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Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is focal epilepsy caused by?

Give a common example

A

Focal structural abnormality

Hippocampal sclerosis

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2
Q

Give examples of symptoms you might be in a frontal lobe seizure.

A

Repetitive muscle/muscle group clonus

Posturing

Personality change

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3
Q

Give examples of symptoms you might be in a parietal lobe seizure.

A

Pain

Indescribable sensory phenomena

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4
Q

Give examples of symptoms you might be in a temporal lobe seizure.

A

Automatism

Deja vu

Dysphoria/euphoria

Unusual speech

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5
Q

Focal epilepsy tends to present in childhood.

T/F?

A

False

Focal epilepsy tends to affect older people as it is caused by structural abnormalities

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6
Q

What causes generalised seizures?

A

Abnormal brain activity in a connecting pathway in the brain

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7
Q

Describe tonic-clonic seizure.

A

Patients stiffen (tonic), jerk (clonic) and are confused/drowsy afterwards

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8
Q

Describe atonic seizure

A

Patient loses tone of muscles without loss of consciousness

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9
Q

Describe absence seizure

A

Brief lapse in awareness where patients stop speaking and stare (seen in children)

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10
Q

Describe myoclonic seizure

A

Sudden jerk of limb, trunk or face

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11
Q

Generalised epilepsy tends to present in childhood.

T/F?

A

True

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12
Q

What is functional attack disorder and how can you clinically differentiate it from epilepsy?

A

Condition caused by past traumas which presents with seizures related to trauma, stress or anxiety

Traumatic event in childhood

Co-ordinated movement during seizure

Describe familiar aura (e.g. sweet smell/taste, not indescribable)

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13
Q

How do you manage functional attack disorder?

A

Exclude epilepsy (EEG)

Counselling (when patient is ready to confront trauma)

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14
Q

What investigations would you order in newly presenting epilepsy?

A

ECG
Essential investigation to look for prolonged QR syndrome which is fatal if missed

EEG
Classifies epilepsy

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15
Q

Management of an acute seizure?

A

IV/rectall benzodiazepine

IV phenytoin

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16
Q

First line management of focal epilepsy

A

Carbamazepine or lamotrigine

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17
Q

First line management of generalised epilepsy

A

Sodium valproate

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18
Q

Second line management of focal epilepsy

A

Levetiracetam or sodium valproate or topiramate

19
Q

Second line management of generalised epilepsy

A

Lamotrigine or levetiracetam

20
Q

Third line management of generalised epilepsy

A

Dual therapy

sodium valproate, lamotrigine, levetiracetam

21
Q

Third line management of focal epilepsy

A

Dual therapy
(carbamazepine, lamotrigine, levetiracetam, topiramate)

Unless they are over 60

22
Q

Last line management of focal epilepsy

A

Excisional sugery (if one epileptogenic focus)

Vagus nerve stimulation (if more than one epileptogenic focus)

23
Q

Patient given new diagnosis of epilepsy.

How long does she lose her driving license for?

A

Until 1 year seizure free

24
Q

Patient has first seizure.

How long do they lose their license for?

A

6 months seizure free

25
Q

Patient who works in HGV has a seizure

How long until she can drive her HGV?

A

5 years

26
Q

Patient who works in HGV is given new diagnosis of epilepsy

How long under she can drive her HGV?

A

10 years seizure free off medication

27
Q

Patient with known epilepsy is acting strangely on the ward.

What should this raise suspicion of?

A

Non-convulsive status epilepticus

28
Q

What is status epilepticus?

Why is it an emergency?

A

Seizure without spontaneous recovery

Brain can’t sustain high metabolic demands of a seizure

29
Q

What is the management of status epilepticus?

A

Benzodiazepines IV/IM (maximum of 2 doses)

30
Q

What increases the chances of sudden death in epilepsy?

A

Sudden Unexpected Death in Epilepsy (SUDEP) risk increased with

  • nocturnal seizure
  • drug use
  • poor medication compliance
31
Q

Mechanism of action of carbamazepine

A

Na channel blocker which decreases neuronal activity

32
Q

Mechanism of action of lamotrigine

A

Na channel blocker which decreases neuronal activity

33
Q

Mechanism of action of topiramate

A

Na channel blocker which decreases neuronal activity

34
Q

Mechanism of action of sodium valproate

A

Increases GABA synthesis

35
Q

Mechanism of action of levetiracetam

A

Inhibits SV2A which inhibits neurotransmitter release

36
Q

Which anticonvulsant is useful for focal seizures but can worsen generalised seizures?

A

Carbamazepine

37
Q

What anticonvulsant should be avoided in young women?

A

Sodium valproate (teratogenic)

38
Q

What is first line management of generalised epilepsy in a pregnant women?

A

Lamotrigine, levetiracetam

39
Q

Which anticonvulsant can cause mood swings?

A

Levetiracetam

40
Q

Which anticonvulsant should be avoided in obesity?

A

Sodium valproate

Causes weight gain

41
Q

Which anticonvulsant can cause weight loss?

A

Topiramate

42
Q

17 year old girl started on carbamazepine.

What should you ask about before sending her away?

A

Contraception

Carbamazepine is hepatic enzyme induced and reduces effectiveness of COCP

43
Q

Women with epilepsy wants to get pregnant.

What do you give her?

A

5mg folic acid daily

Neurology (11 decks)

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