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INTERNAL MED 3+ conditions > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

3 definitions of epilepsy (clinical definitions)

A
  1. 2 or more unprovoked/reflex seizures occurring more than 24 hrs apart
  2. One unprovoked/reflex seizure and a probability of further seizures similar to the general recurrence risk (>60%) after 2 unprovoked seizures occurring over the next 10 years
  3. Diagnosed epilepsy syndrome
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2
Q

3 subtypes of seizures

A
  • Focal
  • Generalised
  • Unknown origin
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3
Q

Define seizure

A

Transient occurrence of signs/symptoms due to abnormal excessive or synchronous neuronal activity in the brain

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4
Q

Describe status epilepticus

A
  • Life-threatening
  • > 5 minutes - continuous seizure or repetitive seizures without regaining consciousness
  • Subtype = generalised convulsive SE
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5
Q

Describe generalised seizures - adults

A
  • These types of seizures are found in many types of epilepsy
  • Tonic-clonic (GTCS)
  • Involves LoC
  • Phasic tonic stiffening - followed by repetitive clonic jerking
  • Subtype = grand-mal epilepsy
  • Usually self-limiting without intervention
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6
Q

What does one see on an EEG during a generalised seizure

A
  • Bisynchronous epileptiform activity in both cerebral hemispheres
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7
Q

Describe generalised seizures - children

A
  • Recurrent generalised seizures in children are classified epilepsy
  • Common
  • Treat with anticonvulsants, ketogenic diets, vagus nerve stimulation and lifestyle
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8
Q

Risk factors for generalised seizures in children

A
  • Genetic
  • Family history
  • History of febrile seizures
  • Head trauma
  • Abnormal nervous system
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9
Q

Describe febrile seizures

A
  • In infants and children - 3 months to 5 years
  • High fever with no infection or defined cause
  • LP to exclude other causes
  • Usually self-limiting
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10
Q

Describe absence seizures

A
  • Abrupt cessation of activity/responsiveness
  • Minimal associated movements
  • Staring
  • 5-10 seconds - several times daily
  • Tends to disappear into adulthood
  • Treat with anticonvulsants
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11
Q

What are absence seizures precipitated by

A
  • Hyperventilation

- Photic stimulation

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12
Q

Describe focal/partial seizures

A
  • Electrical and clinical manifestations
  • Arise from one portion of the brain
  • Temporal lobe most common site
  • 2 subgroups - focal aware and impaired awareness
  • May lead to secondary generalised seizures
  • Treat with antiepileptic medication
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13
Q

Difference between syncope and seizure

A

SYNCOPE - vasovagal and cardiac syncope can have twitching and jerking
EPILEPSY - rhythmic jerking of all limbs, loss of bowel and bladder control, postictal confusion

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14
Q

What defines someone as epilepsy resolved

A
  • Seizure free 10 years

- No antiepileptic medication for 5 years

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15
Q

Epilepsy epidemiology

A

3-3.5% of Australians

40% of epileptics are children - many grow out of it

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16
Q

What % of aetiologies are unknown

A

50%

17
Q

Aetiology of epilepsy

A
  • Genetic
  • Head trauma
  • Stroke or brain haemorrhage
  • Lack oxygen
  • Degenerating conditions
  • Brain infection
  • Tumours
18
Q

Subtyping focal seizures

A
  • Motor and non-motor

- Aware and impaired awareness

19
Q

Subtyping generalised seizures

A
  • Motor = tonic-clonic and others

- Non-motor

20
Q

What % of people with epilepsy have focal seizures

A

60%

21
Q

Simple focal seizure

A

Preserved consciousness

22
Q

Complex focal seizure

A
  • Memory loss

- Impaired responsiveness at time of event

23
Q

What amount of seizures have a known aetiology

A

1/3

24
Q

Define kindling in regards to seizures

A

Repeated seizures lead to increased seizure duration and severity

25
Q

Focal seizure epidemiology

A
  • Incidence highest before 20 and after 60
  • M > F
  • Prevalence 4-8/1000
26
Q

Clinical presentation focal seziure

A
  • Movement of one side of the body
  • Premonitory sensation/experience
  • Automatisms (eg. smacking lips)
  • Temporary aphasia
  • Postictal focal neurological deficit
27
Q

Risk factors for focal seizures

A
  • Febrile seizures
  • CNS infection
  • Brain tumour
  • Dementia
  • Head trauma
  • Stroke
  • Mental retardation
  • Family history
  • Vascular malformations
28
Q

Acute management focal seizure

A
  1. Lorazepam/Diazepam + airway management
  2. Phenytoin
  3. Phenobarbital/Propofol + Midazolam
29
Q

Ongoing management focal seizures

A
  1. Antiepileptic monotherapy = Carbamazepine/Lamotrigine/Lacosamide/Valproic Acid
  2. Alternative antiepileptic monotherapy
  3. Polytherapy
  4. Surgery
30
Q

Epidemiology GTCS

A
  • 25% of epileptic patients have GTCS

- No age/sex/ethnicity association

31
Q

Investigations for seizure

A
  • EEG (to differentiate focal and generalised)

- BGL, FBC, electrolytes, toxicology, CT head, serum prolactin, serum CK

32
Q

Acute management of GTCS

A
  1. Benzodiazepine and supportive care

2. Phenytoin

33
Q

Ongoing management of GTCS

A
  1. Anticonvulsant monotherapy
  2. Alternative monotherapy
  3. Dual anticonvulsants

INTERNAL MED 3+ conditions (18 decks)

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