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systems- neuro- oc > epilepsy > Flashcards

epilepsy Flashcards

1
Q

whats the most common diagnoses in patients referred to first seizure clinics?

A

25% Epilepsy
23% Syncope
16% Single seizure (including provoked)

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2
Q

how do you assess episodes of collapse?

A

History preceding events
Context/timing
Posture

History of event itself
Warning symptoms
Level of awareness/recollection

Afterwards
First recollection
Seizure markers- prolonged disorientation, tongue biting, incontinence, muscle pains

How were they before?
Context

Description of episode
Eyes open or closed
Description of abnormal movements
Pallor, alteration in breathing pattern, pulses
Duration of LOC
Time to recovery
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3
Q

what are the three categories of syncope?

A

Reflex
Orthostatic
Cardiogenic

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4
Q

what is a reflex syncope?

A

Taking blood/medical situations

Cough, Micturation

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5
Q

what is am orthostatic syncope?

A

Dehydration, medication related (anti-hypertensive)

Endocrine, autonomic nervous system

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6
Q

what is a cardiogenic syncope?

A

Arrhythmia, aortic stenosis

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7
Q

how would you assess syncope?

A 
Examination
Heart sounds, pulse
Postural BPs
Must have ECG
Look for heart block
QT ratio
May need 24hr ECG
May need to see cardiology if recurrent (5 day recordings, reveal devices)
Consider Tilt table
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8
Q

how would you assess cardiogenic syncope?

A

Examination
Heart sounds, pulse
Must have ECG
Look for heart block
QT ratio
Refer to cardiology urgently/admission for telemetry
May need 24hr ECG/ECHO/prolonged monitoring

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9
Q

what is epilepsy?

A

the tendency to recurrent seizures

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10
Q

how might a seizure happen?

A

Our neurones have background electrical activity. If this is disrupted it can lead to a seizure

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11
Q

what are things that may provoke a seizure?

A 
Alcohol withdrawal
Drug withdrawal
Within few days after a head injury
Within 24hrs of stroke
Within 24hrs of neurosurgery
With severe electrolyte disturbance
Eclampsia
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12
Q

what are the generalised seizure types?

A 
Absence seizures
Generalised tonic-clonic seizures
Myoclonic seizures
Juvenile myoclonic epilepsy
Atonic seizures
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13
Q

what are the focal siezure types?

A

Simple partial seizures

Complex partial seizures

Secondary generalised

Or by localisation of onset (temporal lobe, frontal etc)

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14
Q

who is most likely to get a primary generalised seizure?

A 
No warning
< 25 years
May have history of absences and myoclonic jerks as well as GTCS e.g in juvenile myoclonic epilepsy
Generalised abnormality on EEG
May have family history
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15
Q

who is likely to get a focal/partial siezure?

A

May get an “aura”
Any age – cause can be any focal brain abnormality
Simple partial and complex partial seizures can become secondarily generalised
Focal abnormality on EEG
MRI may show cause

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16
Q

what would you see if someone was having a generalised tonic clonic seizure?

A

Groaning sound
Tonic (rigid phase)
Then generalised jerking in all four limbs
Eyes open
Staring/ roll upwards
Foaming at the mouth
Jerking for a few minutes and then groggy for 15-30mins

May be agitated afterwards
May have a cluster of episodes, stopping and starting

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17
Q

what are abscence seizures provoked by?

A

hyperventillation/ Photic stimulation (light through trees while in car)

18
Q

what happens to someone having an abscence seizure?

A

Sudden arrest of activity for a few seconds
Brief staring
May have eye-lid fluttering
Re-start what they were doing

19
Q

what are juvenile myoclonic epilepsy provoked by?

A

alcohol, sleep deprivation

20
Q

what happens to someone with Juvenile myoclonic epilepsy?

A

Will often have early morning myoclonus
Drop things in the mornings
Brief jerks in limbs

21
Q

what are the preceding events leading up to a complex partial seizure?

A

Rising feeling in stomach, Funny smell/taste
De ja vu (familiar experience)

History of event itself
No recollection

22
Q

what happens to someone having a complex partial seizure?

A 
Sudden arrest in activity
Staring blankly into space
Automatisms
Lip smacking
Repetitive picking at clothes

May be disorientated for a spell afterwards

23
Q

what are the clinical assessment siezures?

A

Refer to first seizure clinic
Do an ECG, routine bloods (Glc)
A+E will often arrange a CT

From Neurology clinic
May arrange an MRI for focal lesion
May arrange EEG (Usually in <40yrs)
Discuss Anti-epileptic drugs
Refer to Epilepsy nurse (post diagnostic information)
Discuss driving (inform DVLA)
24
Q

what is the incidence of epilepsy?

A

50 - 120 per 100 000 per year

25
Q

what are the investigations for epilepsy?

A

EEG for primary generalised epilepsies including hyperventilation and photic stimulation: sometimes sleep deprivation
MRI for patients under age 50 with possible focal onset seizures: CT usually adequate to exclude serious causes over this age
Video-telemetry if uncertainty about diagnosis

26
Q

what are the factorss influencing siezure risk?

A

Missed medications (most common)
Sleep disturbance, fatigue
Hormonal changes
Drug/alcohol use, drug interactions
Stress/Anxiety
Photosensitivity in a small group of patients
Other rarer reflex epilepsies (patterns, noise)

27
Q

first line treatment of epilepsy for primary generalised epilepsies

A

Sodium Valproate, Lamotrigine, Levetiracetam

28
Q

first line treatment of epilepsy for focal and secondary generalised seizures

A

Lamotrigine, Carbamazepine, Levetiracetam

29
Q

first line treatment of epilepsy for absence seizures

A

Ethosuximide

30
Q

what are the second line treatments for generalised epilepsy?

A

Topiramate
Zonisamide
Clobazam

31
Q

what are the second line treatments for partial seizures?

A 
Sodium valproate
-Topiramate
-Gabapentin
-Pregabilin
-Zonisamide
-Lacosamide
-Perampanel
Long acting Benzodiazepines (Clobazam)
Vigabatrin
32
Q

what are the side effects to phenytoin

A

Arrythmia, hepatitis, medication interactions

33
Q

what are the side effects to sodium valproate?

A

tremor, weight gain, ataxia, nausea, drowsiness, hepatitis

34
Q

what are the side effects to carbamazepine?

A

ataxia, drowsiness, nystagmus, blurred vision, low serum sodium levels, skin rash.

35
Q

what are the side effects to lamotrigine?

A

skin rash, difficulty sleeping

36
Q

what are the side effects to levetiracetam?

A

irritability, depression

37
Q

what are the driving regulations for someone that had a single seizure?

A

After a single seizure, a patient may drive a car after 6 months if their investigations are normal and they have had no further events

38
Q

what are the driving regulations for someone that has epilepsy?

A

Patients with epilepsy can drive a car once they have been seizure free for a year or have only had seizures arising from sleep for a year.

39
Q

what are the first line treatments for status epilepticus?

A

Midazolam: 10mg by buccal or intra-nasal route, repeated after 10mins if necessary

Lorazepam: 0.07mg/kg, usually 4mg bolus repeated once after 10 mins

Diazepam: 10 - 20mg iv or rectally, repeated after 15 mins if necessary

40
Q

what are the second line treatment for status epilepticus?

A

Phenytoin - slow infusion of 15 – 18mg/kg at 50mg/min
Valproate – 20 -30mg/kg iv at 40mg/min
? Leviteracetam 30mg/KG

41
Q

what are the preceding events of a non-epileptic attack?

A

Events may occur at times of stress or while at rest
Will often give lots of detail of others reaction and little of events themselves
History of event itself
May recall what people said during episode
May be prolonged episode, waxing and waining
May describe dissociation

systems- neuro- oc (51 decks)

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