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Block 3 > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What characteristics could be seen in a temporal focal onset seizure?

A

Auras: smell/taste, emotional changes

Oral automatisms: gestures

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2
Q

What characteristics could be seen in a frontal focal onset seizure?

A

Motor seizures: often bilateral, commonly on waking up from sleep

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3
Q

What characteristics could be seen in a parietal focal onset seizure?

A

Sensory seizures: tingling/warmth

Auras: nausea, choking, sinking sensations, body distortion

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4
Q

What characteristics could be seen in a occipital focal onset seizure?

A

Visual hallucinations

Vision blackout

Headturning/headaches/nausea

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5
Q

What is a focal aware seizure? How is it characterised?

A

No loss of consciousness or post-ictal confusion

Symptoms depend on focal site (usually temporal lobe in origin)

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6
Q

What is a focal with impaired awareness seizure?

How is it characterised?

A

Altered consciousness, possibly post-ictal confusion

Symptoms depend of focal site (usually temporal lobe)

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7
Q

Name the 2 types of Jacksonian seizures

A

Focal aware motor

Focal aware sensory

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8
Q

Describe a focal aware motor (Jacksonian seizure)

A

Short lasting

Ripple of muscle activity

Localised but usually ripples distal to proximal

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9
Q

Describe a focal aware sensory (Jacksonian seizure)

A

Short lasting

Sensory changes

Localised or progressing sensory changes distal to proximal

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10
Q

What is a focal to bilateral tonic clonic seizure?

How is it characterised?

A

Focal seizure progressing to generalised (tonic clonic)

Can experience auras

Can have unilateral motor effects

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11
Q

What is a generalised tonic clonic seizure?

How is it characterised?

A

No warning of onset, but may have ‘triggers’

Whole brain involved

Tonic phase: body stiffness, breathing may stop, loss of bladder control

Clonic phase: muscle jerks

Followed by unconsciousness, muscle relaxation, confusion, sleepy

No recall of episode

Large amplitude, syncronised activity on EEG

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12
Q

What is a generalised absence seizure?

How is it characterised?

A

Usually starts between 6-12 yrs

‘Switch off’ - can not be alerted or woken up

Whole brain involved, low level activity

Responds well to anti-epileptics

Focal point tends to be thalamus

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13
Q

What is status epilepticus?

How is it characterised?

A

Generalised tonic clonic, ictal period >5 minutes

Whole brain involved

Repeated seizures with no recovery between >30 mins

MEDICAL EMERGENCY

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14
Q

What is NEAD?

A

Non-epileptic attach disorder

No physical reason or changes in brain activity, but has similar symptoms

Diagnosis through EEG

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15
Q

Name some differences between NEAD and generalised tonic-clonic seizures

A

No changes in EEG brain activity

NEAD - eyes closed, bite tip of tongue

Tonic-clonic - eyes open, bite side of tongue

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16
Q

What are some advantages of electroencephalogram (EEG)

A

Useful for investigations/research

Non-invasive

Painless

Used over long periods

Cost effective

Can pick up coma/brain-dead patients

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17
Q

How is an EEG taken?

What does it record?

A

24-158 plate electrodes

Voltage deflections measured relative to ‘ground’ electrode (ear)

Records activity patterns of populations of neurons by recording changes in gross current flow

Looking at changes in synchrony

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18
Q

Name the 5 types of rhythms seen in an EEG

A

Alpha

Beta

Gamma

Theta

Delta

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19
Q

Describe alpha waves

A

8-13Hz

Mainly occipital

Eyes shut, meditation

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20
Q

Describe beta waves

A

> 14Hz

Parietal and frontal

Sleep spindles

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21
Q

Describe gamma waves

A

40Hz

Binding

Learning and memory

22
Q

Describe theta waves

A

4-7Hz

Parietal and temporal

Alertness - replayed activity in sleep

Learning and memory

23
Q

Describe delta waves

A

<3.5Hz

Cortical

Deep sleep

Coma

24
Q

What 4 things change in seizures (transmitters etc.)

A

Reduction in GABA

Increase in ACh transmission

Increase in Na+ channel activity

Decrease in K+ channel activity

25
Q

What are channelopathies?

A

Mutations in channel structures of linked to congenital forms of seizures and juvenile

Mutations found in K+, Na+, ACh and GABA receptors

26
Q

What are the 3 broad categories of treatment for seizures?

A

Pharmacological

Surgical

Implants

27
Q

What is the first line treatment for focal and focal to generalised seizures?

A

Carbamazepine

Lamotrigine

Sodium valproate

28
Q

What is first line treatment for generalised tonic clonic seizures?

A

Sodium valproate

Lamotrigine

Carbamazepine

29
Q

What needs to be considered when prescribing sodium valproate?

A

Not for women of childbearing age!!

30
Q

What is second line treatment in generalised tonic clonic seizures?

A

Clobazam

Levetiracetam

Topiramate

31
Q

What is second line treatment in focal and focal to generalised seizures?

A

Clobazam

Gabapentin

Topiramate

32
Q

What is first line treatment for generalised absence seizures?

A

ETHOSUXIMIDE

Sodium valproate

33
Q

What is second line treatment for generalised absence seizures?

A

Lamotrigine

34
Q

What drugs are administered in status epilepticus?

A

IV lorazepam (every 10 mins if needed) - if unavailable buccal midaz/IV diaz

Buccal midazolam/PR diazepam

After 25mins - phenobarbital sodium

After 45mins - anaesthetise with thiopental

35
Q

What is first line treatment in NEAD?

A

Antidepressants/antipsychotics

Psychotherapy/CBT

36
Q

What is different in the treatment of generalised absence, generalised atonic, and generalised tonic seizures?

A

Respond poorly to AEDs

First line sodium valproate

37
Q

What is generalised antiepileptic hypersensitivity syndrome?

A

Initial signs of fever, rash, swollen lymph nodes

Starts 1-8weeks after treatment

Sever signs - blood, liver, kidney, respiratory abnormalities, organ failure

38
Q

What is the treatment for antiepileptic hypersensitivity syndrome?

A

Withdraw drug

Topical steroids/antihistamines for rash

System corticosteroids?

Beware of rebound seizures

39
Q

What is the mechanism of action of most of the AEDs?

A

Generalised MoA:

Na+ channel blocker

Ca2+ channel blocker

GABA modulation

GABA mimetics

40
Q

How do Na+ channel blockers work to prevent seizures?

A

Hold the channel in its inactive state

Stop Na+ being up-taken by presynaptic cell, lowering depolarisation, less action potential

41
Q

Name 4 Na+ channel blockers used to treat epilepsy

A

Phenytoin

Carbamazepine

Lamotrigine

Sodium valproate

42
Q

Name same side effects of Na+ channel blocker use

A

CNS effects: cognitive impairment

Gum hyperplasia

Aneamia

Teratogenicity (baby defects)

43
Q

What type of GABA receptor is a target in anti-epileptic drugs?

A

GABA-A receptors

44
Q

What is the MoA of benzodiazepines to treat epilepsy?

A

Co-agonist at GABA-A receptor (gamma subunit) to increase activity of receptor

Reduces neuronal transmission by enhancing inhibition (GABA is inhibitory)

45
Q

What is the difference between BDZs and barbiturates in terms of MoA?

A

BDZs act on the gamma subunit of the GABA-A receptor

Barbiturates act on the beta subunit of the GABA-A receptor

46
Q

What is the MoA of barbituates to treat epilepsy?

A

Co-agonist of GABA-A receptor (beta subunit) to increase activity of receptor

Reduces neuronal transmission by enhancing inhibition (GABA is inhibitory)

47
Q

Give an example of a barbiturate used to treat epilepsy

A

Phenobarbital

48
Q

Name same common side effects of BDZs and barbs

A

Tolerance and dependency

Only to be used short term <12 weeks

Withdrawal on termination

Impaired motor coordination

Impaired cognitive performance

Sedation

Retrograde amnesia

49
Q

What is the MoA of Tiagabine?

What family of drugs is it in?

A

GABA reuptake inhibitor, blocks reuptake transporter

GABA uptake inhibitor

Enhances amount of GABA in synapse = increased inhibition of post-synaptic cell

50
Q

What is the MoA of Vigabatrin?

What family of drugs is it in?

A

Inhibition of GABA transaminase (enzyme that breaks down GABA)

GABA breakdown inhibitor

More GABA available for release from neurone

51
Q

What is the MoA of calcium channel blockers to treat epilepsy?

A

Blocks voltage dependent or low threshold T-type Ca2+ channels

Prevents action potential from stimulating neurone

52
Q

Give 3 examples of Ca2+ channel blockers to treat epilepsy

A

Ethosuximide

Gabapentin

Lamotrigine

Block 3 (14 decks)

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