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Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

In a patient with suspected epilepsy what three stages are important to ask about in the history?

A
  • onset
  • event
  • afterwards
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2
Q

What are important factors when asking about onset?

A

Environment - flashing lights, light head, syncope, what did the patient look like (pallor, posture, breathing)

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3
Q

What are important factors when asking about the event?

A

Tonic phase, clonic movements, corpopedal spasms, rigor, responsiveness, awareness

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4
Q

What are important factors when asking about after the event?

A

Speed of recovery, sleepiness/disorientation, deficits

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5
Q

State the risk factors for epilepsy

A

Birth problems, developmental issues, seizures in the past, head injury, family history, drugs, alcohol

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6
Q

If a patient presents with collapse what must always be done and why?

A

ECG - long QT

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7
Q

When is a CT indicated in a patient who has had a seizure?

A
  • skull fracture
  • deteriorating GCS
  • focal signs
  • head injury with seizure
  • failure of GCS to be 15/15 4 hours after arrival
  • suggestion of other pathology e.g subarachnoid haemorrhage
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8
Q

When is an EEG useful?

A
  1. Helpful when determining whether someone is in non-convulsive status or septic encephalopathy
  2. Non-epileptic attacks
  3. Epilepsy surgery to determine location
  4. Determining the type of epilepsy
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9
Q

State some differential diagnoses for epilepsy

A
  • syncope
  • non-epileptic attack
  • panic attack
  • sleep phenomena
  • TIA
  • migraine
  • hypoglycaemia
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10
Q

What are the driving regulations after a patient has their first seizure?

A

Car - 6 months

HCV/PCV - 5 years

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11
Q

If you have nocturnal seizures how long until you can drive?

A

3 years

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12
Q

How long off medications do you need to be to drive an HCG/PCV?

A

10 years

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13
Q

Define epilepsy

A

A tendency to recurrent, usually spontaneous epileptic seizures

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14
Q

Define epileptic seizure

A

Abnormal discharge of electrical signals in the brain

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15
Q

What factors contribute to the pathology of epilepsy?

A

Genetic, acquired brain injury, metabolic disease, toxic and environmental factors

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16
Q

Name the two key types of epilepsy

A

Focal

Generalised

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17
Q

Describe focal epilepsy

A

Part of the brain does not work properly due to structural abnormality - seizure focus. This irritates the surrounding area and can cause a seizure

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18
Q

How can focal epilepsy lead to a generalised seizure?

A

Cortical networks may be involved and therefore the irritation can spread throughout the brain

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19
Q

Define seizure

A

Abnormal discharge of electrical activity in the brain

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20
Q

What are the three focal symptoms?

A

Motor - jerking, posturing, head and eye deviation
Sensory - olfactory, gustatory, visual, auditory
Psychic - déja vu, depersonalisation, jamais vu, aphasia, hallucinations

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21
Q

Name the five types of generalised seizure

A
  • absence
  • myoclonic
  • atonic
  • tonic
  • tonic clonic
22
Q

What types of generalised seizure can be due to focal epilepsy?

A

Tonic

Tonic clonic

23
Q

Describe generalised epilepsy

A

Seizures happen on the cortical networks and cannot stay in the same place - they propagate around the brain

24
Q

Who is usually affected by each type of epilepsy and why?

A

Generalised - young people, due to genetics

Focal - older people due to structural abnormality

25
Q

What drugs can be used to treat primary generalised epilepsy?

A

Sodium valproate

Lamotrigine

26
Q

What drugs can be used to treat focal onset epilepsy?

A

Carbamazepine

Lamotrigine

27
Q

Why do sodium valproate and lamotrigine work well in combination?

A

As sodium valproate inhibits the metabolism of lamotrigine

28
Q

What drugs are used to treat generalised absence seizures?

A

Sodium valproate

Ethosuximide

29
Q

What drugs are used to treat generalised myoclonic seizures?

A

Sodium valproate
Leveliracetam
Clonazepam

30
Q

What drugs are used to treat atonic, tonic, tonic-clonic seizures?

A

Sodium valproate
Levetiracetam
Topriamate
Lamotrigine

31
Q

What is the problem with sodium valproate?

A

Teratogenic

32
Q

How do anti-convulsants alter the efficacy of contraception?

A

By induction of hepatic enzymes

33
Q

State the name for the most serious seizures

A

Status epilepticus

34
Q

Describe status epilepticus

A

Recurrent epileptic seizures without full recovery of consciousness, lasting more than 30 minutes

35
Q

After what amount of time of status epilepticus would a patient get treated?

A

10 mins

36
Q

Name the three types of status epilepticus

A

Generalised convulsive (tonic-clonic)
Non-convulsive status
Epilepsia partialis continua

37
Q

What can precipitate status epilepticus?

A
  • severe metabolic disorders
  • infection
  • head trauma
  • sub-arachnoid haemorrhage
  • abrupt withdrawal of anti-convulsant
  • treating absence seizures with carbamazepine
38
Q

What happens in a non-convulsive status?

A

Conscious but altered state

39
Q

Describe how generalised convulsive status can kill you

A

First 30 mins - aspirations
30mins -2 hours - hypoxia, hypotension, hyperthermia, excess demand for cerebral energy and poor substrate delivery
Longer term - glutamate release causes excitotoxicity and ultimately neuronal death

40
Q

What drug is given if a patient has had status epilepticus for more than 10 mins?

A

Benzodiazepines - buccal midazalam, maximum of 2 doses as risk of respiratory distress

41
Q

What anti-convulsant drugs can be given in status epilepticus?

A

Phenytoin
Levetiracetam
Sodium valproate

42
Q

What non-anticonvulsant drugs may be needed in status?

A

Thiamine and glucose

43
Q

In non-convulsive status what investigation is done?

A

EEG to rule of septic encephalopathy

44
Q

Why are benzodiazepines given in non-convulsive status?

A

To treat central brain firing problems

45
Q

What is an aura?

A

Epileptic seizure that happens in the sensory area of the brain - numbness, tingling, electric shocks

46
Q

What happens in a visual aura?

A

Flashing, static, moving lights, occipital or temporal lobe involvement

47
Q

Describe an autonomic aura

A

Similar to syncope - occurs in the temporal lobe

48
Q

State three features of functional attacks

A
  1. Prominent motor activity
  2. Episodes of collapse with no movement
  3. Abreactive attacks - fear, gasping, hyperventilation
49
Q

How long do functional attacks usually last?

A

10-20 mins

50
Q

How can functional attacks be diagnosed?

A

EEG and video with provocation, linguistic analysis very matter of fact language

Neurology (29 decks)

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