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Y3 MedEd > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

Define epilepsy

A

A recurrent tendency to have unprovoked seizures.

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2
Q

Define seizure

A

An abnormal paroxysmal discharge of cerebral neurons

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3
Q

Define convulsion

A

the motor signs of electrical discharges

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4
Q

Which neurotransmitters balance excitation and inhibition

A

Excitation:
Glutamate
Aspartate

Inhibition:
GABA

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5
Q

Causes of secondary seizures (4)

A

Tumours
Infection
Inflammation
Trauma

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6
Q

What should you always establish at the start when taking a collapse history in OSCE?

A

Whether there was a witness

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7
Q

Triggers of an epileptic seizure (5)

A 
Lack of sleep
Flickering lights
Alcohol
Stress
No trigger
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8
Q

What can happen before an epileptic seizure

A

Aura

strange feeling in the gut, deja vu, strange smells, flashing lights

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9
Q

How long does an epileptic seizure last

A

Under three minutes

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10
Q

Things that are associated with happening during a seizure (3)

A

Tongue biting
Incontinence
Jerking movements

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11
Q

Speed of recovery from an epileptic seizure

A

Slow

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12
Q

Things that are associated with happening post-ictal (3)

A

Post-ictal confusion
Post-ictal headache
Post-ictal myalgia

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13
Q

What is Todds paresis

A

is a syndrome associated with weakness or paralysis of part or all of the body after a focal-onset seizure. It most commonly affects one limb or one half of the body but can have a wide range of presentations. Approximately 13% of all seizures show signs ofTodd paresisin onepresentation or another.

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14
Q

What is a syndrome associated with weakness or paralysis of part or all of the body after a focal-onset seizure known as

A

Todds paresis

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15
Q

How long does Todds paresis last for

A

This postictal syndrome may last anywhere from minutes to days, with the vast majority of patients seeing spontaneous and complete resolution within 36 hours. Complete resolution of symptoms is seen within 15 hours on average

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16
Q

What should you ask about regarding before an epileptic seizure (2)

A

Triggers: alcohol, stress lack of sleep, lights
Aura: rising epigastric sensation, deja-vu, out of body experience

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17
Q

What should you ask about regarding during an epileptic seizure (5)

A 
< 3 minutes
LOC
Tongue biting
Jerking 
Incontinence
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18
Q

What should you ask about regarding after an epileptic seizure (5)

A 
Slow recovery
Post-ictal headache
Confusion
myalgia
Todd’s paresis
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19
Q

2 main types of seizures

A

Focal and generalised

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20
Q

3 types of focal seizures

A

Focal impaired awareness seizures
Focal aware seizures
Focal seizures with secondary generalised weakness

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21
Q

6 types of generalised seizures

A 
Tonic-clonic seizures
Myoclonic seizures
Clonic seizures
Tonic seizures
Atonic seizures
Absence seizures
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22
Q

What happens during the tonic phase

A

all the muscles go stiff

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23
Q

What happens during the clonic phase

A

there is quick and rhythmical jerking of the limbs.

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24
Q

What happens in a tonic clonic seizure

A

there is first a tonic phase and then a clonic phase.

25
Q

What is the most common type of epileptic seizure

A

tonic clonic

26
Q

in which phase is there quick and rhythmical jerking of the limbs.

A

clonic

27
Q

in which phase do all the muscles go stiff

A

tonic

28
Q

What is a tonic clonic seizure also known as

A

grand mal

29
Q

What is a grand mal seizure also known as

A

tonic-clonic

30
Q

What is a petit mal seizure also known as

A

absence

31
Q

What is a absence seizure also known as

A

petit mal

32
Q

Which type of seizure is most common in puberty

A

Myoclonic

33
Q

When are atonic seizures most common

A

in children

34
Q

When are absence seizures most common

A

children

35
Q

Whats the difference between clonic and myoclonic seizures

A

Myoclonic are loads of small contractions whereas clonic are big contractions

36
Q

What happens in a atonic seizure

A

Loss of muscle tone

37
Q

What happens in a temporal lobe focal seizure (3)

A

Aura (epigastric discomfort, epigastric discomfort)
Automatisms (playing with fingers, lip smacking)
Hallucinations

38
Q

What happens in a occipital lobe focal seizure (3)

A

Visual phenomena (spots, lines, flashes)

39
Q

What happens in a parietal lobe focal seizure (3)

A

Sensory disturbances (pain, tingling, numbness)

40
Q

What happens in a frontal lobe focal seizure (4)

A

Motor symptoms
Jacksonian march: muscular spasm spreads from distal part of limb to larger area of the body
Post-ictal flaccid weakness (Todd’s palsy)
Involuntary actions (disinhibition)

41
Q

What is the diagnostic criteria for epilepsy

A

2 or more unprovoked seizures occurring more than 24 hours apart

42
Q

Ix for suspected epilepsy

A

EEG
Bloods
Brain imaging (CT, MRI)

43
Q

What do we request in the bloods of someone suspected of epilepsy and why (4)

A 
Blood glucose (hypoglycaemia can cause seizures)
FBC (evaluate systemic or CNS infection)
Electrolyte panel (electrolyte disturbances can provoke seizures)
Serum prolactin (can be transiently elevated following seizures)
44
Q

Which AEDs are recommended for focal seizures

A

Carbamazepine

Lamotrigine

45
Q

Which AEDs are recommended for generalised seizures

A

1st line: sodium valproate

2nd line: carbamazepine

46
Q

SE’s of most AED’s

A

Psychiatric symptoms e.g. depression

Weight gain

47
Q

S.E’s of carbamazapine

A

Neutropenia and osteoporosis

48
Q

S.E’s of lamotrigine

A

Stevens-Johnson syndrome (severe skin reaction)

49
Q

Which AED’s are recommended for pregnancy (1) and which should be avoided (2)

A

Avoid sodium valproate and phenytoin

Lamotrigine is preferred

50
Q

What is the definition of status epilepticus

A

seizure lasting > 5 minutes or repeated seizures

without recovery or regain of consciousness in between

51
Q

Triggers of status epileptics (3)

A

non-adherence to medication
alcohol abuse,
OD & toxicity

52
Q

Mx of status epilepticus (6 steps)

A

ABC approach
We should secure airway and give 100% oxygen
IV access and continuous monitoring of sats, BP, ECG and glucose
IV lorazepam
Repeat after 10 minutes if seizure doesn’t terminate
If after 10 minutes it still hasn’t terminated give phenytoin
Then transfer to ITU

53
Q

What should we always monitor in status epilepticus (4)

A

Sars BP ECG and !glucose!

54
Q

Which trigger of status epilepticus should you immediately exclude and how do you resolve it

A

Hypoglycaemia - 50ml of 50% glucose should be given immediately

55
Q

What type of drug is the first line treatment for SE

A

Benzodiazepine

56
Q

How do BZD’s work

A

bind to the gamma-aminobutyric acid (GABA)-A receptors, increasing channel opening frequency at the receptor, with subsequent increased chloride conductance and neuronal hyperpolarization, leading to enhanced inhibitory neurotransmission and antiepileptic action

57
Q

Complication of epilepsy (4)

A

SUDEP (sudden death in epilepsy)
Behavioural problems
Fractures (from seizures)
Complications from drugs

58
Q

A 16-year-old boy presents to A & E after collapsing on a cricket game. According to his cricket coach, the boy was unconscious for about one minute during which time, he was moving his arms and legs around. Further review revealed that he had experienced a similar episode a month before. What is the most appropriate drug for this patient?

A

Sodium valproate

Y3 MedEd (34 decks)

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