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09- Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

what are focal and generalised seizures?

A

focal = one part of the brain

generalised = larger part of the brain

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2
Q

who tends to suffer from focal and generalised seizures?

A

focal more common in 50s

generalised more common <30 as tend to be genetic

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3
Q

what are provoked seizures?

A

alcohol

sleep deprivation

hypoglycaemia

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4
Q

are provoked seizures classed as epilepsy?

A

no

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5
Q

what is important to ask about to determine epileptic seizure vs faint?

A

what happens before/after

eye witness

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6
Q

how would you describe an epileptic event?

A

lose awarness and go stiff

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7
Q

what exam must be carried out if investigating syncope?

A

cardiovascular exam

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8
Q

what is used to investigate epilepsy?

A

ECG

cerbral hypoperfusion and hypotension (watch for prolonged QT syndrome)

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9
Q

is an EEG manatory when investigating epilepsy?

A

no- 1 in 5 will show abnormal activity but not have epilepsy, likewise people will have nromal result when they do have epilepsy

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10
Q

when will an EEG be used?

A

in those <30 to differentiate between focal/generalised

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11
Q

how would an epileptic seizure affect someones ability to drive?

A

first seizure: car 6 months, HGV 5yrs

epilepsy: car 1yr, HGV 10yrs

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12
Q

how does focal epilepsy affect the brain?

A

one part of brain is structurally abnormal which predisposes to seizures i.e. sensory cortex gives sensory seizure

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13
Q

how can seizures propagate through the brain?

A

cortical networks

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14
Q

if a focal epilepsy results in a generalised siezure by propagating through brain what is this then termed?

A

secondary generalised seizure

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15
Q

what part of the brain is affected in generalised epilepsy?

A

abnormality already in cortical network so will always get generalised seizures

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16
Q

what are the kinds of generallised seizure people can experience?

A

absence

myoclonic

atonic

tonic

tonic clonic

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17
Q

what drug can be given to treat focal epilepsy?

A

carbamazepine

lamotrogine

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18
Q

what is side effect of carbamazepine?

A

lessens effects of other drugs i.e. COCP, chemo

wgt gain

hair loss

fatigue

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19
Q

what is used to treat genrealised epilepsy?

A

sodium valproate

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20
Q

what do you need to consider when prescribign sodium valproate?

A

teratogenic so muct be given contraception if child bearing age

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21
Q

lamotrogine can cause which syndrome if given too quickly?

A

steven-johnson syndrome

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22
Q

how long should it take to titrate up lamotrogine?

A

3 months

23
Q

what drug should never be given to treat generalised epilepsy?

A

carbamazepine

24
Q

can phenytoin be used to treat epilepsy?

A

used acutely- 6months to 1 year

25
Q

what other anti-epileptic can be used as few drug interaction but can cause mood swings?

A

levetiracetam

26
Q

carbamazepine, oxcarbazepine, phenobarbital, phenytoin, primidone and topiramate are all what kind of anti-epileptic drug?

A

enzyme inducing AEDs

27
Q

what is status epilepticus?

A

recurrent epileptic seizures without full recovery of consciousness >30mins

28
Q

status epilepticus can last >30mins, at what point is it treated?

A

10 mins as chances of self-terminating after then are near 0

29
Q

what is generalised convulsive status?

A

generalised convulsions without cessation

30
Q

what can cause generalised convulsive status?

A

severe metabolic disease

withdrawal of anti-convulsant

head trauma

sub-arachnoid haemorrhage

31
Q

what is the management of generalised convulsive state?

A

stabalise patient- ABS and identify cause

anticonvulsant: benzo, phenytoin, sodium valproate

if possible hypo give glucose/if alcohol give thiamine

32
Q

what is the max dose of benzodiazepine that can be given when suffering seizure?

A

max 2 doses

33
Q

what is teh name given to continous focal seizures with consciousness preserved?

A

epilepsia partialis continua

34
Q

what is an absence seizure?

A

interrupts activity with pause i.e. makes you stop what youre doing then start again

35
Q

what will be seen in frontal lobe seizure?

A

motor signs i.e. stiffness, twitching or spasm

36
Q

what will be seen in parietal lobe seizure?

A

sensory manifestations i.e. tingling, numbness, pain

37
Q

what will be seen seizures in occipital lobe seizures?

A

visual phenomena such as flashing lights, colours or hallucinations

38
Q

what will be seen in temporal lobe seizure?

A

change in mood or behaviour

rising epigastric sensation is common manifestation

39
Q

hippocampal sclerosis is the most common cause of temporal lobe epilepsy typically assoc w what type of seizure?

A

complex partial seizures

(focal)

40
Q

what is a complex partial seizure?

A

arises in one lobe of the brain rather than whole brain itself

41
Q

what are the three components seen in complex partial seizures?

A

aura

absence

automatism

42
Q

what is classically seen on EEG in absence seizure?

A

3Hz generalised spike-wave

43
Q

clonic seizures are most frequent in which age groups?

A

neonates and young children

44
Q

what imaging is helpful in those who develop epilepsy before the age of 2?

A

MRI

45
Q

what is teh MoA of carbamazepine and phenytoin?

A

Na+ channel inactivation

46
Q

what is the MoA of lamotrogine?

A

blocks voltage-gated Na+ channels

47
Q

what is the MoA of sodium valproate?

A

Na+ channel inactivation with increase GABA concentration

48
Q

what is first line treatment in community and in hospital for status epilepticus?

A

community: buccal or rectal midazolam
hospital: IV lorazepam

IV phenobarbital or phenytoin if sezures persist

49
Q

describe absence seizures?

A

brief, sudden lapse in consciousness

50
Q

describe myoclonic seizures?

A

sudden, jerking spasms of teh muscle/ muscle groups

51
Q

describe atonic seizures?

A

aka ‘drop seizure’

partial or compelte loss of muscle tone

52
Q

describe a tonic seizure?

A

sudden stiffness in muscles of arms/ legs/ trunk

uncoordinated, can last 20 secs

53
Q

describe a tonic clonic seizure?

A

loss of consciousness

stiffening of muscles followed by jerking movements (muscles relaxing: stiff/relax/stiff/relax)

09- Neurology (16 decks)

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