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NEUROLOGY > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What should you always ask the patient about a suspected seizure?

A

What happened before?

During?

After?

Was there an eye witness who could describe their before, during and after?

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2
Q

What should you ask the patient and eye witness about the onset of a suspected seizure?

A
  • What were they doing? Environment (flashing lights?)
  • Symptoms (syncope?)
  • What did they look like? (Pale, deep breathing, limb posture, head turning)
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3
Q

What should you ask the patient/ eyewitness about during the event?

A
  • Making movements? (Tonic/clonic, Corpopedal spasms, rigors)
  • Was pt responsive/aware throughout?
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4
Q

What should you ask the patient/eye witness about after the event?

A
  • Speed of recovery
  • sleepiness/disorientation
  • Neurological deficits
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5
Q

What are potential risk factors for epilepsy?

A
  • Birth/ developmental problems
  • seizures in past (inc. febrile fits)
  • head injury (inc. LOC)
  • family history
  • drugs, alcohol
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6
Q

If you suspect a patient is just experiencing syncope, what examinations are important?

A

cardiovascular examination

Lying + Standing BP important

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7
Q

Even if you are suspective of a seizure, what investigation should always be done and why?

A

ECG

- may diagnose Long QT which is fatal AND can make patients prone to seizures

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8
Q

What patients get an acute CT?

A
  • skull fracture
  • Deteriorating/unresolving GCS
  • Focal signs
  • Head injury with seizure
  • Suggestion of other pathology – eg Subarachnoid Haemorrhage
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9
Q

Why are EEGs usually not necessary?

A

Many of the general population have an abnormal EEG despite not having epilepsy

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10
Q

How long must epileptic patients wait after a seizure to drive again?

A

1st SEIZURE (not epilepsy) – car = 6 months, 5 years for HGV

Epilepsy – car = 1 year or 3 years during sleep
1 yr if conscious seizures exclusively
10 years off medication for HGV

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11
Q

Raising a limb and turning of the head indicates a seizure in what part of the brain?

A

Frontal lobe seizure phenomenon

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12
Q

Tongue biting and loss of urinary continence are specific features of generalised seizures. TRUE/FALSE?

A

FALSE

these symptoms are NOT seizure specific
e.g. pt can lose urinary continence during a vaso-vagal episode

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13
Q

Why should you check a patient’s drug history before making a diagnosis of seizure?

A

Incase they are on medication which could cause syncope/ fall

e.g. BP meds

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14
Q

What classes of drug are known to induce seizures?

A

antibiotics - penicillins, quinolones etc
painkillers (tramadol) and opioids
Anti-emetics e.g. prochlorperazine

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15
Q

What indicates the need for an EEG?

A
  • to classify epilepsy
  • to confirm non-epileptic attacks
  • to confirm non-convulsive status epilepticus
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16
Q

What are the differential diagnoses for epilepsy?

A

Syncope
Non-epileptic attack disorder
Panic attacks
Sleep phenomena

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17
Q

When does generalised epilepsy normally present, and what is the diagnostic pattern of this on EEG?

A

Present in childhood and adolescence

- generalised spike-wave abnormalities on EEG

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18
Q

What is the treatment of choice for Primary Generalised epilepsy?

A

Sodium valproate treatment of choice, but teratogenic.

=> Lamotrigine as alternative.

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19
Q

Describe the usual symptoms of juvenile myoclonic epilepsy

A
  • Early morning jerks
  • Generalised seizures
  • Risk factors: sleep deprivation/flashing lights
20
Q

Describe the pathophysiology of focal onset epilepsy.

A
  • Due to underlying structural cause (brain injury/haemorrhage etc)
  • Area around this becomes irritated
  • Causes abnormal discharges of energy
    => seizure
21
Q

Focal seizures can also become generalised. TRUE/FALSE?

A

TRUE
if a focal seizure excites a neighbouring pathway which can spread activity around the brain, then the seizures can become generalised

22
Q

What treatment is first line for focal epilepsy?

A

Carbamazepine or lamotrigine

Sodium valproate works as well, but not first choice because of side effects

23
Q

What is the most common cause of focal/partial epilepsy in patients <30 years?

A

complex partial seizures

due to hippocampal sclerosis

24
Q

Why should carbamazepine not be used for generalised seizures?

A

It can make them worse

25
Q

What are the different types of generalised seizures?

A 
myoclonic - jerks
atonic - loss of tone
tonic
tonic/clonic 
absence - pt goes blank
26
Q

Why is lamotrigine sometimes unsuitable at the beginning of generalised epilepsy treatment?

A

It can take around 2-3 months to reach peak action

27
Q

What other treatment, with less side effects than Sodium Valproate, can be used in generalised epilepsy if lamotrigine is taking too long to work?

A

Levetiracetam (Keppra)

28
Q

What age group is more likely to get focal seizures?

A

> 50 as they are more likely to have the structural damage

29
Q

Carbamazepine is a well tolerated drug. TRUE/FALSE?

A

FALSE
NOT well tolerated
patients feel dizzy and unsteady

30
Q

Why should sodium valproate and lamotrigine be given together with caution?

A

Sodium valproate makes the lamotrigine dose higher, therefore a LOWER dose of lamotrigine should be prescribed if dual therapy is used.

31
Q

What anticonvulsant medications are considered “old”?

A

Phenytoin
Sodium Valproate
Carbamazepine

32
Q

What anticonnvulsant medications are considered “new”?

A

Lamotrigine
Levetiracetam
Topiramate
Gabapentin/pregabalin (not widely used anymore)

33
Q

What side effects can occur from older anticonvulsants?

A

Phenytoin - causes unwanted cosmetic change
Sodium Valproate - see above and also teratogenic
Carbamazepine - dizzy/unsteady

34
Q

What side effects do the new anti-convulsant drugs have?

A

Lamotrigine - Steven Johnson Syndrome => check for rash
Levetiracetam - mood swings
Gabapentin/Pregabalin - addictive

35
Q

When should anticonvulsants be prescribed?

A
  • if patient has EPILEPSY not just seizures

- UNLESS extremely high risk of seizure recurrence in non-epileptic patient

36
Q

What anticonvulsants affect hepatic enzymes, therefore causing problems for females?

A 
Carbamazepine
oxcarbazepine
phenobarbitol
phenytoin
primidone
topiramate
37
Q

What contraceptives are affected by anticonvulsant drugs?

A
  • combined oral contraceptive pill
  • Should NOT use progesterone only pill
  • Depot progesterone inj. needs more frequent dosing
  • Progesterone implants not effective
  • Morning after pill needs increased dose to be effective
38
Q

Why should all females of child bearing age be given pre-conceptual counselling?

A

Allows them to balance the risk of uncontrolled seizures if NOT taking medication OR teratogenicity if they continue with medication

39
Q

If females with epilepsy do wish to conceive, what medication must they start 3 months prior to conception?

A

Folic acid and vitamin K

40
Q

What is status epilepticus?

A

Recurrent epileptic seizures without full recovery of consciousness
Can last for over 30 mins

41
Q

What are the different types of status epilepticus

A

Generalized convulsive

Non convulsive status => conscious but in “altered state”

Epilepsia partialis continua (continual conscious focal seizures)

42
Q

What can precipitate a status epilepticus?

A
  • Severe metabolic disorders – hyponatraemia, pyridoxine deficiency
  • Infection
  • Head trauma / Sub-arachnoid haemorrhage
  • Abrupt withdrawl of anti-convulsants
43
Q

Generalised convulsive status epilepticus can cause what further effects on the body?

A

respiratory insufficiency and hypoxia
hypotension
hyperthermia
rhabdomyolysis

44
Q

How is status epilepticus treated?

A
  • ABCDE
  • identify cause!! => Emergency blood tests +/- CT
  • if suspicious of hypoglycaemia give 50mls 50% glucose
  • Benzodiazepines x2 doses (10 mins, then 15 mins) (buccal midazolam usually)
  • Phenytoin if unresolving
    + Sodium Valproate
    + Levetiracetam (Keppra)• A quick way to admit to ITU
45
Q

When should you consider transferring a patient in status epilepticus into ITU?

A

When requiring to give them phenytoin as it has been unresolved for a prolonged period

46
Q

How would you confirm a patient with acute confusion is in partial status epilepticus?

A

EEG

47
Q

How do benzodiazpines work to reverse status epilepticus?

A

They suppress the area of the brain which is over-excited and impairing consciousness
=> consciousness returns when electrical activity in that area is sedated

NEUROLOGY (29 decks)

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