Epilepsy Flashcards
in a falls history, what aspects should be asked about in the “before” segment
pallor light headedness triggers - flashing lights posturing of limbs head turning
in a falls history what aspects should be asked about in the “during” segment
tonic
clonic
rigidity
responsiveness and awareness
in a falls history what aspects should be asked about in the “after” segment
speed of recovery
disorientation
risk factors for epilepsy
complicated birth delayed development previous seizures including febrile head injury family history drugs alcohol
list drugs precipitating epileptic seizures
theophylline tramadol opioids penicillins cephalosporins quinolones lithium lidocaine antidepressants anticholinergics prochlorperazine
which single investigation should all people who have had a fall/collapse get?
ECG
which cardiac condition is it vital not to miss in terms of falls
LQTS
who gets a CT scan acutely
skull fracture
deteriorating GCS
focal neurological deficit head injury with seizure failure of GCS 15/15 after 4 hours
suggestion of other pathology
what is an EEG and is it a good test to diagnose epilepsy after a collapse
electroencephalogram
it is a dreadful test and should not be used to diagnose epilepsy after a collapse
what is an EEG used for
to classify epilepsy
confirm non-epileptic attack/non-convulsive status
surgical evaluation
differential diagnoses of collapse
syncope seizure hypoglycaemia pseudoseizure sleep phenomena parasomnias migraine cataplexy tonic spasms of MS
how long until you are able to drive a car after your first seizure
6 months
how long until you are able to drive a HGV/PCV after your first seizure
5 years
1 seizure = epilepsy, true or false
false
when can you drive a car if you have epilepsy
1 year being seizure free
or 3 years during sleep
when can you drive a HGV/PCV if you have epilepsy
after being medication free for 10 years
define epilepsy
a tendency to recurrent spontaneous epileptic seizures
define seizure
abnormal synchronisation of electrical activity
- excitatory
- inhibitory
what is SUDEP
sudden unexplained death in epilepsy
how are seizures classified
focal/partial
generalised
describe focal seizures
irritation occurs in a certain area of the brain eg stroke, haemorrhage, demyelination, tumour
focal seizures can have secondary generalisation, true or false
true
describe generalised seizures
abnormal electrical activity all over the brain
how can epilepsy be classified
focal
generalised
how can focal epilepsy be classified
simple
complex
describe simple focal epilepsy
consciousness NOT impaired
describe complex focal epilepsy
consciousness IS impaired
define focal epilepsy
recurrent focal seizures +- 2ndary generalisation
how can generalised epilepsy be classified
absence atonic tonic tonic clonic / primary generalised myoclonic
define generalised epilepsy
recurrent generalised seizures
what group of epilepsy is Juvenile Myoclonic Epilepsy and what is the best treatment
primary generalised
Na valproate but lamotrigine is used as an alternative
what group of epilepsy is Complex partial epilepsy with hippocampal sclerosis and what is the best treatment
focal epilepsy
carbamazepine or lamotrigine
occurs in <30 yo
what is the benefit of anti epileptic drugs AEDs
to reduce likelihood of having more seizures in the first place
AEDs are prescribed after 1 seizure, true or false
FALSE
not prescribed after a one off seizure
carbamazepine is used for focal/generalised epilepsy only
focal
makes generalised epilepsies worse
what is phenytoin and what is it used for
side effects?
anti-convulsant
acute management only
enzyme inducer
what is Na valproate and what is it used for
Na channel inhibitor anti convulsant
all types of epilepsy
side effects of Na valproate
TERATOGENIC
weight gain
hair loss
fatigue
what is carbamazpine and what is it used for
Na channel blocker anti convulsant
focal epilepsy only
what is lamotrigine and what is it used for
Na channel blocker anti convulsant
focal and generalised epilepsies
what is a side effect of lamotrigine and what is done as a result
Steven Johnson Syndrome
dose is slowly titrated up
what is levetiracetam
side effects?
anti convulsant
well tolerated but can cause mood swings
what is a side effect of topiramate
weight loss parasthesia poor cognition sedation dysphasia enzyme inducer
which anti convulsants induce hepatic enzymes and why is this a problem
carbamazepine oxcarbazine phenobarbitol phenytoin primodone topiramate They alter the efficacy of the OCP
Progestogen only pills and implants can be used with antoconvulsants, true or false
FALSE, they should not be used
how should contraception be managed in ladies on anti-convulsants
need higher dose of contraceptive pill and morning after pill
management of women wanting to get pregnant on AEDs
preconceptual counselling
risk benefit balance with drugs
high dose folic acid + vit K
what is status epilepticus SE
recurrent epileptic seizure without full recovery of consciousness
continuous seizure lasting >30 min
what types of status epilepticus are there
generalised convulsive
non-convulsive
continuous focal seizures
list precipitants of SE
severe metabolic disorders abrupt withdrawal of AEDs infection trauma SAH treating absence seizures with carbamazepine
why is SE so dangerous
multi organ failure
excitotoxicity results in neuronal death
investigations in SE
ABCDE
bloods - FBC, LFT, U+E
+- CT scan
pharmacological management of SE
benzodiazepines: buccal/IM midazolam twice maximum with 5 minute intervals phenytoin Na valproate keppra thiopentone, propofol - ICU!
