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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:

A

Vision

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.

A

Syncope

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

A

30%

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:

A

EEG
CT
MRI

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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