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Yr5 Neuro > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is epilepsy?

A

Recurrent spontaneous, intermittent, abnormal hyper proliferation of neurones → seizures

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2
Q

What are the 2 main types of epilepsy? How are these further divided?

A
  • Generalised: Myoclonic, Tonic, Clonic, Tonic-Clonic, Atonic, Absence
  • Focal/Partial: Simple, Complex
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3
Q

What is the criteria needed to diagnose epilepsy?

A

> 2 seizures >2weeks apart

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4
Q

Describe what myoclonic seizures look like

A

Shock like movement of one/several parts of the body

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5
Q

Describe what tonic seizures look like

A

Stiff sustained contractions

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6
Q

Describe what clonic seizures look like

A

Rhythmic jerking of one limb/side/whole body

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7
Q

Describe what tonic-clonic seizures look like

A

Stiffness + rhythmic jerking

Associated w/post-ictal confusion & drowsiness

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8
Q

Describe what atonic seizures look like

A

Myoclonic jerks
Sudden loss of muscle tone → fall to floor
NO loc

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9
Q

Describe what absence seizures look like

A

Abrupt psychomotor arrest (5-15secs)
Upward deviation of eyelid
Perioral myoclonus (mouth twitching)

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10
Q

Describe a simple seizure

A

AKA Focal Aware seizure
No post-ictal Sx
Awareness intact
Focal motor, sensory, autonomic, psych Sx

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11
Q

Describe a complex seizure

A 
AKA Focal Unaware seizure
Awareness impaired
Post-ictal Sx OR rapid recovery 
Sx: Lip-smacking, grunting
CAN BECOME A GENERALISED SEIZURE
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12
Q

What auras are there pre-seizure?

A

TEMPORAL: COMMON Gastric discomfort, anxiety, hallucinations, memory disturbance, lip smacking, head turning
OCCIPITAL: Multi-coloured bright lights spreading from one homonymous field, flashes, floaters
FRONTAL: Dystonic posture w/rapid recovery
CENTRO-PARIETAL: C/L paraesthesia (pain, tingling, numb) spreads from 1 limb to 1 side

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13
Q

How is epilepsy investigated?

A

ECG: Arrhythmia/ Long QT
EEG +/- sleep-deprived EEG
MRI/CT: NOT ROUTINELY DONE- New diagnosis → exclude infective/vascular causes
Bloods: Find causes- U&E, Ca, Glucose

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14
Q

When is an EEG indicated?

A

> 2 seizures
OR
1 seizure if considered necessary by neurologist

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15
Q

Is an EEG helpful in the diagnosis of epilepsy?

A

Support diagnosis
Cannot exclude/refute epilepsy
Use photic/hyperV techniques to provoke seizure
Often just done for generalised/status

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16
Q

When should an epileptic be referred to secondary care?

A

All patients with diagnosis

Re-refer if seizure not controlled or dose change

17
Q

When should an epileptic be referred to tertiary care?

A 
Seizures not controlled
Drugs ineffective
Child <2yo
Structural lesion
Diagnostic doubt 
ACCESS GIVEN TO ALL PATIENTS WITH EPILEPSY
18
Q

How is epilepsy managed?

A

1) Anti-epileptic: After diagnosis confirmed/ usually after 2nd seizure
2) Med fail: Surgical resection/ Vagal nerve stimulation
3) Ketogenic diet, deep brain stimulation

19
Q

What anti-epileptics are given for the different types of seizures?

A
  • Myoclonic: 1) Sodium Valproate 2) Kepra
  • Focal: Carbamazepine or Lamotrigine
  • Absence/tonic-clonic/atonic: 1) Sodium Valproate, 2) Lamotrigine
20
Q

When is Sodium Valproate contraindicated?

A

Woman of child bearing age/sexually active
Pregnant
Give Lamotrigine

21
Q

What is the pathway for giving/changing AEDs?

A

Monotherapy → ↑dose of maximal tolerated → switch to 2nd line → combine

22
Q

When should you consider stopping an AED?

A

> 2years seizure free

Wean down over 3months

23
Q

What needs to be reviewed an an annual epilepsy review?

A
  • Seizure diary: no. frequency, date of most recent, type
  • Meds: Name, dose, adherence, SE, cognitive problems, effect, adjust dose if needed
  • Bloods: Folate, Vit D, FBC
  • Lifestyle: Driving, contraception, pregnancy planning, employment
24
Q

What is the prognosis of epilepsy?

A

90% absence fits in children resolve

60-70% seizure free

25
Q

What is a major complication of epilepsy?

A

SUDEP- sudden unexpected death in epilepsy
Common in uncontrolled epilepsy
Related to nocturnal seizure associated w/apnoea or asystole

26
Q

What are the DVLA rules related to epilepsy?

A 
Car/motorcycle:
Eligible if seizure free for one year
If seizure no driving for 6m
Lorry/bus:
Seizure free for 10years
No AEDs in 10years
One off seizure no driving for 5years
27
Q

What are the causes of status epilepticus?

A 
Idiopathic
Stroke
Epilepsy: Precipitated by med withdrawal
OH-
Infection &amp; tumours
Hypoxia
Drugs of abuse
Hypoglycaemia
Metabolic (hypoNa, hypoCa)
28
Q

What are the worrying features of status?

A 
Preceding headache/ head injury
Duration >5mins
Prolonged post-ictal phase
Adult onset
Recent depression (?OD)
29
Q

What is Todd’s paresis?

A

Focal weakness in a part or all of the body after a seizure

30
Q

What investigations should be done in status?

A 
Bloods: FBC, U&amp;E, LFT, Glucose, ↓Ca2+, Mg2+, ↑/↓Na+, Cultures
ABG
Urine: Drug screen, bHCG
ECG
CT/MRI/LP
31
Q

What is the management of status in the first 0-5mins?

A 
SECURE AIRWAY
15L/O2
Nasopharyngeal
Recovery position
IV access at 3-4mins
GLUCOSE: <3.5 = 100ml of 20% glucose STAT
32
Q

What is the management of status in the first 5-20mins?

A 
HELP- Notify anaesthetics &amp; ICU
Attach cardiac monitor
Buccal Midazolam 10mg/ IV Lorazepam 4mg over 2mins/ Rectal Diazepam 10mg over 2mins
REPEAT at >10mins
OH-: Pabrinex 2 pairs IV over 10mins
33
Q

What is the management of status in the first 20-40mins?

A 
ANAESTHETICS
Phenytoin 20mg/kg IV over 20mins
(Need to monitor cardiac function &amp; BP)
OR
Phenobarbital 10mg/kg IV over 10mins
OR 
Valproate
34
Q

What is the management of status in >40mins?

A

RSI
Thiopentone OR Propofol
ICU

35
Q

How is status managed in a child?

A

5mins: Buccal midazolam/ PR Diazepam/ IV Lorazepam
15mins: IV Lorazepam over 2mins
25mins: IV Phenytoin
>45mins: RSI w/Thiopentone

36
Q

What are the complications of status epilepticus?

A

Brain anoxia

Neuronal death w/permanent deficits

37
Q

What should be done post-status?

A

Consider CT/LP
Tox screen
Blood levels of AEDs
Abx/Antivirals

Yr5 Neuro (8 decks)

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