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Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is a prodrome?

A

Change in mood or behaviour before a seizure

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2
Q

What is an aura? Give some examples

A

Part of seizure, patient is aware of it, may precede other manifestations

  • strange gut feeling
  • deja vu
  • strange smell
  • flashing lights

Implies a partial/focal seizure, often from temporal lobe

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3
Q

What are post-ictal symptoms?

A

After the seizure

  • headache
  • confusion
  • myalgia
  • sore tongue
  • Todd’s palsy
  • dysphasia after focal seizure in temporal lobe
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4
Q

What is Todd’s palsy?

A

Temporary weakness after focal seizure in motor cortex

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5
Q

Name some metabolic disturbances that can cause seizures

A 
hypoxia
hypo- or hyper- natraemia
hypocalcaemia
hypo- or hyper glycaemia
uraemia
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6
Q

Name some drugs that can cause seizures

A

Tricyclic antidepressants
Cocaine
Tramadol
Theophylline

Alcohol or benzodiazepine withdrawal

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7
Q

What is the difference between simple and complex partial seizures?

A

Impaired consciousness in complex partial seizures

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8
Q

Give 5 different types of generalised seizures

A 
Absence
Myoclonic
Atonic (akinetic)
Tonic
Tonic clonic
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9
Q

Give some example features of temporal lobe partial seizures

A
  • automatisms e.g. lip-smacking, grabbing, kissing
  • abdominal rising sensation or pain
  • deja/jamais vu
  • emotional disturbance (hippocampal)
  • hallucinations (smell, taste, auditory)
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10
Q

Give some example features of frontal lobe partial seizures

A
  • motor features e.g. peddling
  • Jacksonian march
  • dysphasia
  • post-ictal Todd’s palsy
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11
Q

Which type of features would you expect with a parietal lobe partial seizure?

A

Sensory

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12
Q

Which type of features would you expect with an occipital lobe partial seizure?

A

Visual e.g. spots, lines, flashes

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13
Q

How would you describe a partial seizure?

A

Focal onset

Features referable to a part of one hemisphere

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14
Q

How would you describe a simple partial seizure?

A

Awareness unimpaired

No post-ictal symptoms

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15
Q

How would you describe a complex partial seizure?

A

Awareness impaired
May have simple onset (aura)
Most often from temporal lobe
Post-ictal confusion

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16
Q

What is secondary generalisation?

A

electrical disturbance starts focally but spreads widely

–> secondary generalised seizure (usually convulsive)

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17
Q

What is a primary generalised seizure?

A

Simultaneous onset throughout entire cortex
No localising features referable to one hemisphere
Generalised spike-wave abnormalities on EEG

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18
Q

What is an absence seizure?

A

Brief (<10 second) pause, then carries on

Presents in childhood

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19
Q

What are the features of tonic clonic seizures?

A

Loss on consciousness
Limbs stiffen (tonic) then jerk (clonic)
Post-ictal confusion and drowsiness

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20
Q

What are the features of a myoclonic seizure?

A

Sudden jerk of limb, face or trunk

e.g. suddenly thrown to ground, violently disobedient limb

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21
Q

What is an atonic (akinetic) seizure?

A

Sudden loss of muscle tone –> fall to ground

No loss of consciousness

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22
Q

Generally, how many seizures does a patient have to have before a diagnosis of epilepsy confirmed?

A

2 (unless features very typical of epilepsy)

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23
Q

When is an EEG used?

A

Not diagnostically

Only to support diagnosis and determine type/syndrome

24
Q

Which tests should be done in any adult with suspected epilepsy?

A

ECG
MRI –> structural abnormalities
U&E, glucose, calcium –> other causes

25
Q

Who should inform the DVLA if a patient has had a seizure?

A

Patient

26
Q

How long should a patient with a PROVOKED seizure stop driving for? (e.g. known electrolyte imbalance)

A

6 months

27
Q

When a diagnosis of epilepsy is made, how long should the patient stop driving for?

A

Must be seizure free for 1 year, with or without AEDs

28
Q

When can a person with epilepsy drive a HGV?

A

If they are seizure free, off medication, for 10 years

29
Q

If a patient wants to stop their AEDs, what should they do about driving?

A

Stop for 6 months to see if they are seizure free

30
Q

Which drugs are first line for generalised tonic clonic seizures?

A

Sodium valproate

Lamotrigine

31
Q

Which drugs are first line for absence seizures?

A

Ethosuximide

Sodium valproate

32
Q

Which drug should be avoided in tonic, atonic and myoclonic seizures?

A

Carbamazepine

33
Q

Which drug is first line for partial seizures?

A

Carbamazepine

34
Q

Which drug must be avoided in women of child bearing age (or younger)?

A

Sodium valproate

35
Q

What are some of the side effects of sodium valproate?

A 
Valproate
Appetite increase --> weight gain
Liver failure (monitor LFTs for first 6 months)
Pancreatitis
Reversible hair loss
Oedema
Ataxia
Teratogenicity, tremor, thrombocytopenia
Encephalopathy
36
Q

When is carbamazepine used and when should it be avoided?

A

Used for focal (partial) seizures

Avoid in primary generalised seizures - can make them worse

37
Q

What are some side effects of carbamazepine?

A 
Leucopenia
Diplopia, blurred vision
Reduced balance
Droswiness
Rash
SIADH
38
Q

What are some side effects of Levetiracetam?

A 
Psychiatric e.g. depression
D&amp;V
Dyspepsia
Diplopia
Drowsiness
Blood dyscrasias
39
Q

What are some side effects of lamotrigine?

A

Maculopapular rash common
–> rarely Steven-Johnson syndrome or toxic epidermal necrolysis
–> warn patients to see doctor if rash or flu symptoms
Hypersensitivity (fever, raised LFTs, DIC)
Diplopia, blurred vision
Photosensitivity
Tremor
Agitation
Vomiting
Aplastic anaemia

40
Q

When is phenytoin used in epilepsy?

A

Can be used in status epilepticus

No longer used in long term management due to toxicity

41
Q

What are the signs of phenytoin toxicity?

A 
Nystagmus
Diplopia
Tremor
Dysarthria
Ataxia
42
Q

What are some side effects of phenytoin?

A 
Reduced intellect
Depression
Course facial features
Acne
Gum hypertrophy
Polyneuropathy
Blood dyscrasias
43
Q

What are some side effects of topiramate?

A

Sedation
Dysphasia
Weight loss

44
Q

Which tablet should women of child bearing age take while on AEDs?

A

Folic acid

45
Q

Is it okay to breastfeed while taking lamotrigine?

A

Yes, it is present in breast milk but not thought to be harmful

46
Q

Which AEDs are enzyme inducers?

A

Carbamazepine
Phenytoin
Topiramate

47
Q

What is the effect on enzyme inducers on contraception?

A

Alter the efficacy of the COCP

  • POP and implant not effective, injection needs more frequent dosing
  • require increased dose of morning after pill
48
Q

What are the criteria for stopping AEDs?

A
  • normal CNS examination
  • normal IQ
  • normal EEG before withdrawal
  • seizure free > 2 years
  • no juvenile myoclonic epilepsy
49
Q

What is the definition of status epilepticus?

A

Recurrent epileptic seizures without full recovery of consciousness
Continuous seizure activity > 30 mins

50
Q

What are some complications of convulsive status?

A

Respiratory insufficiency + hypoxia
Hypotension
Hyperthermia
Rhabdomyolysis

51
Q

What are some precipitants of status epilepticus?

A
  • metabolic disturbance e.g. hyponatraemia
  • infection
  • head trauma
  • SAH
  • abrupt withdrawal of anticonvulsants
  • treating absence seizures with carbamazepine
52
Q

When should you intervene in suspected status?

A

Seizure > 5 minutes

53
Q

What is the initial management of status epilepticus?

A

ABCDE

Identify cause –> emergency bloods +/- CT

54
Q

Which drugs should be given first line in status epilepticus/

A 
IV Lorazepam (slow bolus into large vein, max 2 doses)
- buccal medazolam/ IV or rectal diazepam as alternative
55
Q

What risk should you be aware of when given benzodiazepines?

A

Respiratory depression/arrest

56
Q

Which drug should you give if seizure continues despite 2 doses of benzos?

A

IV phenytoin

57
Q

What needs to be monitored if giving phenytoin?

A

BP (hypotension)
ECG (bradycardia, heart block)
Blood phenytoin levels

Neurology (16 decks)

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