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Cognition, movement and senses > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

Causes of reflex syncope:

A

Vasovagal
Carotid sinus syndrome
Situational (cough, micturition)
Ictal (post-seizure/stroke)

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2
Q

Causes of orthostatic syncope:

A

Drug-induced

Autonomic failure

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3
Q

Cardiac cause of syncope?

A

Arrhythmias

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4
Q

Which lesions can cause tumours?

A

Hippocampal sclerosis
Glionruronal tumours
Focal cortical dysplasia
Arterio-venous malformation

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5
Q

Seizures attributable to genetics:

A

Childhood absence
Juvenile myoclonic
Juvenile absence

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6
Q

Adult seizures:

A

Post-traumatic epilepsy
Symptomatic partial epilepsies
Malignant gliomas (5% of adult presentation)
Substance abuse
Elderly: stroke, malignant gliomas and degeneration

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7
Q

How is epilepsy defined clinically?

A

Two or more unprovoked seizures in under 24 hours/1 event + abnormal CTH

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8
Q

Examples of acute symptomatic seizures:

A

Febrile convulsions
Alcohol withdrawal
Metabolic
Eclampsia

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9
Q

What is a focal seizure?

A

Affects only one part of the brain e.g. one hemisphere

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10
Q

Types of focal seizures:

A

Partial with retained awareness
Partial with loss of awareness - TLE, FLE
Partial progressing to full tonic clonic (whole cortex)

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11
Q

Generalised seizures:

A

Tonic clonic
Tonic
Absence

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12
Q

80% of seizures arise or involve which region due to the hippocampus?

A

Parietal lobe

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13
Q

Temporal involvement causes what?

A 
Memory disturbances (deja vu)
Emotional disturbances (fear/elation)
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14
Q

Effect of seizure in Broca’s area?

A

Asphasia

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15
Q

Insula is buried under frontal and temporal lobes. Its involvement in a seizure causes what?

A

Autonomic involvement

Epigastric sensations, salivation, change in HR, palpitations

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16
Q

Seizure in lateral temporal lobe causes what?

A

Hallucinations
Dream recollection
Illusions

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17
Q

What do occipital seizures (rare) cause?

A

Visual symptoms

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18
Q

What do parietal seizures (very rare) cause?

A

Vertigo and pain

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19
Q

Aura in temporal lobe epilepsy:

A

Epigastric sensation
Autonomic involvement (palpitations, salivation)
Deja vu
Pungent smell - burning/pencilin
Hallucinations if lateral temporal/parietal lobe

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20
Q

Features of Jacksonian epilepsy:

A

Spread of motor seizure up/down one side of the body

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21
Q

Somatosensory aura:

A

+ve symptoms
Jacksonian jerks
Pins and needles
Rarely pain

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22
Q

Visual hallucinations in epilepsy vs migraine:

A

Coloured mobile blobs in epilepsy

Sparkly white and black lines in migraine

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23
Q

Temporal seizure character:

A

Motionless stare then automatisms
Unresponsive and unconscious
Red in face

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24
Q

Features of tonic clonic seizure:

A 
Go rigid and falls, cry as air squeezed out of lungs
Lateral tounge bites (differential)
Cyanosis
Clonic jerks
Salivation/frothing
Post-ictal confusion/unconscious
1-2 minutes
Occur after loss of sleep/alcohol
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25
Q

Features of dissociative seizures:

A

Stress/anxiety driven
Aware with bilateral directed movements, distractible
Back arches, thrashes, hits out, grabs
Need psychological intervention

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26
Q

History markers:

A 
Lateral tounge bite
Occur out of sleep
Aura: epigastric rising, flashing lights
Automatisms
Rigid and violent jerks (not thrashing)
Cyanosed/obstructed respiration
Post-ictal unrousable/confused
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27
Q

Routine EEG procedure:

A

20-30 minutes

Photic stimulation and over breathing

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28
Q

Sleep EEG procedure:

A

60 minutes

Drug-induced sleep

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29
Q

Telemetry procedure:

A

Continuous

EEG with video/polysomnography

30
Q

EEG of focal anterior temporal lobe seizures:

A

Spikes

31
Q

EEG of generalised epilepsy:

A

Spike and wave at regular intervals

32
Q

Diagnosis of epilepsy is…

A

Clinical

EEG is used for aetiology

33
Q

When is epilepsy considered resolved?

A

Past age of age-dependent epilepsy

Seizure free for the last 10 years, off medication for last 5 years

34
Q

Management of a provoked seizure?

A

Correct provoking factor

Benzos for alcohol withdrawal and delirium tremens

35
Q

When are anti-epileptic drugs not indicated?

A

Prophylactically post-acute brain insult/neurosurgery
Concussive convulsions
Provoked
1st seizure with low risk of recurrence

36
Q

1st seizure management:

A

Refer to first-fit clinic: EEG and MRI

37
Q

Treatment for generalised seizures:

A

First line: VPA (mainstay as better tolerated than TPM and more efficacious than LTG)
Second line: LTG, CBZ, TPM

38
Q

Contraindication of sodium valproate?

A

Teratogenic so avoid in young women

39
Q

Treatment for focal seizures:

A 
LTG (mainstay)
CBZ
GBP
TPM
OXC
40
Q

VPA =

A

Valproate

41
Q

LTG =

A

Lamotrigine (reduces efficacy of progesterone component of COC pill)

42
Q

TPM =

A

Topiramate

43
Q

CBZ =

A

Carbamazepine

44
Q

GBP =

A

Gabapentin

45
Q

OXC =

A

Oxcarbamazepine

46
Q

Combination of VPA and LTG?

A

Synergistic function

47
Q

What reduces the absorption of phenytoin?

A

Nasogastric tube

48
Q

Interaction between VPA and PHT?

A

Compete as both bind to albumin

49
Q

Which AEDs are enzyme inducing?

A

CBZ
PHB
PHT
(reduce efficacy of combined oral contraceptive pill but not progesterone only injectables)

50
Q

Absence seizure medication:

A

VPA or ethosuximide

51
Q

Myoclonic seizure medication:

A

VPA

Clanazepam, LTG

52
Q

Risks of CBZ?

A

Will exacerbate absence and myoclonic seizures

53
Q

Interactions of VPA?

A

Causes enzyme inhibition and will interfere with mainstay drugs e.g. warfarin
Does not affect oral contraception

54
Q

Allergic hypersensitivity reactions more common with…

A

Aromatic AEDs: CBZ, PHB, PHT
also VPA
Chinese with HLA B1502 react to CBZ

55
Q

Severe skin reaction to AEDs:

A

Steven’s-Johnson’s syndrome

56
Q

What counts as an “attack”?

A

Any event: major/minor/aura

57
Q

DVLA policy:

A

After attack stop driving for 1 year if causative factor with risk of recurrence
Otherwise 6 months after attack you can get a 3 year license
If seizure free for 5 years then a “til 70 group 1 license”

58
Q

What is AED hypersensitivity syndrome?

A

Multi-organ damage especially liver following skin rash

59
Q

MFM:

A

Normal chance = 1-2%
AED chance = 2-4% (don’t stop AED)
VPA chance = 6-9% (+ASD)

60
Q

Pregnancy effects:

A

Slight association between AEDs and minor malformations and a drop in verbal reasoning IQ
Maternal seizures are associated with drop in verbal reasoning IQ, small for gest age and sudden death
Glucoronidation in pregnancy so most except CBZ decrease
Give vitamin K to mother in last 4 weeks and newborn

61
Q

Breastfeeding and AEDs:

A

Recommended
PHT, CBZ and VPA are safe
Monitor withdrawal/sedation and slow metabolism of benzos in foetus

62
Q

Surgical options:

A

Hemispherectomy, callostomy, multiple sundial transections are all resective
Vagal nerve stimulation is functional (better in children)

63
Q

What is status epileptics?

A

Failure of termination/abnormally prolonged seizures

64
Q

What do t1 and t2 indicate?

A 
t1 = when treatment should be initiated
t2 = when there are long-term consequences (neuronal damage at 30 minutes, spontaneous cessation unlikely after 5 minutes)
65
Q

Stage 1 SE =

A

0-10 minutes

66
Q

Stage 2 SE =

A

0-30 minutes

67
Q

Stage 3 SE =

A

Established SE: 0-60 minutes

68
Q

Stage 4 SE =

A

Refractory status: 30-90 minutes

69
Q

Step 1 in treating SE =

A

Benzos in >5mins
IV lorazepam/diazepam
If not able then buccal/IM midazolam/rectal diazepam
Basic bloods, AEDs, glucose and pabrinex

70
Q

Step 2 in treating established SE (no response within 10 minutes) =

A

PHT/levetiracetam/VPA/PHB (risk of resp failure with PHB)

71
Q

Step 3 in treating refractory convulsive SE (no response to step 2 within 30 minutes) =

A

ICU admission
Anaesthesia - propofol, thiopentone, midazolam
Monitor for 24-48 hours and withdraw if no seizures

72
Q

Side-effects of PHT:

A

Hypotension
Arrhythmia
Precipitation of crystals

Cognition, movement and senses (20 decks)

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