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Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is key in the diagnosis of a seizure?

A

EYE - WITNESS

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2
Q

What should you find out about the seizure?

A

Before, during and after

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3
Q

What should you find out about the onset of a seizure?

A

What were they doing?

Environment?

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4
Q

What is an important CVS question to ask?

A

Did they experience any syncopal symptoms or light headedness?

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5
Q

What sort of things do you want to know when asking what they looked like?

A
  • Pallor
  • Breathing
  • Posture of limbs
  • Head turning
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6
Q

What should you find out about the event itself?

A
  • Types of movement
  • Tonic phase, clonic movements
  • Carpopedal spasms, rigor
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7
Q

What is a ‘general tonic-clonic seizure’?

A

Tonic component

  • all muscles in the body are rigid
  • if the respiratory muscles are involved, person may become blue due to hypoxia.

Clonic component

  • jerky movements due to discharge of electrical activity
  • clonic component becomes of greater amplitude as discharge rate decreases
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8
Q

What is a ‘general tonic-clonic seizure’?

A

Tonic component

  • all muscles in the body are rigid
  • if the respiratory muscles are involved, person may become blue due to hypoxia

Clonic component

  • jerky movements due to discharge of electrical activity
  • clonic component becomes of greater amplitude as discharge rate decreases
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9
Q

Why may a person become blue during a seizure?

A

If the seizure is tonic, the respiratory muscles may be involved and will be rigid and the person will become hypoxic

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10
Q

What do carpopedal spasms suggest?

A

Hyperventillation

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11
Q

In a tonic-clonic seizure, will the person be aware of their surroundings?

A

NO

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12
Q

What do you want to know about what happened after the seizure?

A
  • Speed of recovery
  • Sleepiness/disorientation
  • Deficits
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13
Q

Post - epileptic attack, what do patients feel like?

A

Sleepy and disorientated

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14
Q

Give examples of epilepsy risk factors.

A 
Birth (ie. premature).
Development. 
Seizures in past (inc. febrile fits). 
Head injury (inc. LOC). 
Family hx. 
Drugs. (BENZOS!!!)
Alcohol.
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15
Q

What should you reassure a patient with epilepsy of in terms of their occupation?

A

Reassure pt that they can’t be sacked because of this dx since epilepsy is classed as a disability.

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16
Q

Is an exam carried out in 1st seizure appointment?

A

NO - history is most important

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17
Q

What exams should be carried out if a diagnosis of syncope is made?

A

Cardiovascular examination

Lying and standing BP important

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18
Q

What should you never forget to ask about in a history of someone with seizures?

A

Drugs

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19
Q

What drugs/drug classes are particularly bad for worsening epilepsy?

A 
Aminophylline/Theophylline. 
Analgesics ie. tramadol. 
Antibiotics ie. penicillins, cephalosporins, quinolones. 
Anti-emetics ie. prochlorperazine. 
Opioids ie. diamorphine, pethidine
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20
Q

What is the biggest cause of death in patents with epilepsy?

A

Suicide :(

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21
Q

What investigation MUST you always do in a patient who has had a seizure?

A

ECG

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22
Q

Why should an ECG always be done?

A

To find out if it was a hypoxic seizure

e.g from prolonged QT

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23
Q

What is prolonged QT a common cause of?

A
  • Seizures

* Cardiac arrest

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24
Q

You don’t need to (+ shouldn’t) CT every person who presents having had a seizure. Who, however, should get a CT scan acutely?

A 
Clinical or radiological skull fracture
Deteriorating GCS
Focal signs
Head injury with seizure
Failure to be GCS 15/15 4 hours after arrival
Suggestion of other pathology – eg SAH
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25
Q

Who should always get a CT?

A

Those who you think will need neurological help in the next few days

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26
Q

For what 4 reasons should an EEG be used?

A

Classification of epilepsy
Confirmation of non-epileptic attacks
Surgical evaluation
Confirmation of non-convulsive status

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27
Q

EEG’s are shite

A

Pie them off

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28
Q

When should EEG’s absolutely not be used?

A

To investigate the cause of an ‘attack’

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29
Q

What 4 conditions are commonly confused with epilepsy?

A
  • Syncope
  • Non-epileptic attack disorder (pseudopseizures, psychogenic non-epileptic attacks)
  • Panic attacks/Hyperventilation attacks
  • Sleep phenomena
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30
Q

Seizures doesn’t always mean epilepsy

A

TRUE

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31
Q

How can risk of recurrence of seizures be decreased?

A

Avoid alcohol, drugs and lack of sleep

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32
Q

What are the rules with regard to driving a i) car ii) HGV/PCV after the 1st seizure?

A

i) Can’t drive car for 6 months

ii) Can’t drive for 5 years

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33
Q

What are the rules with regard to driving a i) car ii) HGV/PCV after a diagnosis of epilepsy?

A

i) Must be seizure free for 1 year

ii) Can drive if had no seizures, and been OFF MEDICATION for 10 years

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34
Q

What is SUDEP?

A

Sudden Unexpected Death in Epilepsy

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35
Q

What are the risk factors for SUDEP?

A

Non-compliance with meds.
Drinking/Drugs.
Nocturnal seizures, and don’t have a bed partner

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36
Q

If someone presents with a seizure, what should you assume until proven otherwise?

A

That the cause of the seizure is a brain tumour

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37
Q

What is epilepsy?

A

A tendency to recurrent, usually spontaneous, epileptic seizures.

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38
Q

At what age does epilepsy occur?

A

At any age, but is most common in INFANCY and OLD age

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39
Q

Describe ‘focal’ seizures.

A

There is a focal abnormality which is a bit more sensitive than other areas of the brain. If the seizure starts there, it usually stays there.

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40
Q

What can focal seizures become?

A

If it ‘hits’ one of the cortical networks, it can spread more widely, causing a secondary generalized seizure

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41
Q

Describe generalised seizures.

A

KEY: a generalized seizure can start from a focal point, then propagate around a tract in the brain ie. corticothalamic circuitry

42
Q

Who is most likely to develop focal epileptic seizures?

A

Older people  50/60+ because, as people get older, the brain is more likely to be injured

43
Q

Who is more likely to develop generalised epileptic seizures?

A

Children - due to genetics

44
Q

What is a seizure?

A

An abnormal discharge of electrical activity in the brain

45
Q

Focal seizures can be either ______ or ______?

A

Simple OR Complex

46
Q

Describe simple focal seizures.

A

Seizure WITHOUT impaired consciousness

47
Q

Describe complex focal seizures.

A

Seizure WITH impaired consciousness

48
Q

List the different types of generalised seizures.

A 
Absence. 
Myoclonic. 
Atonic. 
Tonic. 
Tonic clonic
49
Q

What do most people with generalised epilepsy have?

A

A genetic predisposition

50
Q

What motor features are focal seizures associated with?

A 
Rhythmic jerking. 
Posturing. 
Head and eye deviation. 
Other movements (ie. cycling). 
Automatisms (ie. plucking). 
Vocalisation.
51
Q

What sensory features are focal seizures associated with?

A 
Somatosensory. 
Olfactory. 
Gustatory. 
Visual. 
Auditory.
52
Q

What psychic features are focal seizures associated with?

A 
Memories. 
Déjà vu.
Jamais vu.
Depersonalisation. 
Aphasia.
Complex visual hallucinations
53
Q

What is the characteristic appearance of generalised epilepsy on an EEG?

A

Spike - wave abnormalities

54
Q

An ‘aura’ before a seizure is the focal seizure which then spreads to become a generalized seizure

55
Q

What is the treatment of choice for CHILDREN with GENERALISED epilepsy?

A

Sodium valproate

56
Q

What is the biggest side effect of using sodium valproate?

A

It is teratogenic

57
Q

What is the treatment of choice for ADULTS with GENERALISED epilepsy?

A

Lamotrigine

58
Q

What is the most common type of primary generalised epilepsy?

A

Juvenile Myoclonic Epilepsy

59
Q

How does Juvenile Myoclonic Epilepsy usually manifest?

A

As early morning jerks.

Generalized seizures

60
Q

What are the risk factors for JME?

A

Sleep deprivation

Flashing lights

61
Q

In focal epilepsy, there is an underlying _____ cause?

A

STRUCTURAL

62
Q

What drugs are used in the treatment of focal epilepsy?

A

Carbamazepine (Tegretol).
or
Lamotrigine

63
Q

Why is sodium valproate not the first drug of choice in focal epilepsy?

A

It has too many side effects

64
Q

What is the effect of Na+ influx on a cell?

A

It increases excitability and drives action potentials

65
Q

What AED’s inhibit Na+ influx into a cell?

A

Carbamazepine, lamotrigine, oxcarbazepine, phenytoin, eslicarbazepine, rufinamide

66
Q

What is the effect of K+ efflux from a cell?

A

Reduces neuronal excitability

67
Q

What AED acts on K+ efflux from a cell? What is the effect of this?

A

Retigabine – increases channel activity, opening the channels, stabilising the neuron and reducing excitability

68
Q

What does Ca2+ influx into a cell do?

A

Drives neurotransmitter release

69
Q

What AED’s act on the Ca2+ channel of cells? What is the effect of this?

A

Pregabalin + Gabapentin (also ethosuximide)

These inhibit this channel

70
Q

What AED enhances GABA synthesis?

A

Sodium valproate

71
Q

What does a GABA transporter do?

A

Removes GABA from the synapse

72
Q

What AED acts on the GABA transporter? What is the effect of this?

A

Tigabine – inhibits the GABA transporter to elevate GABA levels

73
Q

What does GABA transaminase do?

A

Degrades GABA

74
Q

What AED acts on GABA transaminase? What is the effect of this?

A

Vigabatrin – inhibits GABA transaminase to elevate GABA levels

75
Q

What drugs are used in the initial treatment of focal seizures?

A
  • **Carbamazepine

* ** Lamotrigine

76
Q

What drugs are used to treat ABSENCE seizures?

A

Sodium valproate.
Ethosuximide.
(topiramte, levetiracetam)

77
Q

What drugs are used to treat MYOCLONIC seizures?

A

Sodium valproate.
Levetiracetam.
Clonazepam.
(lamotrigine, topiramate)

78
Q

What drugs are used to treat ATONIC / TONIC / GENERALISED TONIC CLONIC seizures?

A

***Sodium valproate.
Levetiracetam
Topiramate
Lamotrigine

79
Q

List some side effects of sodium valproate.

A

Weight gain.
Teratogenicity.
Hair loss.
Fatigue

80
Q

What does Carbamazepine make worse?

A

Primary generalized epilepsies

81
Q

What is the advantage of using lamotrigdine?

A

It is well tolerated in general and focal seizures

82
Q

What are the disadvantages of using lamotrigdine?

A

Takes a long time to titrate up.

Can cause a severe skin rash - can cause Stevens Johnson Syndrome

83
Q

What drug causes mood swings?

A

Levitiracetam

think ‘lev me alone’

84
Q

What are the side effects of topiramate?

A

Sedation
Dysphasia
Weight loss

85
Q

What is pregabalin and gabapentin used for?

A

Neuropathic pain

86
Q

When do we give drugs?

A
  • If the patient has epilepsy
  • If the patient had a single seizure but was at a high risk of recurrence
  • Only if the patient wants the drug
    (Need to balance benefits and side effects)
87
Q

What can some anti-convulsants induce?

A

Hepatic enzymes

88
Q

Give examples of drugs that induce hepatic enzymes.

A

Carbamazepine, oxcarbazepine, phenobarbitol, phenytoin, primidone

89
Q

Drugs that alter hepatic enzymes also….

A

Alter the efficacy of the COMBINED ORAL CONTRACEPTIVE PILL

90
Q

What should not be used in women who take anti-convulsants that induce hepatic enzymes?

A

The progesterone only pill

91
Q

What is not effective when on an enzyme inducer?

A

Progesterone implants

92
Q

What are the implications on the morning after pill when a pt is taking enzyme-inducing AEDs?

A

The usual morning after pill is not adequate, so the dose should be increased

93
Q

Women must be taking _________ 3 months prior to pregnancy

A

FOLIC ACID

94
Q

What is status epilepticus?

A

Recurrent epileptic seizures without full recovery of consciousness.
Continuous seizure activity, lasting more than 30 minutes

95
Q

What are the 3 types of status epilepticus?

A
  • Generalized convulsive status epilepticus.
  • Non-convulsive status  conscious, but in ‘altered state.’
  • Epilepsia partialis continua  continual focal seizures, consciousness preserved
96
Q

List some precipitants to status epilepticus.

A
  • Severe metabolic disorders (e.g hyponatraemia)
  • Infection
  • Head trauma
  • SAH
  • Abrupt withdrawal of anti-convulstants
  • Treating absence seizures with CBZ
97
Q

What is convulsive status?

A

Generalised convulsions without cessation

98
Q

What causes lasting damage in convulsive status?

A

Excess cerebral energy demand and poor substrate delivery

99
Q

What can convulsive status cause?

A
  • Respiratory insufficiency and hypoxia
  • Hypotension
  • Hyperthermia
  • Rhabdomyolysis
100
Q

How is status epilepticus managed?

A
  1. ABCDE - to stabilise pt as this is an emergency
  2. Find cause
  3. Emergency bloods +/- CT
  4. Anti-convulsants
  5. Benzodiazepine (NEVER more than 2 doses of 10mg)

Neurology (42 decks)

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