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Neurological, neuromuscular and musculoskeletal disease > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

Prevalence of epilepsy =

A

5-10/1000

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2
Q

60% of individuals have what type of seizure

A

Focal

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3
Q

60-70% of focal seizures originate in which lobe?

A

Temporal lobe

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4
Q

What % of people become seizure free after treatment with anticonvulsants

A

60-70%

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5
Q

Seizure vs epilepsy =

A

Seizure - abnormal paroxysmal discharge of cerebral neurones enough to cause clinically detectable intermittent disturbance of consciousness, behaviour, emotion, motor or sensory function.

Epilepsy - seizures reoccur, usually spontanoeously (2+ in calendar year)

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6
Q

2 types of seizure =

A

generalised

focal

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7
Q

focal seizure =

A

arises from a single lobe in the brain. starts at a particular point (motor, sensory)

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8
Q

What can a focal seizure become?

A

generalised

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9
Q

types of focal seizure

A

Focal aware
Focal impaired awareness
Emotional
Focal to bilateral tonic clonic

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10
Q

Focal aware =

A

No loss of awareness, retains memory

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11
Q

Focal impaired awareness =

A

Consciousness is affected

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12
Q

Generalised seizures =

A

Affects both hemispheres of the brain

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13
Q

In a generalised seizure a person will be … (except in myoclonic)

A

Unconscious

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14
Q

Types of generalised seizures =

A 
Tonic
Clonic
Atonic
Tonic-clonic
Myoclonic
Absence
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15
Q

Most common type of generalised seizure =

A

Tonic-clonic

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16
Q

Absence seizure =

A

lose and regain consciousness.

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17
Q

when a seizure lasts too long/when seizure occurs to close together

A

Status epilepticus

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18
Q

Things that can cause a status epilepticus

A
  • Active part of tonic clonic lasts >5 mins
  • Person goes into second seizure without recovering consciousness first
  • Repeated seizures for 30 mins or longer
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19
Q

Aetiology of seizures:

A 
Unprovoked
Genetic
Tumors
Hippocampal sclerosis
Vascular malformations
Malformations of cortical development
Cerebral vascular disease
Post-traumatic
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20
Q

Mendelian genetic epilepsy

A

ADNFLE

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21
Q

ADNFLE

A

Autosomal dominant nocturnal frontal lobe epilepsy

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22
Q

Ex of mendelian disorders in which epilepsy is part of phenotype

A

Tuberous sclerosis

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23
Q

Non-mendelian genetic epilepsy:

A

JME

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24
Q

JME =

A

Junivile myoclonic epilepsy

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25
Q

Neuro disorders occur commonly in

A

Mitochondrial disorders

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26
Q

Frontal lobe function

A 
Intellectual functions
Inhibiton
Bladder continence
Saccadic eye movement
Motor function
Expression of langauge
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27
Q

Features of frontal lobe seizures =

A 
Jacksonian seizures
Adversive seizures
Todds paresis
Hyperkinetic behaviour
Vocalisation
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28
Q

Consciousness in frontal lobe seizures =

A

Retained

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29
Q

Jacksonian seizures =

A

One side (march)

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30
Q

Todds paresis

A

Paresis after seizure in focal part of body

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31
Q

Diagnose: 52 year old lady with episodes of twitching of right face and shaking of right arm and leg lasting for 2 minutes. Fulling conscious but difficulty speaking during attacks.

A

Frontal lobe seizure

32
Q

Function of parietal lobe:

A

Sensory integration

Receptive language

33
Q

Features of parietal lobe seizures:

A

Positive sensory disturbances

34
Q

Differential diagnosis for parietal lobe seizure?

A

TIA - tends to be negative symptoms

35
Q

68 year old lady with episodes of right sided tingling lasting 30 seconds.

A

Parietal lobe

36
Q

Function of temporal lobe:

A 
Memory
Smell
Hearing
Vestibular
Emotion
37
Q

Features of temporal lobe epilepsy:

A 
Aura
Auditory/visual hallucinations
- Speech arrest
- Motionless
- Automatism
- Odd behaviour
- Confusion, headache, dysphasia
38
Q

Time line of temporal lobe seizure =

A

Gradual evolution over 1-2 mins and lasts for 2-5 mins

39
Q

Aura can be =

A

smell
taste
dejavu
fear

40
Q

Automatisms ex

A

lip smacking
fidgeting
fumbling

41
Q

9 year old lady with episodes of going ‘blank’ associated with strange behaviour of lip smaking and undressing. She says she is not aware of the above but has a wanring in the form of an odd smell prior to the attacks.

A

Temporal lobe

42
Q

Function of occipital lobe:

43
Q

Features of occipital lobe seizures:

A

Unfomrmed, circular, multicoloured, confined to hemifield

44
Q

Visual disturbance: migraine vs occipital

A

Migraine: black and white, zig-zag, transverse field
Occipital: colour, circles, hemifield

45
Q

24 year old man who has intermittent attacks where he sees colours blobs lasting 30 seconds. Has several attacks a day. Eye tests normal, no heaches.

A

Occipital lobe

46
Q

Factors to consider when taking a Hx:

A 
Speed of onset
Circumstances surrounding
Symptoms prior to attack
Duration and evolution
\+ve and -ve symptoms
Awareness
Stereotyped
Recovery time
47
Q

Why are circumstances surrounding important?

A

Disgust, pain etc - syncope

48
Q

DDs for seizures:

A

TIA
Syncope
Migraine
Hyperventilation

49
Q

Aura in migraine vs epilepsy

A 
Migraine = throughout
Epilepsy = start
50
Q

What may happen before syncope?

A

Nausea

Lightheaded

51
Q

Incontinence can occur when

A

Syncope

Epilepsy

52
Q

Epileptic seizures DD

A 
Brief
Stereotypical
Multiple
Not situational
Positive symptoms
Come around later
53
Q

‘Stereotypical’

A

Same all the time, one person doesn’t have a variety of symptoms

54
Q

TIA DD

A

Quick onset

Negative symptoms

55
Q

Migraine has what kind of symptoms =

A

Positive and negative

56
Q

Syncope =

A

Sudden impairment of consciousness with loss of postural tone

57
Q

Why does injury not occur in syncope

A

Loss of postural tone

58
Q

Causes of syncope:

A

Reduced cerebral perfusion:

  • arrthymia
  • postural hypotension/orthostatic
  • vasovagal (situational)
59
Q

16 year old girl with recent LOC. Wittnessed by mum who describes convulsitons with urinary incontinence. Similar blackout 1 year ago.
Severe abdo pain, felt lightheaded with greying of vision. Got up to go to toilet, nausea, then LOC. Came round on the floor, incontinent, no injury, violently sick.

60
Q

43 year old remale admitted with overdose. Husband posted in Iraq. Having attacks of palpitations and hypervenitlation. Also awaiting neuro appointmet as some of these are followed by LOS and shaking.

A

Seizure in temporal lobe (anxiety doesn’t have LOC)

61
Q

Things that suggest organic cause:

A

Early morning myoclonic jerks
Absences
Aura/deja vu

62
Q

Red flags:

A

FHx
Hx of trauma, childhood seizures
Drugs and alcohol

63
Q

Management of single seizure:

A
  • Explanation
  • DVLA
  • occupation
  • Precipitating factor advice
  • what to do if further attack
64
Q

Risk of reoccurance of seizure after 1

65
Q

DVLA after single seizure =

A

6 month driving ban

66
Q

Precipitating factors of seizures -

A

Lack of sleep, stress, alcohol, meds, metabolic problems, drugs

67
Q

How to investigate epilepsy:

68
Q

EEG of epilepsy

A

Spike and wave

69
Q

EEG cannot

A

Exclude epilepsy

70
Q

Management of epilepsy:

A
  • Explantaion: condition, side effects of drugs
  • DVLA
  • Occupation
  • Precipitaing factors
  • What to do about attacks
  • Psychological support
71
Q

DVLA for epilepsy

A

1 year ban

72
Q

Drugs for idiopathic generalised epilepsy:

A 
Sodium valporate
Lamotrigine
Levetriacetam
Topiramate
Phenobarbitone
73
Q

Drugs for focal seizures:

A 
Sodium valporate
Lamotrigine
Leveltriacetan
Topiramate
Phenobarbitone
Carbamazepine
74
Q

Surgery for epilepsy

A

VNS

Lobectomy

75
Q

VNS =

A

Vagal nerve stimulation

Neurological, neuromuscular and musculoskeletal disease (22 decks)

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