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Neuro > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is an epileptic seizure

A

Transient occurrence of signs/symptoms secondary to abnormal excessive neuronal activity in cerebral cortex

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2
Q

What are convulsions

A

Rapid and repeated muscle contractions leading to uncontrolled shaking of body
It is a form of clinical manifestations of seizure

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3
Q

What is an aura

A

Perceptual disturbance experienced by some prior to a seizure

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4
Q

What is epilepsy

A

Brain disorder characterised by enduring predisposition to generate seizures, and by neurobiological/social/cognitive/psychological consequences of the condition

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5
Q

What is status epilepticus

A

Medical emergency characterised by continuous seizures and incomplete recovery inbetween them, lasting >5 minutes

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6
Q

How are seizures classified

What are the classifications

A

By neuronal activity + clinical manifestation

Partial:
Simple
Complex
Secondarily generalised

Generalised: 
Tonic clonic
Absence
Myoclonic 
Tonic 
Atonic
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7
Q

What are partial seizures

A

Focal excessive neuronal activity, localised to part of the brain

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8
Q

What are the subtypes of partial seizures

A

Simple partial - no loss of consciousness
Complex partial - impaired consciousness
Secondarily generalised - partial seizure spreads and becomes generalised seizure

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9
Q

What are clinical manifestations of temporal lobe epilepsy

A

Auras:
Sensory - auditory, visual, olfactory, gustatory, rush of memories
Psychic - Deja vu, Jamais vu (unfamiliarity)

Lip smacking
Amnesia

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10
Q

What are clinical manifestations of frontal lobe epilepsy

A

Abnormal muscle movement Of any part of motor homunculus on contralateral side
Dysphasia

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11
Q

What are clinical manifestations of parietal lobe epilepsy

A

Somatosensory - Tingling, numbness on contralateral side

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12
Q

What are clinical manifestations of occipital lobe

A

Visual - Flashes of light, patches of darkness on contralateral visual field

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13
Q

What is generalised seizure

A

Widespread Abnormal neuronal activity in brain, arises from a foci and rapidly spreads bilaterally
It occurs with loss of consciousness

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14
Q

What are clinical manifestations of tonic-clonic seizures

What can precipitate this

A

Sudden onset LOC followed by

  1. Tonic stage: body stiffens up for 1min
  2. Clonic stage: rapid repeated contractions of all 4 limbs causing uncontrolled shaking, for 1 mins
  3. Relaxed + unconscious stage

Strobe lighting, hyperventilation

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15
Q

What are clinical manifestations of absence seizures
What might this be precipitated by
At What age group does this occur

A

Sudden LOC followed by
‘Blank’ period lasting 30s
With muscle twitching of face and hands
Return without post-ictal confusion and patient unaware of LOC

Relaxing after Mental/physical exercise

4-14yo

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16
Q

What are clinical manifestations of myoclonic seizures

A

Sudden LOC followed by uncontrolled body shaking due to rapid and repeated muscle contractions

17
Q

What are clinical manifestations of Tonic seizures

A

Sudden LOC followed by sudden stiffening of body due to increased muscle tone

18
Q

What are clinical manifestations of atonic seizure

A

Sudden LOC followed by sudden loss of muscle tone causing patient to drop down
Aka. Drop attack

19
Q

What do you need to ask in clinical history for seizures

A 
Must also have a collateral history 
Before:
Triggers
Aura
First sign/symptom

During:
Description of seizure
Duration
Abrupt/gradual end

After:
Post-ictal state
Tongue biting
Incontinence 
Neurological deficit
Bleeding after fall
20
Q

What are main differentials of epileptic seizure

A 
Stroke/TIA
Meningitis
Intracerebral haemorrhage (trauma) 
Autoimmune - SLE
Metabolic - hypoglycaemia, electrolyte, hypoxia
Iatrogenic - alcohol withdrawal, drugs 
Neoplastic - intracerebral mass
21
Q

What investigations are used

A

EEG

MRI

22
Q

What are indications and contraindications of EEG

What do you do if EEG results are inconclusive

A

To support diagnosis when Hx suggests epileptic origin

In isolation to make a diagnosis - NOT a diagnostic test
Probable syncope - risk of false +ve
Hx suggests non-epileptic origin

Repeat EEG
Sleep EEG
Ambulatory EEG

23
Q

What imaging investigation is used for seizures

A

MRI - imaging of choice
In all patients with new onset seizures
To exclude SOL

24
Q

Why is status epilepticus a medical emergency

A

High mortality: risk of vomiting + aspiration, blocked airway + hypoxia, permanent neuronal damage

25
Q

How do you manage status epilepticus

A
  1. ABCDE assessment
  2. Exclude hypoglycaemia
  3. ITU for paralysis + ventilation
  4. IV lorazepam or IV phenytoin
26
Q

What are the driving regulations for epileptic seizures

A

Epilepsy when awake: license taken away until 1year seizure free
Epilepsy due to medication change: license taken away until 6months seizure free
Epilepsy when sleep: assessment by DVLA
One off seizure: 6 months seizure free and assessment by DVLA

Neuro (18 decks)

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