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Neurology and Special Senses > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is epilepsy?

A

Recurrent tendency of spontaneous, intermittent, abnormal electrical activity in parts of the brain manifesting as seizures

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2
Q

What are convulsions?

A

Motor signs of electrical discharges

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3
Q

What causes epilepsy?

A

2/3 idiopathic

Cortical scarring
Developmental causes
Space occupying lesions
Stroke
Hippocampal sclerosis
Vascular malformations
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4
Q

What can patients experience before an epileptic event?

A

Prodrome lasting days/hours - change in mood or behaviour

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5
Q

What is an aura indicative of?

A

Focal seizure in the temporal lobe

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6
Q

What can aura involve?

A

Déjà vu
Strange feeling in gut
Strange smell
Flashing lights

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7
Q

What is the post-ictal phase?

A

Altered state of consciousness after an epileptic seizure

Typically 5-30 mins

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8
Q

What can patients experience in the post-ictal phase?

A 
Headache
Myalgia
Confusion
Temporary weakness - motor cortex
Dysphagia - temporal seizures
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9
Q

What must happen to patients who have suffered with a seizure?

A

Referred for further investigation

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10
Q

What is important about an epileptic history? (long answer)

A 
GET ONE FROM A WITNESS
Rule out other causes - pseudoseizure
Family history
Previous head injury
Birth problems
Ask what happened before, during and after the episode
Before
Illness?
Medications?
Triggers
During
Headaches - migraines can manifest in similar ways
Loss of consciousness?
Lose control of bladder/bowels?
Bite tongue/cheeks?
Could you talk, move etc?

After
Confused, headache, myalgia?

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11
Q

What investigations would you ask for if you suspect epilepsy?

A

EEG

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12
Q

What are types of seizures?

A

Focal

Generalised - Absence, Tonic-clonic, Myoclonic, Atonic, (Tonic, Clonic)

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13
Q

What is the difference between focal and generalized seizures?

A

Focal seizures only affect one hemisphere and are usually associated with structural disease

Generalised originate at some point but spread bilaterally and rapidly distribute. They have no localising features

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14
Q

How are focal seizures managed?

A

Carbamazepine -1st line

Lamotrigine

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15
Q

What is used to manage generalised seizures?

A

Sodium valproate

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16
Q

What seizures can carbamazepine exacerbate?

A

Myoclonic and Absence

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17
Q

What is an absence seizure?

A

Brief (usually <10s) event where subject stop talking mid sentence then carry on where they left off

Often seen in childhood

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18
Q

What happens in a tonic-clonic seizure?

A

Lose consciousness

Limbs stiffen - tonic
Then jerk - clonic

Often lose continence, have aura before and severe headache after

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19
Q

What happens in a myoclonic seizure?

A

Sudden jerk of limb, face or trunk - suddenly thrown to ground

Violently disobedient limb

No loss of consciousness and continue as normal after

20
Q

What happens in an atonic seizure?

A

Sudden loss of muscle tone –> fall

No loss of consciousness

21
Q

What symptoms are indicative of temporal lobe seizures?

A 
Complex motor phenomena
Impaired awareness
Oral movements - lip smacking, chewing, swallowing
Deja vu
Emotional disturbance
Sound, smell, taste hallucination
Delusional behaviour
22
Q

What symptoms are indicative of frontal lobe seizures?

A 
Motor feature - posturing or peddling movement
Jacksonian march
Motor arrest
Subtle behavioural disturbance
Speech arrest
23
Q

What is a jacksonian march?

A

Tingling begin in periphery then spread to larger area of body

24
Q

What symptoms are indicative of parietal lobe seizures?

A

Sensory disturbances
Tingling numbness
Pain
Motor symptoms

25
Q

How do occipital lobe seizures present?

A

Visual phenomena - spots, lines and flashes

26
Q

What things are important when giving management advice?

A

Pharmacological side effects

CBT can be recommended

Driving advice

27
Q

What is the driving advice for a first unprovoked seizure?

A

Can’t drive for 6 months if no structural abnormality and no abnormality on EEG, if not 12 months off

28
Q

What is the driving advice for patients with epilepsy?

A

Fit free for 12 months

29
Q

What is the driving advice when withdrawing from anti-epileptic medication?

A

No driving until 6 months after last dose

30
Q

Over what time period should anti-epileptic drugs be stopped?

A

Decreased slowly over 2-3 months

31
Q

Over what time period should barbituates and benzodiazepines be stopped?

A

Decreased slowly over 6 months

32
Q

What patients is it especially important to carefully consider management of epilepsy for?

A

Patients on other medication - CYP inducers/inhibitors

Women wishing to get pregnant

Women on contraception

33
Q

Name some ADR’s associated with carbamazepine

A 
Leucopenia
Visual disturbance
Balance issues
SIADH
Erythematous rash

P450 Inducer

34
Q

What is important to consider about dosage with Lamotrigine?

A

Dose changes depending on valproate and carbamazepine use alongside

35
Q

What are some ADR’s associated with Lamotrigine?

A

Maculopapular Rash

Steven Johnson Syndrome - warn them to see a doctor if they have flu like symptoms

36
Q

Name some ADR’s associated with Sodium Valproate

A 
Nausea
Teratogenic
Liver failure
Pancreatitis
Hair loss
Obesity
Ataxia
Tremor
Thrombocytopenia
Encephalopathy

P450 inhibitor

37
Q

How does carbamazepine work?

A

Bind to sodium channels to increase refractory period

38
Q

How does lamotrigine work?

A

Sodium channel blocker

39
Q

How does sodium valproate work?

A

Enhance GABA receptors

40
Q

How does phenytoin work?

A

Bind to sodium channels to increase refractory period

41
Q

Give some ADR’s of Phenytoin

A 
Nystagmus
Diplopia
Tremor
Dysarthria
Dizzy/drowsy
Peripheral neuropathy
Gingival hyperplasia

CYP450 Inducer

42
Q

What medication is used for pregnant women?

A

Lamotrigine

43
Q

What is important to remember about the contraceptive pill and lamotrigine?

A

Lamotrigine reduce effectiveness of Contraceptive

Contraceptive reduce lamotrigine levels

44
Q

What must women of child bearing age on Anti-epileptics take?

A

5mg Folate OD

45
Q

How should patients having a fit be managed immediately?

A

Most resolve within 5 minutes.

If not resolving after 5-10 mins, administer benzodiazepine (4mg lorazepam)

Neurology and Special Senses (28 decks)

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