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Neuro Pathology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

Definition of an epileptic seizure

A

An intermittent stereotyped disturbance of consciousness, behaviour, emotion and motor function or sensation which, on clinical grounds, is believed to result from abnormal neuronal discharges

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2
Q

Definition epilepsy

A

A condition in which seizures recur, usually spontaneously

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3
Q

What age does epilepsy occur?

A

J shaped curve

  • high in infancy and - childhood
  • then falls in adulthood
  • increases when older (mostly due to CVS problems)
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4
Q

What % of people with learning disorders have epilepsy?

A

22%

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5
Q

What classifies epilepsy?

A

International league against epilepsy (ILAE)

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6
Q

What classifies epilepsy into groups?

A

Clinical data

EEG

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7
Q

What does EEG stand for?

A

Electroencephalogram

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8
Q

Two broad types of epileptic seizures

A

Generalized

Focal

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9
Q

Types of generalised seizures

A 
Tonic-clonic
Myoclonic 
Clonic
Tonic
Atonic 
Absence
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10
Q

Features of tonic clonic seizures

A

Usually start tonic (stiff - may stop breathing for a while)

Then go into jerking clonic (and start breathing again)

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11
Q

Features of myotonic seizures

A

Very clumsy and jerky especially in the mornings

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12
Q

Features of clonic seizures

A

Jerking movements

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13
Q

Features of tonic seizures

A

Stiffening movement

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14
Q

Features of atonic seizures

A

Collapse to the floor very rapidly

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15
Q

Features of absence seziures

A

Lasts seconds, may not see even see if not looking for it

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16
Q

What age do children usually grow out of absence seizures?

A

12

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17
Q

What is very common with atonic seizures?

A

Facial / head injuries

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18
Q

What are focal seizures characterised by?

A

Aura
Motor features
Autonomic features
Degree of awareness or responsiveness

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19
Q

What may focal seizures evolve into?

A

Generalized convulsive seizures

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20
Q

Definition of status epilepticus

A

Prolonged or recurrent tonic-clonic seizures persisting for more than 30 minutes with no recovery period between seizures

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21
Q

What will status epilepticus cause unless intervention?

A

Brain damage

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22
Q

Who does status epilepticus usually occur in?

A

No previous history or epilepsy (r.g. caused by stroke, tumour, alcohol)

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23
Q

Mortality of status epilepticus

A

5 - 10%

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24
Q

Do most people who have a first seizure go onto develop epilepsy?

A

NO

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25
Q

Where does epilepsy develop in the brain?

A

Grey matter

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26
Q

What does SUDEP stand for?

A

Sudden unexplained death in epilepsy

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27
Q

What does TCSE stand for?

A

Tonic clonic status epilepticus

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28
Q

Who has the greatest mortality in TCSE?

A

Very young

Very old

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29
Q

How many people with epilepsy have SUDEP?

A

1 in 1000 every year

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30
Q

Differential diagnosis of blackouts

A 
Syncope
First seizure
Hypoxic seizure
Concussive seizure 
Cardiac arrythmia 
Non-epileptic attack (narcolepsy, movement disorder, migraine)
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31
Q

What questions should be asked in the history about a seizure from the patient?

A

What were they doing at the time?
What if any warning feelings did they get?
What were they doing the night before?
Have they had anything similar in the past?
How did they feel afterwards?
Any injury, tongue biting or incontinence?

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32
Q

What questions should be asked in the history about a seizure from a witness?

A

Detailed description of observations before and during attacks - including level of responsiveness, motor phenomena, pulse, colour, breathing, vocalisation
Detailed description of behavior following the attack

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33
Q

What additional information to ask about which may potentially be relevant?

A 
Age
Sex
PMH
- head injury 
- birth trauma
- febrile convulsions
Past psychiatric history 
Alcohol and drug use
FH
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34
Q

What is the most common cause of fainting?

A

Vasovagal syncope

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35
Q

Prodrome for vasovagal syncope

A 
Light headedness 
Nausea
Tinnitus
Hot, sweating
Tunnel vision
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36
Q

Triggers for vasovagal syncope

A 
Prolonged standing
Standing up quickly
Trauma
Venepuncture
Watching/experiencing medical procedures
Micturition 
Coughing
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37
Q

Definition of micturition

A

Act of passing urine

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38
Q

Presentation of syncope

A

Upright posture
Pallor common
Prodromal symptoms

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39
Q

Onset of syncope

A

Gradual onset

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40
Q

Results of syncope

A

Injury rare

Incontinence rare

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41
Q

Are precipitants common in syncope?

A

Yes

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42
Q

How quick is recovery in syncope?

A

Rapid

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43
Q

Presentation of seizure

A

Any posture
Pallor uncommon
Movements

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44
Q

Onset of seziure

A

Sudden onset

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45
Q

Results of a seizure

A

Injury common

Incontinence common

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46
Q

Recovery time of a seizure

A

Slow

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47
Q

Are precipitants common for a seizure?

A

No

48
Q

When do hypoxic seizures occur?

A

When individuals are kept upright in a faint - then the faint turns into a seizure

49
Q

Where are common places for hypoxic seizures to occur?

A

Aircrafts on the upright chairs

Someone catching someone who is fainting and help them to their feet

50
Q

When do concussive seizures occur?

A

After any blow to the head

51
Q

Why are you unlikely to have a seizure during exercise?

A

Because the brain is very busy

52
Q

Can seizures cause cardiac arrythmias?

A

Yes

53
Q

Which gender are non epileptic attacks more common in?

A

Women

54
Q

Most epileptic attacks are over in how long?

A

5 minutes

55
Q

If a seizure if over 5 minutes long, what is it not likely to be?

A

An epileptic attack

56
Q

Clues in the history pointing towards a non epileptic attack

A

History of other medically unexplained symptoms

History of abuse

57
Q

Presentation of a non epileptic attack

A

Well in between attacks
May look bizarre
May superficially resemble a generalised tonic clonic seizure
Movement of arm and legs and movement of head from side to side
May resemble a “swoon” (flat on the ground looking pale)
May involve bizarre movements

58
Q

What is the most common ages for getting primary generaised seziures?

A

< 25 y/o

59
Q

What is common to get before a focal/partial seizure?

A

Aura

60
Q

What age is common for getting focal seizures?

A

Any age

61
Q

What can simple partial and complex partial seizures become?

A

Secondary generalised

62
Q

Types of focal seizures

A

Simple partial

Complex partial

63
Q

What is a simple partial seizure?

A

You are still aware but e.g. arm may be jerking

64
Q

What is a complex partial seizure?

A

When there is any loss of consciousness at all

65
Q

What may show a cause when there is a focal/partial seizure?

A

MRI

66
Q

Investigations of possible first seizures

A

Blood glucose
ECG
Alcohol / drugs
CT head

67
Q

Features suggestive of primary generalised epilepsy

A

History of myoclonic jerks, especially first thing in the morning
Absences of feeling strange with flickering lights

68
Q

Features suggestive of focal onset epilepsy

A

History de ja vu rising in sensation from abdomen

Episodes where look blank with lip smacking, fiddling with clothes

69
Q

Stimulants for EEG for primary onset epilepsy

A

Hyperventilation
Photic stimulation
Sleep deprivation

70
Q

What % of primary generalised seizures are picked up on EEG?

A

70%

71
Q

What do patients need to get advise on when have a seizure?

A

Employment
Potentially dangerous leisure activities
Driving regulations

72
Q

First line treatment of juvenile myoclonic epilepsy

A

Sodium valproate

73
Q

Who is sodium valproate avoided in and why?

A

Young women

Teratogenic

74
Q

First line treatment for primary generalised epilepsy

A

Levetiracetam

75
Q

First line treatment for partial and secondary generalised seizures

A

Lamotrigine

Carbamazepine

76
Q

First line treatment for absence seziures

A

Ethosuximide

77
Q

First line treatment for status epilepticus

A 
Lorazepam 
Midazolam (diazepam)
Valproate 
phenytoin 
Levetiracetam IV
78
Q

Second line treatment for generalised epilepsy

A

Topiramate

Zonisamide

79
Q

Second line treatment for partial seziures

A 
Sodium valproate
Topiramate 
Leviteraetam 
Gabapentin 
Pregabilin 
Zonisamide
Lacosamide
perampanel 
Benzodiazepines
80
Q

Side effects of sodium valproate

A 
Tremor (in high doses)
Weight gain 
Ataxia
Nausea
Drowsiness
Transient hair loss
Pancreatitis
Hepatitis
81
Q

Side effects of carbamazepine

A 
Ataxia
Drowsiness
Nystagmus
Blurred vision 
Low serum sodium levels
Skin rashes
82
Q

Side effects of lamotrigine

A

Skin rash

Sleep difficulties

83
Q

Side effects of levetiracetam

A

Irritability

Depression

84
Q

Side effects of topiramate

A

Weight loss
Word finding difficulties
Tingling in hands and feet

85
Q

Side effects of zonisamide

A

Bowel upset

Cognitive problems

86
Q

Side effects of lacosamide

A

Dizziness

87
Q

Side effects of pregabilin

A

Weight gain

88
Q

Side effects of vigabatrin

A

Behavioural problems

Visual field defects

89
Q

Treatment of TCSE

A 
1st line
- midazolam 
- lorazepam 
- diazepam 
2nd line
- phenyotin 
- valproate
3rd line
- anaesthesia usually with propofol or thopentone
90
Q

What are the driving regulations with epilepsy?

A

After a first seizure

  • can drive after 6 months if investigations are normal and have no further events
  • if scan or EEG abnormal or seizure likely alcohol related, cannot drive for one year
  • can drive HGV or PSV after 5 years if investigations are normal, have no further events and are not on anti-epileptic medication
91
Q

What is the most common first line medication for terminating acute seizures?

A

Benzodiazepines

92
Q

1st line treatment for focal seizures

A

Carbamazepine

Lamotrigine

93
Q

1st line treatment for a male with generalised tonic clonic seizures

A

Sodium valproate

94
Q

1st line treatment for a male with myoclonic seizures

A

Sodium valproate

95
Q

What is the protocol for stopping anti epileptic drugs?

A

Can be considered if seizure free > 2 years, with AEDs being stopped over 2 - 3 months

96
Q

If a one of seizure (no diagnosis of epilepsy), how long can they not drive for?

A

6 months

97
Q

If diagnosis of epilepsy, how long do they have to be seizure free before driving?

A

12 months

98
Q

What is carbamazepine generally INEFFECTIVE in treating?

A

Absence seizures

99
Q

What are localising features of a temporal lobe seizure?

A

Lip smacking

Post ictal dysphagia

100
Q

What do jacksonian movements in children indicate?

A

Frontal lobe epilepsy

101
Q

Indications of temporal lobe seizure

A

Aura
Lip smacking
Clothes plucking

102
Q

Indications of parietal seizures

A

Sensory abnormalities

103
Q

First line treatment for patients with early status epilepticus

A

IV lorazepam

104
Q

What is likely to represent a pseudoseizure / psychogenic non epileptic seizure?

A

Widespread convulsions without conscious impairment

105
Q

Stepwise treatment of paediatric status elipticus

A
  1. Buccal midazolam / IV lorazepam
  2. IV lorazepam
  3. IV phenytoin
  4. Rapid sequence induction of anaesthesia using thiopental sodium
106
Q

Anti epileptic medication should NOT be started after a first seizure before review except in certain cases, which are….

A
  1. Seizure activity observed on EEG
  2. Presence of a neurological deficit
  3. Presence of a structural brain abnormality
  4. Patient, carer or parent considers the risk of a further seizure to be unacceptable
107
Q

What would buccal midazolam be used for and who would it be prescribed to?

A

For status elipticus

Only prescribed to patients who have had a previous episode of prolonged or sequential generalised seizures

108
Q

When a patient is in status elipticus, what two most important causes should be ruled out 1st as a cause?

A

Hypoxia

Hypoglycaemia

109
Q

What are psychogenic non epileptic seizures also known as?

A

Pseudoseizures

110
Q

Factors favouring pseudoseizures

A 
Pelvic thrusting
Family member with epilepsy 
Much more common in females
Crying after seizure
Don't occur when alone
Gradual onset
111
Q

What blood test can indicate that it was a true epileptic seizure and not a pseudoseizure?

A

Raised serum prolactin 10 - 20 mins after an episode

112
Q

Describe jacksonian march with secondary generalisation

A

Characteristically starts by affecting a peripheral body part such as a big toe, finger or section of the lip and then spreads quickly ‘ marches ‘ over the respective foot, hand or face
The electrical disorder can then spread over larger areas of the brain causing the seizure to develop into a tonic clonic seizure

113
Q

What type of seizure is a jacksonian march?

A

Focal aware seizure

114
Q

What diet is used in treatment of epilepsy in children that is hard to control and is generally unresponsive to antiepileptic medications?

A

Ketogenic diet

115
Q

What does the ketogenic diet consist of?

A

High fat
Low carb
Controlled protein

Neuro Pathology (21 decks)

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