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Neurology HK > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

what is epilepsy

A

response to spontaneous, intermittent abnormal excitatory signals in the brain

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2
Q

inhibitory neurotransmitter in brain

A

GABA

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3
Q

what increases with GABA

A

Chloride

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4
Q

excitatory neurotransmitter in the brain

A

glutamate

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5
Q

what receptors does glutamate bind to

A

NMDA receptors

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6
Q

what increases with glutamate

A

Calcium

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7
Q

what are the 2 broad groups of seizures

A

generalized

focal (partial)

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8
Q

what are the 3 types of partial seizure

A

simple
complex
partial with secondary generalization

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9
Q

features of partial simple seizure

A

awareness intact
focal motor/autonomic/psychic or sensory (e.g. visual, olfactory) symptoms
no post-ictal symptoms

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10
Q

clinical features of partial complex seizures

A

awareness impaired
deja vu
lip smacking/jaw clenching/vertigo (automatism)
post ictal symptoms common

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11
Q

what lobe does complex partial seizures usually arise in

A

temporal

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12
Q

describe a partial seizure with secondary generalisation

A

electrical disturbance starts focally then spreads widely causing a typically convulsive seizure (pseudoseizure)

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13
Q

what are post ictal symptoms

A

headache
confusion
myalgia
sore tongue

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14
Q

seizures in frontal lobe

A

motor features - posturing, head/eye movements, peddling of legs dysphagia/speech arrest

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15
Q

seizures of parietal lobe

A

sensory disturbances - tingling, numbness

motor symptoms are rare - only if spread to pre-central gyrus)

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16
Q

seizures of occipital lobe

A

visual phenomena - spots, lines, flashes

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17
Q

1st line treatment for partial seizures

A

carbamazepine

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18
Q

2nd line treatment for partial seizures

A

sodium valproate

lamotrigine if woman of child bearing age

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19
Q

lamotrigine will diffuse into breast milk. True/false?

A

true - no harm to baby

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20
Q

what are the types of generalized seizures

A 
absent (petit mal) 
tonic-clonic seizure (grand mal)
myoclonic
tonic atonic 
infantile spasms
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21
Q

brief (<10s) pauses e.g. suddenly stops talking mid sentence then carries on

A

absent seizures

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22
Q

typical EEG finding for absent seizures

A

3 hertz notch

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23
Q

when do absent seizures typically present

24
Q

limbs stiffen then jerk with loss of consciousness

A

tonic-clonic

25
do you commonly get post-ictal symptoms in tonic-clonic seizures
yes
26
sudden jerk of a limb, face of trunk | may throw suddenly to ground
myoclonic
27
what drug should be avoided in myoclonic seizures
carbamazepine
28
sudden loss of muscle tone causing fall with no loss of consciousness (floppy)
atonic seizure
29
what condition is associated with infantile spasms
tuberous sclerosis
30
most common cause of seizures
idiopathic (often familial)
31
structural causes of seizures
``` cortical scarring (previous head injury) developmental space occupying lesion stroke hippocampal sclerosis ((after febrile convulsion) vascular malformations ```
32
non-epileptic causes of seizure
``` trauma stroke haemorrhage raised ICP alcohol/benzodiazepine withdrawal metabolic disturbances infection ```
33
what drugs can trigger seizures
cocaine tricyclics tramadol theophylline
34
triggers for seizures
``` alcohol stress sounds/flashing lights drugs lack of sleep ```
35
most common time for epilepsy to present
childhood-adolescence
36
investigations of suspected seizure
ECG MRI/CT - if suspected skull fracture, deteriorating GCS, focal signs, suggestion of other pathology EEG - doesn't always prove patient doesn't have epilepsy
37
treatment of generalised tonic-clonic
1st - sodium valproate or lamotrigine | 2nd line - carbamazepine or topiramate
38
treatment of absence seizures
sodium valproate lamotrigine ethosuximide
39
myoclonic seizures treatment
sodium valproate or lamotrigine 1st line | avoid carbamazepine
40
process of switching drugs
introduce new drug when still on old drug | only withdraw old drug when established on new drug
41
carbamazepine action SE
action - blocks voltage gated Na channels in pre-synaptic neuron which decreases excitable action potentials SE: leucopenia, visual changes, impaired balance/drowsiness, rash
42
lamotrigine action SE
action - blocks voltage gated Na channels in pre-synaptic neuron which decreases excitable action potentials SE: rash (toxic epidermal necrolyis,)hypersensitivity, visual changes, tremor, agitation, vomiting, aplastic anaemia
43
phenytoin action SE
action - blocks voltage gated Na channels in pre-synaptic neuron which decreases excitable action potentials SE: visual changes, tremor, ataxia
44
Na valproate action SE
``` action: enhances GABA synthesis (increasing inhibitory signals) SE: VALPROATE Appetite (weight gain) Liver failure Pancreatitis Reversible hair loss Oedema Ataxia Teratogenic, tremor, thrombocytopenia Encephalopathy ```
45
levetiracetam SE
mood swings
46
topiramate SE
sedation dysphagia weight loss
47
advice for women with epilepsy planning a pregnancy
folic acid supplements 5mg/day no valproate most drugs present in breast milk (lamotrigine not thought to be harmful to infants)
48
what drugs are liver enzyme-inducing AEDs
carbamazepine phenytoin barbiturates
49
what is affected in enzyme inducing AEDs
morning after pill not adequate | affect contraceptive pill and Depo-Provera
50
rules for ordinary driving licenses with diagnosed epilepsy
can drive if had not had a seizure (on or off medication) for one year only have seizures when asleep have previously had awake seizures but have only had seizures when asleep for the last 3 years
51
rules for ordinary driving license with one -off seizure
can drive 6 months after seizure if: only ever one seizure clear EEG don't need to take AEDs
52
rules for HGV/PCV license in one-off seizure
can get license back after 5 years if :only ever one seizure clear EEG no AEDs low risk of further seizures
53
rules for HGV/PCV with diagnosis of epilepsy
can get license if: seizure free for 10 years no treatment for 10 years low risk of seizure in the future
54
seizure for >5 minutes
status elipticus
55
acute management of status elipticus
airway management and O2 benzodiazepine - IV lorazepam (if IV access) if not - IM midazolam
56
what is non-epileptic attack disorder
happens for psychological reasons rather than physical ones | e.g. thoughts, feelings, past experiences
57
clinical findings on non-epileptic distress disorder
normal EEG | seizure like episodes

Neurology HK (26 decks)

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