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Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is the approach to the fallen?

A

History
Patient; before, during and after
Eye witness; before, during and after

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2
Q

What are the important features to an epilepsy history?

A

Onset; what were they doing, light headedness or other syncopal symptoms, what did they look like (pallor, breathing, posturing of limbs, head turning)
Event itself;
Type of movements; tonic phase, clonic movements, corpopedal spasm, rigor, responsiveness and awareness throughout
Afterwards; speed of recovery, sleepiness/disorientation, deficits

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3
Q

What is common of a frontal lobe tonic clonic seizure?

A

Right hand moves upwards
Head turns to the right
Stiff movements
Clonus

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4
Q

What is important to do if you suspect syncope over epilepsy?

A

CV exam

L+S BP

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5
Q

What are common drugs which can precipitate epilepsy?

A 
Theophylinne
Amphetamines
Tramadol
Antibiotics; penicillins, cephalosporins, quinolones
Antidepressants
Anticholinergics
Antiemetics; prochlorperazine 
Cocaine
Opioids; diamorphine, pethidine
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6
Q

What investigation is the MOST important when working someone up for a seizure?

A

ECG; prolonged QT syndrome can trigger a generalised tonic clonic seizure and is LIFE THREATNING

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7
Q

Who gets a CT scan acutely?

A

Clinical or radiological skull#
Deteriorating GCS
Focal signs; stroke or bleed
Head injury with seizure
Failure to be GCS 14/15 4 hours after arrival
Suggestion of other pathology eg. SAH or stroke

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8
Q

When are EEGs helpful?

A

Classification of epilepsy
Confirmation of non-epileptic attacks
Surgical eval for epilepsy surgery
Confirmation of non-convulsive status

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9
Q

Can you diagnose epilepsy with an EEG?

A

NO

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10
Q

What are conditions that can “mimic” epilepsy?

A 
Syncope
Non-epileptic attack disorder (pseudoseizures, psychogenic non-epileptic attacks) 
Panic attacks/ hyperventilation attacks
Sleep phenomena
Hypoglycamia; ALWAYS DO A BG
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11
Q

What are the laws around driving and epilepsy?

A

1st seizure; 6 months or if HGV/PCV 5 years

Epilepsy; 1 year seizure free or 3 years seizure free if nocturnal epilepsy. If HGV/PCV; 10 years seizure free

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12
Q

What is a good description of myoclonus?

A

Clumsy and jerky in the morning

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13
Q

What is epilepsy?

A

A tendency to recurrent, usually spontaneous, epileptic seizures

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14
Q

What is an epileptic seizure?

A

Abnormal synchronisation of neuronal activity; usually excitatory with high frequency action potentials
Can be focal or generalised

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15
Q

Why do epileptic seizures happen?

A

Too little inhibition/ too much excitation
Changes in:
Cell number/type
Connectivity
Synaptic function
Voltage gated ion channel function
Genetic, acquired brain, metabolic (hypoglycaemia), toxic

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16
Q

What is SUDEP?

A

Sudden Unexplained Death in Epilepsy; seizure with subsequent cardiac arrest

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17
Q

What is a focal seizure?

A

Brain abnormal; stroke, haemorrhage, demyelination, tumour which will irritate the surrounding area resulting in abnormal discharge of electricity
If it hits a pathway; it will become generalised SO you can get a focal seizure with secondary generalisation

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18
Q

What is a generalised seizure?

A

A seizure that begins on a pathway such as the corticothalamic circuit and therefore every time a person has a seizure it will be generalised
This differs from focal seizures where you can have purely focal seizures which secondarily generalise

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19
Q

What is the difference between simple and complex partial/focal seizures?

A

Simple; without impaired consciousness

Complex; with impaired consciousness

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20
Q

What are the different types of generalised seizures?

A 
Absence
Myoclonic
Atonic
Tonic
Tonic clonic
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21
Q

Which seizures can cause a loss of consciousness?

A

Complex partial seizure Generalised absence seizure

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22
Q

What motor symptoms can be involved in partial seizures?

A 
Rhythmic jerking
Posturing
Head and eye deviation 
Cycling 
Automatisms (plucking) 
Vocalisation
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23
Q

What sensory symptoms an be involved in partial seizures?

A 
Somatosensory 
Olfactory
Gustatory
Visual 
Auditory
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24
Q

What psychic symptoms can be involved in partial seizures?

A 
Memories
Deja vu
Jamais Vu
Depersonalisation 
Aphasia
Complex visual hallucinations
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25
Q

Who is likely to get generalised seizures?

A

Genetic predisposition

Present in childhood and adolescence

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26
Q

What EEG pattern will generalised seizures show?

A

Spike wave pattern

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27
Q

What is the treatment of choice for primary generalized epilepsy?

A

Sodium valproate

28
Q

What is the alternative treatment for primary generalized seizures for women of child bearing age?

A

Lamotrigine

29
Q

Describe juvenile myoclonic epilepsy

A

Early morning jerks
Generalised seizures
Risk factors; sleep deprivation, flashing lights

30
Q

What are some common side effects of sodium valproate?

A

HIGHLY TERATOGENIC
Weight gain
Hair loss

31
Q

What is the treatment for focal onset epilepsy?

A

Identify the underlying structural cause

1st line: carbamazepine or lamotrigine

32
Q

What is the most common type of focal onset epilepsy?

A

Complex partial seizures with hippocampal sclerosis

33
Q

What is the most common type of primary generalised epilepsy?

A

Juvenile myoclonic epilepsy

34
Q

What is a very important side effect of carbamazepine?

A

Enzyme inducing in the liver; reduced the efficacy of the OCP and morning after pill

35
Q

What channel will carbamazepine, lamotrigine and phenytoin inhibit?

A

Voltage gated sodium channel

Reduced pre-synaptic excitability

36
Q

What channel will levetiracetam inhibit?

A

SV2A which is required for the release of neurotransmitter at the presynaptic terminal

37
Q

What channel will pregabalin and gabapentin inhibit?

A

Voltage gated Ca 2+ channels in the presynaptic terminal

38
Q

What will benzos and barbiturates target in the neurone?

A

GABA receptor which reduced neuronal activity

39
Q

What will sodium valproate target?

A

Enhances GABA synthesis

40
Q

Why do you need to be careful when co-prescribing sodium valproate and lamotrigine?

A

Sodium valproate inhibits the metabolism of lamotrigine so cana get a toxic dose BUT they work synergistically well together, just need to prescribe a lower dose of lamotrigine

41
Q

Treatment for partial seziures

A

INITIAL:
Carbamazepine
Lamotrigine

42
Q

What is the treatment for absence generalised seizures?

A

Sodium valproate

Ethosuximide

43
Q

What is the treatment for myoclonic seizures?

A

Sodium valproate
Levetiracetam
Clonazepam

44
Q

What is the treatment for atonic, tonic and tonic clonic seizures?

A

Sodium valproate
Levetiracetam
Topiramate
Lamotrigine

45
Q

When is phenytoin used?

A

Acute management ONLY as rapid loading dose possible

46
Q

Should you prescribe carbamazepine in primary generalised seizures?

A

NO; makes MUCH worse. This is why you NEED to determine the cause for the epilepsy

47
Q

What condition is topiramate commonly used in?

A

Idiopathic Intracranial Hypertension; causes weight loss

48
Q

Why does lamotrigine take a long time to titrate up?

A

Can cause SJS; start at a very low dose then build up

If there are ANY rashes, STOP immediately

49
Q

When should you prescribe anticonvulsants?

A

If the patient has epilepsy

If there has been a single seizure but a high risk of recurrence

50
Q

Which anticonvulsants induce hepatic enzymes?

EXAM QUESTION

A 
Carbamazepine 
Oxcarbazepine
Phenobarbital
Phenytoin
Primidone
Topiramate
51
Q

Why is it important to know which anticonvulsants induce hepatic enzymes?
EXAM QUESTIONS

A

Can alter the efficacy of OCP and emergency contraception - you MUST get the higher dose
SHOULDN’T use POP; not effective

52
Q

What should be given to women preconception who have epilepsy?

A

3 months preconception:
High dose folic acid
Vitamin K

53
Q

What is status epilepticus?

A

Recurrent epileptic seizures without full recovery of consciousness
Continuous seizure activity lasting more than 10-30 mins

54
Q

What are the different types of status epilepticus?

A

Generalised convulsive status epilepticus
Nonconvulsive status; conscious but in altered state (Use EEG for this)
Epilepsia partialis continus (continual focal seizures, consciousness preserved)

55
Q

What are precipitants of status?

A 
Severe metabolic disorders; hyponatraemia, pyridoxine deficiency 
Infection 
Head trauma
SAH
Abrupt withdrawal of anticonvulsants
Treating absence seizures with CBZ
56
Q

What can status cause?

A 
Respiratory insufficiency and hypoxia
Hypotension
Hyperthermia
Rhabdo
DEATH
57
Q

What occurs after 30-60 mins of status?

A

Peripheral metabolic effects due to SUCH high demand

58
Q

What occurs after 60 mins - 8 hours of status?

A

Multiorgan failure

59
Q

What occurs after 8 hours of status?

A

Central effects

60
Q

What is the order of drugs you would give in status?

EXAM QUESTION

A

10mg benzo then repeat after 5 mins. ONLY GIVE 2 DOSES OF BENZO
THEN
Phenytoin, sodium valproate and levetiracetam

61
Q

What should you do if phenytoin/ sodium valproate/ levetiracetam doesn’t work?

A

Phone ICU as they need to be sedated with propofol to flatten EEG for around 48 hours`

62
Q

What should be given if there is ANY suggestion of a hypo in a patient in status?

A

50m 50% glucose

63
Q

What should be given if there is ANY suggestion of alcoholism or nutritional deficiency in a patient in status?

A

IV thiamine

64
Q

What are the different types of benzos?

A

Lorazepam 4mg IV (long duration

Diazepam 10-20mg IV

65
Q

What should you do if you don’t have IV access in a patient in status?

A

Diazepam or midazolam PR

66
Q

What are the dosages of phenytoin and phenobarb given in status?

A

Phenytoin i18mg/kg IV <50mg/min with ECG monitoring

Phenobarb 15mg/kg IV 100mg/min

67
Q

What is important to do surrounding a patients normal anticonvulsant medication when they are in status?

A

Give normal dosages down NG tube as abrupt withdrawal of anticonvulsant medication is a trigger of status epilepticus

Neurology (48 decks)

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