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Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is a seizure?

A

Paroxysmal

Synchronous

Uncontrolled

Excessive discharge of neurons

In cerebral cortex

Manifesting as a stereotyped disturbance of

  • consciousness
  • behavior
  • emotion
  • motor function
  • sensation
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2
Q

What is epilepsy?

A

Recurrent

Unprovoked seizures

Occurring >24 hours apart

With a sudden onset, short duration and spontaneous cessation

Not associated with a precipitant

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3
Q

What is status epilepticus?

A

A medical emergency where

Continued

Or recurrent seizures

Over 30 minutes

Failure to regain consciousness between seizures

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4
Q

What is a prodrome?

A

Premonitory changes

In mood or behavior

Preceding a seizure

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5
Q

What is a an aura?

A

Subjective sensation or phenomenon

Preceding and marking onset of epileptic seizure

Localizes the seizure origin

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6
Q

What is the post ictal period?

A

Time after the seizure

Drowsy

Confused

Disorientated

Residual focal neurological signs

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7
Q

What is the classification of seizures?

A

PARTIAL/ FOCAL seizures

       SIMPLE (no LOC) -seconds-
             With motor
             With sensory
             With autonomic
             With psychological (deja vu)
   COMPLEX (LOC) -minutes-
         Simple + loc 

   PARTIAL WITH SECONDARY
   GENERALIZATION

GENERALIZED seizures

       ABSENCE
              typical (petit mal)
              Atypical 
       OTHER
              GTCS (grand mal)
              Tonic
              Clonic 
              Myoclonic
              Atonic
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8
Q

What are the aetiologies of epilepsy?

A

PRIMARY - no cause identifiable
(2/3rds)

SECONDARY

     Vascular
Cerebrovascular disease👈
Venous sinus thrombosis
Arteritis
AVM
     Infectious
Encephalitis 
Meningitis
Cerebral abscess
Neurosyohillis
     Neoplastic 👈
Intracranial tumors (specially new onset adult)
 Degenrative Dementias
     Congenital
IU infections (tox, rub)
Maternal drug abuse
Irradiation
Perinatal trauma and anoxia
     Trauma / toxic
Head injury👈
Brain surgery
Chronic alcohol abuse👈
Carbon monoxide
Phenothiazines
MAO inhibitors 
TCAD
Amphetamines
Lidocaine
Nalidixic acid
Sudden withdrawal of anticonvulsants
   Endocrine/ metabolic
Hyponatremia
Hypernatremia
Hypocalcemia
Hypomangesemia
Hypoglycemia 
Uremia
Hepatic
Hypoxia
Porphyria

Photosensitivity
Sleep deprivation

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9
Q

What are the diagnostic criteria for epilepsy?

A

At least 2 unprovoked seizures occurring >24 hours apart

One unprovoked seizure and a probability of further seizures risk of 60% over next 10 years

Diagnosis of an epilepsy syndrome

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10
Q

What are the sites of origin of focal epilepsies by frequency?

A

Temporal 60%

  • early adult/ adolescents
  • hippocampus damage
  • Dysembryoblastic NET

Frontal

Parietal

Occipital

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11
Q

What are automatisms?

A

Involuntary

Complex

Motor activity

Which occur PRE, INTRA or POST ictal

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12
Q

What are the features of temporal lobe seizures?

A 
Complex aura
\+
Subtle clouding of consciousness 
\+
Lasting few seconds
\+
Post ictal confusion and headache
Can generalize

COMPLEX AURA

          Visceral disturbances 
Epigastric fullness
Olfactory or gustatory hallucinations 
Lip smacking 
Choking sensation
Nausea
Pallor
Mydriasis
Tachycardia
          Memory disturbances 
Deja vu
Jamais vu
Flashbacks
Depersonalization 
Derealization
Visual or auditory hallucinations
          Motor disturbances
Fumbling
Rubbing
Chewing
Walking
          Affective disturbances 
Displeasure
Pleasure
Depression 
Elation
Fear
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13
Q

What are the features of frontal lobe seizures?

A

Abrupt onset

Indescribable aura

Automatisms, stereotyped movements

Head and eye versions to contralateral side

Fencing posture

Lasts seconds

Post ictal rapid recovery

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14
Q

What is a Jacksonian seizure?

A

Motor cortex

Matching pattern from face/ hands

Clonic or tonic

Todd’s paralysis for few hours

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15
Q

What are the features of parietal lobe seizures?

A

Somatosensory symptoms
-paresthesia, tingling, pain

Distortion of space and body image

Motor involvement

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16
Q

What are the features of GTCS?

A

Sudden LOC, no aura

Fall to the ground

Tonic phase lasting 10 seconds
-open eyes, flexed elbows, pronated arms,
Legs extended, clenched teeth, dilated pupils, cyanotic, ending with incontinence

Clonic phase lasting 1 to 2 minutes
-violent generalized shaking, eyes roll back
Bitten tongue, tachycardia

Post ictal sleep, confusion and headache, drowsiness

17
Q

What are the features of absence seizures?

A

Children with inattentiveness and poor grades

Several times a day

Lasting seconds

Triggered by hyperventilating

Sudden vacant stare

Blinking and myoclonic jerks

Characteristic 3 Hz EEG generalized spike and wave pattern

18
Q

What are the causes of neonatal seizures?

A 
Asphyxia 
ICH
Hypocalcemia
Hypoglycemia 
Hyperbilirubinemia 
Over hydration
Inborn errors of metabolism
19
Q

What are the causes of infant and childhood seizures

A 
Febrile convulsions 
CNS Infection 
Trauma
Congenital defects
Inborn error of metabolism 
Tumors
20
Q

What are the DDx for seizures?

A

Syncope

Arrhythmia

Hypoglycemia

Episodic confusion

Panic attacks

Narcolepsy

21
Q

What are the idiopathic epilepsy syndromes?

A

West syndrome

Lennox Gastaut syndrome

Childhood absence epilepsy

Juvenile myoclonic epilepsy

22
Q

How is epilepsy investigated?

A

Corroborate the diagnosis

Classify the epilepsy

Find an aetiology

Eliminate DDxs

INVESTIGATIONS
Imaging MRI > CT
EEG + videotelemetry
Blood tests - ABG, CPK, PRL,

23
Q

What is status epilepticus?

A

Successive

Tonic clonic seizures

With a gap inbetween

Where consciousness does not return

Lasting for more than 5 minutes (30 mins)

Life threatening

24
Q

What are the risk factors for status epilepticus?

A

Frontal lobe lesions

Head injury

Drug withdrawal (phenobarbitone)

Alcohol

Drug intoxication (TCAD)

Infections

Hyponatremia

Pregnancy

25
Q

How is status epilepticus managed?

A

Premonitory stage (0-10 mins)

ABC
Establish airway, high flow O2
Normal saline infusion
Do ABG, CBS, SE, RFT, LFT
Treat causes
Treat complications

Diazepam 10-20mg sup
Midazolam 10 mg buccal
Repeat in 10-20 mins if necessary

Early status (10-30 mins)
Lorazepam 4 mg iv
Can repeat but beware respiratory loss

Established status (30-60 mins)
Phenytoin 15-18 mg/kg
Fosphenytoin 15-20 mg/kg iv
50 mg/ min and monitor heart

Refractory status (after 60 mins)
GA with propofol 2 mg/kg bolus then 5-10 mg/kg/h infusion
26
Q

How is epilepsy managed?

A

Medical

Anticonvulsant monotherapy if high risk of recurrence

1st line
Carbamazepine 
Sodium valproate
Lamotrigine
Phenytoin
2nd line
Clobazam 
Clonazepam
Gabapentin
Topiramate
Levetiracetam
Pregabalin
Zonisamide
Lacosamide
Rufinamide
Retigabine
Oxcarbazepine
Phenobarbital

Surgical

27
Q

What are febrile seizures?

A

Seizures in the presence of fever which can’t even prevented by antipyretics

Most common cause of seizure in 6 month to 6 year age group

Not common in children (4%)

Typical / simple febrile seizures are generalized, last <15 mins and occur only once in a 24 hour period in a neurologically and developmentally normal child

Excellent prognosis, normal intellect, can recur

Risk of epilepsy is same as other children

Atypical febrile seizures are focal, last longer than 15 mins, recur within 24 hours in a child with preexisting neurological challenges

Neurology (21 decks)

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