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Neurology Year 3 > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is the approach to a fallen patient.

A

History- Patient and eye witness before and after
Onset - environment and what they looked like
Event itself - movement, responsiveness awareness
Afterwards - Speed of recovery deficits

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2
Q

List some risk factors for epilepsy.

A

Difficult birth
Seizures in the past
Head injury
Drugs

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3
Q

Why is social history very important?

A

Driving is illegal whilst uncontrolled and un medicated need to alert the DVLA.

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4
Q

List some respiratory drugs which can trigger a fit.

A

Theophyline

Aminophyline

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5
Q

Give an example of an analgesic that can precipitate a fit.

A

Tramadol

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6
Q

Give an example of an anti emetic which can trigger a fit.

A

Prochlorperazine

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7
Q

Which opioid can trigger a fit?

A

Diamorphine

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8
Q

What investigations should someone who has presented with a new onset seizure/fall undergo?

A

ECG

CT/MRI

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9
Q

Why is an ECG so important for someone who has fallen?

A

To rule out syncope or Long QT syndrome all of which can present with falls.

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10
Q

When is a CT used instead of an MRI?

A

Residual focal signs
Trauma - e.g. skull fractures
Faling GCS
Suggestion of other pathology

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11
Q

List some differential diagnosis for epilepsy.

A 
Syncope 
Panic attack
Sleep phenomena
TIA
MIgraine
Hypoglycaemia
MS - tonic spasms
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12
Q

What is epilepsy?

A

The tendency to have recurrent usually spontaneous epileptic seizures.

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13
Q

In counselling the patient what should be explained?

A

Seizures doesn’t mean epilepsy is certain
Risk of recurrence
Driving and the risks

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14
Q

What is the physiology behind an epileptic fit?

A

Abnormal synchronisation of neuronal activity. Causing focal or generalised cessation of normal activity.

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15
Q

What is the most common cause of lack of synchronisation behind epilepsy?

A

Too much excitatory AP

Too much inhibitory is rarer

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16
Q

Focal seizures can be divided into what?

A

Simple - no impairment of consciousness

Dicognative - impaired consciousness

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17
Q

Focal Motor seizure

A

Rhythmic jerking.
Head and eye deviation
Vocalisation

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18
Q

Focal Sensory Seizure

A

Auras - floating lights

Somatosensory changes

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19
Q

Conscious Focal Seizures

A

Deja Vu
Depersonalisation
Hallucination

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20
Q

What is the physiology behind focal seizures.

A

Due to structural abnormality i.e too many synaptic connection

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21
Q

How can focal seizures become generalised?

A

If the AP irritates enough tissue it can be propagated throughout the brain.

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22
Q

When do most people present with Primary Generalised Epilepsy?

A

Childhood early teens

23
Q

How do most people with Primary generalised epilepsy present?

A

Early morning jerks

Generalised Seizures

24
Q

What are risk factors for triggering a seizure in someone with Primary Generalised Epilepsy?

A

Sleep deprivation

Flashing Lights

25
Q

Are EEGs useful in Primary Generalised Epilepsy?

A

Yes as they can help identify the subtype

26
Q

What is the mainstay of treatment for someone with Primary Generalised Epilepsy?

A

Sodium Valproate

27
Q

If someone with Primary Generalised Epilepsy is looking to conceive what must happen?

A

Sodium Valproate stopped before trying to conceive as it is teratogenic.
Lamotrigine is used

28
Q

A Focal seizure which has become a generalised seizure is classified as what?

A

Secondary Generalised

29
Q

Focal seizures present themselves at what age?

A

Any age

30
Q

How do Focal Seizures present?

A

Frequent complex seizures

Hippocampal Sclerosis

31
Q

What is the treatment of choice for Focal Seizures?

A

Carbazemepine

Lamotrigine

32
Q

Which drugs affect presynaptic excitability ?

A

Carbazemapine Lamotrigine

Retigabine

33
Q

What is the action of Lamotrigine and Carbazemapine?

A

Block Voltage gated Na+ channels prevent depolarisation of the neurone.

34
Q

What is the action of retigabine.

A

Increases activity of K+ Ion channels hyper polarising the neurone and therefore reducing propagation of the signals.

35
Q

What drugs inhibit neurotransmitter release?

A

Levetiracetam

Pregablin Gabapentin

36
Q

What is the mode of action of Levetiracetam?

A

Levetiracetam inhibits SV2A which is required for the exocytosis of neurotransmitter release

37
Q

What is the mode of action of Pregablin and Gabapentin?

A

Ca2+ channel blocker .

Calcium influx drives neurotransmitter release.

38
Q

Why should Sodium Valproate be taken alongside Lamotrigine ?

A

Sodium prevents the metabolism of lamotrigine thus increasing the efficacy of the drug.

39
Q

How do Benzodiazapines help in epilepsy?

A

Increase GABA activity thus reducing the excitability of the neurones.

40
Q

What is the mode of action of sodium Valproate?

A

Enhance GABA synthesis

41
Q

Which drug targets the GABA transporter and how does that reduce excitability?

A

Tiagabine
Reduce GABA reuptake
Increased GABA in cleft
Increased inhibitory action

42
Q

What drugs are used for absence fits?

A

Sodium Valproate

Ethosuximate

43
Q

What are absence fits?

A

Stop whatever they are doing

Look spaced out

44
Q

What is the treatment for myoclonic muscle twitches?

A

Sodium Valproate

Clonazepam

45
Q

What anticonvulsant drug is used acutely?

A

Phenytoin

46
Q

Focal Onset seizures are generally treated with…

A

Carbazemapine

47
Q

Women on lamotrigine should be aware of what?

A

Alters efficacy of the combined oral contraceptive pill

Shouldn’t used progesterone morning after pill

48
Q

What is Status Epilepticus?

A

Recurrent epileptic seizures without full recovery of consciousness between.

49
Q

What are the different types of Status Epilepticus?

A

Generalised Convulsive
Non Convulsive status
Epilepsia Partialis Continua

50
Q

Non Convulsive status

A

Conscious but in altered state

51
Q

Epilepsia Partialis Continua

A

Focal seizures but consciousness is preserved

52
Q

What are some causes of Status Epilepticus

A 
Severe metabolic disorder
Infection
Head trauma
Sub arachnoid haemorrhage 
Abrupt withdrawal of anti convulsants
53
Q

How can Status Epilepticus be fatal?

A

Glutamate release and storm.
Hypoxia
Respiratory Insufficiency
Hypotension

Neurology Year 3 (29 decks)

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