge choice for women in child baring age

absent seizure?

A

Na valproate

Carbamezapine

Lamotrigine

Lamotrigine & valproate & clonazepam> short tem use tho

51
Q

types of Benzodiazipines given during emergency and mode of administration

A

Lorazepam: IV bolus 4mg is 1st line in emergency

Midazolam: Buccal if no IV access in emergency

Diazepam- can be given rectally in no acces

52
Q

why is Lorezepam preferred over diazepam ?

A

lasts longer and longer half life

Neuropsyciatry (21 decks)

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