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Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is epilepsy?

A

A tendency to recurrent, usually spontaneous epileptic seizures

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2
Q

What causes epileptic seizures?

A

occur due to abnormal synchronisation of neuronal activity usually excitatory, this causes interruption of normal brain activity (how seizures happen at a molecular level is not fully understood at the moment)

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3
Q

Describe duration of epileptic seizures?

A

They are usually brief lasting seconds to minutes

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4
Q

2 main classifications of epilepsy?

A

Focal

General

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5
Q

Describe the difference between focal and general seizures?

A

Focal seizures occur in a focal region of the brain e.g. a focal motor or focal sensory seizure
General seizures affect the whole brain

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6
Q

Describe focal epilepsy?

A

This is a type of epilepsy where there is a seizure focus (part of brain that doesn’t work properly) that can irritate the surrounding brain. This focus can cause a focal seizure if the irritation stays in that area or it can cause a general seizure if the abnormal electrical activity hits a cortical network which allows it to spread throughout the brain.

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7
Q

Describe generalised epilepsy?

A

This is a type of epilepsy where the seizures occur on cortical networks so as soon as they happen they immediately propagate around the brain and generalised seizures occur (FOCAL SEIZURES CANNOT HAPPEN)

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8
Q

Explain what types of seizures you can get in focal and generalised epilepsy?

A

Focal epilepsy: can get both focal and general seizures

General epilepsy: can only get general seizures

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9
Q

List five types of generalised seizure?

A 
Absence
Myoclonic
Tonic 
Atonic 
Tonic Clonic
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10
Q

Describe absence seizures?

A
  • loss of awareness and vacant expression < 10 s before returning abruptly to normal and continuing as though nothing happened
  • patients are not aware but may have many a day
  • like day dreaming/ dozing except you cant be snapped out of it
  • may have slight eye flutterings but apart from that no motor symptoms
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11
Q

What type of seizure is being described?

Loss of awareness and vacant expression < 10 s before returning abruptly to normal and continuing as though nothing happened

A

Absence

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12
Q

Describe myoclonic seizures?

A

Jerks
Momentary brief contractions of muscles or muscle groups
e.g. involuntary twitch of a finger or hand

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13
Q

What type of seizure is being described?

Momentary brief contractions of muscles or muscle groups

A

Myoclonic

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14
Q

Describe tonic seizures?

A

Consists of a stiffening of the body not followed by jerking

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15
Q

What type of seizure is being described?

Consists of a stiffening of the body not followed by jerking

A

Tonic

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16
Q

Describe atonic seizures?

A

Sudden collapse with loss of muscle tone and consciousness

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17
Q

What type of seizure is being described?

Sudden collapse with loss of muscle tone and consciousness

A

Atonic

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18
Q

Describe tonic clonic seizures?

A
  • often no warning
  • an initial tonic stiffening is followed by the clonic phase with synchronous jerking of the limbs reducing in frequency over about two mins until the convulsion stops (may be incontinence)
  • a period of flaccid unresponsiveness is followed by gradual return of awareness with confusion and drowsiness lasting 15 mins to an hour, headache is common after
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19
Q

What type of seizure is being described?

An initial tonic stiffening is followed by the clonic phase with synchronous jerking of the limbs reducing in frequency over about two mins until the convulsion stops

A

Tonic clonic

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20
Q

Primary generalised epilepsies tend to present in _____1______ and account for up to___2__ of all patients with epilepsy. Structurally the brain is ___3_______

A

1) childhood and early adult life
2) 20%
3) normal, ion channel and neurotransmitter release abnormalities are hypothesised as the causes

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21
Q

Name 3 types of primary generalised epilepsy?

A

Childhood absence epilepsy
Juvenile myoclonic epilepsy
Monogenic epilepsy

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22
Q

Describe childhood absence epilepsy?

A

Type of primary generalised epilepsy

get absence seizures, spontaneous remission by age 18 is usual

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23
Q

Describe juvenile myoclonic epilepsy?

A

Type of primary generalised epilepsy
accounts for 10% of all epilepsies, typically myoclonic jerks start in teenage years (usually ignored) followed by generalised tonic clonic seizures that bring them to medical attention, seizures and jerks often occurs in the morning after wakening, lack of sleep alcohol and strobe or flickering lights can be triggers, good response to treatment but required lifelong

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24
Q

Describe some triggers for juvenile myoclonic epilepsy?

A

Lack of sleep, alcohol and strobe or flickering lighting.

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25
Q

Describe monogenic epilepsies?

A

Type of primary generalised epilepsy

Caused by single gene mutations in voltage gated channels

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26
Q

A focal seizure often indicates _______ and _____ is required

A

structural cause

imaging

27
Q

List seven potential causes for focal epilepsy?

A 
Hippocampal sclerosis
Genetic and developmental disorders
Trauma, hypoxia, surgery
Vascular disorders
Infections
Alcohol and drugs
Immunological disorders
28
Q

Describe hippocampal sclerosis and how it causes focal epilepsy?

A

There is damage with scarring and atrophy of the hippocampus and surrounding cortex. Main cause of temporal lobe epilepsy. Childhood febrile convulsions are the main risk factor. It is usually visible on MRI. It is one of the more common causes of refractory epilepsy so sometimes surgery is done.

29
Q

What is the main risk factor for hippocampal sclerosis and focal epilepsy?

A

Childhood febrile convulsions

30
Q

Describe hippocampal sclerosis treatment in refractory epilepsy?

A

May do surgery to remove the damaged part of the temporal lobe however careful psychological assessment must be done beforehand because if someone is not psychologically well balanced the surgery can actually result in them suffering from non epileptic attacks after.

31
Q

What is a genetic disorder that can cause focal epilepsy?

A

Tuberous sclerosis

32
Q

If someone has rapid recovery from a blackout episode is it more likely syncope or epilepsy?

A

Syncope

Epilepsy takes a while to recover, drowsy and headache

33
Q

What triggers for a blackout episode would make you think of syncope as opposed to epilepsy?

A

Pain, heat, prolonged standing

34
Q

If someone goes pale before a blackout episode would you think syncope or epilepsy?

A

syncope

35
Q

After blackout episode what tests should you do?

A

blood tests, check glucose, serum calcium, ECG (MUST CHECK FOR LONG QT), brain MRI, EEG

36
Q

What guidelines must you give someone who has had a seizure about driving?

A
  • must tell the patient to stop driving after a single seizure
  • if the patient continues to drive the doctor has the responsibility to inform the DVLA
  • after a single seizure you are not allowed to drive a motor car for 6 months or a HGV for 5 yrs
  • if diagnosis of epilepsy you are not allowed to drive a car until a year seizure free and not allowed HGV until 10yrs off all medication seizure free
  • if the only type of seizure ever had doesn’t affect the consciousness or ability to drive and first one was 12 months ago can still drive
  • if seizures only ever been a night and 1st one 12 months ago can drive OR if past 3 yrs only had night seizures can drive even if used to have day seizures
37
Q

What is SUDEP?

A

Sudden unexpected death in epilepsy
Basically describes point that chance of dying is increased in those with epilepsy
However well controlled epilepsy decreases the risk of this
There is no common cause of SUDEP

38
Q

What is the main drug used for generalised tonic clonic, tonic or atonic epilepsy?

A

sodium valproate

39
Q

What are the main drugs used for focal epilepsy?

A

Carbamazepine if can tolerate

Lamotrigine if cant tolerate

40
Q

What is the main drug used for myoclonic epilepsy?

A

Sodium valproate

41
Q

What anti epileptic drug can actually make some generalised epilepsies worse?

A

Carbamazepine

42
Q

List some side effects of sodium valproate?

A

teratogenic, weight gain, hair loss and fatigue

43
Q

A number of anti convulsants induce hepatic enzymes… why is this relevant for women?

A

it makes the combined oral contraceptive pill ineffective, also the morning after pill is ineffective

44
Q

What drugs can enzyme inducing anti convulsants make ineffective?

A

COCP, morning after pill, anti-hypertensives, cholesterol lowering, warfarin, chemo drugs

45
Q

What provides greater contraceptive security for women on enzyme inducing anti epileptics?

A

a COCP with higher dose of oestrogen or the progesterone only pill

46
Q

Describe advice for women with epilepsy thinking of getting pregnant?

A

women need counselling as some AEDs are teratogenic but has to be weighed up to risk of stopping the drug as uncontrolled epilepsy poses a risk to the baby
Recommended they take high dose folic acid before conception and until the first trimester is finished, vitamin K also in enzyme inducing AEDs in last 4 weeks before delivery to prevent neonatal haemorrhage.

47
Q

Status epileptics is a medical _____

A

emergency

48
Q

Define status epilepticus?

A

continuous seizure activity without recovery for 30 mins

49
Q

What could lead to AKI in status epilepticus?

A

Rhabdomyolysis

50
Q

After how many minutes should status epilepticus be treated?

A

After 10 (even though it isn’t technically status until 30 mins after 10 mins the seizure is unlikely to stop independently)

51
Q

3 types of status epilepticus? What is most dangerous?

A 
Generalised convulsive status (most dangerous type)
Non convulsive (conscious but in altered state)
Epilepsia partialis continua (continuous focal seizures but consciousness preserved)
52
Q

What can kill people quickly who are in generalised convulsive status epilepticus?

A

Aspiration

53
Q

Describe management of status epilepticus?

A

1) stabilise with ABC
2) identify cause
3) at 10 mins give buccal midazolam (benzodiazepam)
4) wait 5 mins, if not stopped give rapid onset anti-convulsant drug e.g. phenytoin
6) Still no response call intensive care (likely to need intubation etc)
7) one status is stabilised get them back on normal anti-convulsant drugs

> any suggestion of hypoglycaemia give IV glucose
any suggestion of nutritional deficiency or alcoholism give thiamine

54
Q

In status epilepticus why should you not give more than 2 doses of benzodiazepam?

A

Could cause a respiratory arrest

55
Q

Most acute seizures stop so ______

A

don’t need any treatment (only need to treat status)

56
Q

Name 6 potential precipitants of status epilepticus?

A

1) severe metabolic disorders
2) infection
3) head trauma
4) sub arachnoid haemorrhage
5) abrupt withdrawal of anti convulsants
6) treating absence seizures with carbamazepine

57
Q

When should partial status epilepticus (type of non-convulsive status) be considered? How can it be confirmed and what is the treatment?

A

Should be considered in any patient presenting with an acute confusional state
Only way to confirm is EEG (as it presents similarly to encephalitis)
Give benzodiazepam like in convulsive status

58
Q

What is psychogenic non-epileptic attack disorder?

A

A functional disorder, often linked to trauma, not due to uncoordinated electrical activity but can be difficult to distinguish from epilepsy.

59
Q

Describe differences in how patients may describe epileptic attacks vs non-epileptic attacks?

A

NEA are usually easier for patients to describe, speak factually.
Epileptic attacks are harder to describe as the uncoordinated electrical activity makes them feel really weird as never felt it before.

60
Q

Does coordinated movement suggest NEA or epilepsy?

A

non epileptic attack

61
Q

Any episode of collapse with non movement in adults suggests_______

A

non epileptic attack (there is no part of the adult brain that could make someone drop down like that in epilepsy)

62
Q

Duration of non epileptic attacks are usually longer or shorter?

A

longer

63
Q

Describe what treatment of NEA may involve?

A

Counselling for trauma, CBT etc.

Neurology (22 decks)

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