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2nd year > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

what is a seizure?

A

sudden change in behaviour caused by electrical hypersynchronisation of neuronal networks in cerebral cortex. Can be provoked or unprovoked

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2
Q

provoked seizures

A

occurs at time of systemic or brain insult
metabolic derrangements
drug or alcohol withdrawal
acute neurological disorders

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3
Q

what neurological disorders can cause seizures?

A

stroke
encephalitis
acute head injury

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4
Q

unprovoked seizures

A

unknown aetiology

pre-existing brain lesion or progressive neurological disorder

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5
Q

what are the 2 types of seizures?

A

generalised or focal

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6
Q

focal seizures

A

originate in 1 hemisphere
can evolve to generalised
2 types = simple focal or focal dyscognitive

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7
Q

simple focal seizure

A

retained awareness

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8
Q

focal dyscognitive

A

consciousness is impaired at onset but otherwise the same as simple focal

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9
Q

generalised seizures

A

both hemispheres
bilateral discharges involve subcortical structures
impairment of consciousness
different types

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10
Q

what are the different types of generalised seizures?

A 
absence
myoclonic
atonic
clonic
tonic 
tonic-clonic
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11
Q

absence seizure

A

act lost

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12
Q

myoclonic seizure

A

sudden burst of activity causing jerking once

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13
Q

atonic seizure

A

loss of muscle power and tone

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14
Q

tonic-clonic seizure

A

stiffness and repetitive limb shaking

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15
Q

gelastic seizure

A

giggling at start

then limb and head jerking

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16
Q

simple focal occipital seizure

A

multi-coloured flashing colours
short-lived
no lasting effect

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17
Q

Temporal lobe seizure

A 
most common
complex aura
visceral disturbance 
deja vu 
jamais vu 
memory 
automatisms
affective disturbance - fear, pleasure, elation, supernatural
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18
Q

frontal lobe seizure

A

motor cortex affects
jacksonian march
paralysis
fencing posture - contralateral head movement and arm extension with flexion of ipsilateral arm
lasting weakness while repolarisation occurs

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19
Q

what is the jacksonian march?

A

discharge propagates through cortex

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20
Q

todds paralysis

A

post - ictal paralysis

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21
Q

what is automatism?

A

repetitive movements, e.g. lip smacking

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22
Q

what is jamais vu?

A

strange feeling

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23
Q

parietal lobe seizure

A

paraesthesia and tingling
motor symptoms
jacksonial match

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24
Q

occipital lobe seizure

A

unformed images and flashing lights
complex visual hallucinations
post-ictal blindness - temporary

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25
Q

primary generalised seizures

A

Tonic-clonic seizure phases

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26
Q

phases of primary generalised seizures

A
  1. abrupt loss of consciousness
  2. epileptic cry
  3. tonic phase
  4. clonic phase
  5. postictal
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27
Q

what is the epileptic cry?

A

tonic contraction of respiratory muscles

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28
Q

what happens in the tonic phase?

A 
lasts less than 1 min
rapid neuronal discharge 
all muscles of arms, legs, chest and back become stiff
eyes open
pupils dilated 
elbows fixed
arms pronated
legs extended
teeth clenched
breath held
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29
Q

what happens in the clonic phase?

A 
1-2 mins
slow neuronal discharge
muscles begin to jerk and twitch rhythmically
tongue biting
incontinence - loss of sphincter tone
bloody sputum 
mouth frothing 
eyes roll back or forwards
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30
Q

what happens in the post ictal phase?

A

deep sleep
confusion
agitation

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31
Q

absence seizures features

A 
usually during childhood 
5-10 seconds of vacant staring 
often occur in clusters 
95% remission during adolescence 
affect education
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32
Q

what can bring on an absence seizure?

A

hyperventilation

phonic stimulus

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33
Q

myoclonic seizure

A

sudden generalised muscle contractions
normally occur on the edge of sleep in healthy people but when they occur during the day epilepsy can be diagnosed
can develop into tonic-clonic seizures
need lifelong treatment with antiepileptics

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34
Q

pathophysiology of provoked seizures

A

insult causes infiltration of inflammatory cells which react with microglia and astrocytes
alters function of neurone membrane and causes hyper-excitation of neurones which spreads through the brain

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35
Q

what brain injuries can cause provoked seizures?

A
  • stroke – haemorrhagic
  • subdural haematoma
  • subarachnoid haemorrhage
  • traumatic brain injury
  • hypoxic ischaemic injury
  • brain abscess
  • meningitis
  • encephalitis
  • neoplasm
  • vascular malformations
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36
Q

medical illnesses that cause provoked seizures

A
  • hypoglycaemia – insulin dependants
  • hyperglycaemia – nonketotic hyperglycaemia
  • hyponatraemia – rapid fall
  • hypocalcaemia – more likely with neonates
  • hypomagnesemia
  • hyperthyroidism
  • uraemia – renal failure causing myoclonic seizures
  • alcohol withdrawal
  • acute intermittent porphyria
  • drugs
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37
Q

what drugs can cause provoked seizures?

A

cocaine
amphetamines
MDMA
tricyclic antidepressants

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38
Q

aetiology of seizures

A 
vascular
infections
trauma/ toxins
autoimmune
metabolic imbalances
idiopathic
neoplasm
syndromes
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39
Q

how to diagnose epilepsy?

A

presenting features
history
investigations
differential diagnostic investigations - ECG to ensure blackout is not cardiac

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40
Q

history taking for a seizure

A 
description of events and circumstances 
video footage if possible 
what happened beforehand - tiredness/ triggers etc. 
past medical history
drug history
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41
Q

what drugs can cause a seizure?

A 
tramadol
neuroleptics
vasodilators
older anti-depressants 
amitriptyline - prolongation of QT interval
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42
Q

red flags of seizures

A 
eyes open 
tongue biting on side
cyanosis
retrograde amnesia 
hot feeling 
unwell feeling 
stretuous breathing
loss of consciousness 
incontinence - urine and faeces 
postictal recovery 
lasting neurological features - odd sensation and tingling
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43
Q

post-ictal state

A

pain
injuries
exhaustion

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44
Q

investigations for seizures

A 
may be absent of clinical findings 
look for structural or metabolic causes
eliminate differential diagnoses
MRI
EEG
CT scan 
lumbar puncture
45
Q

Fever fit

A

doesn’t normally develop into epilepsy

46
Q

fainting vs seizure

A

fainting can appear like a seizure but recovery tends to be much quicker

47
Q

EEG tracing

A

done over 24-48 hours to eliminate non-epileptic episodes caused by psychosocial factors

48
Q

what are the differential diagnoses for seizures/ epilepsy

A 
syncope
vasovagal syncope with reflex anoxic event 
cardiac arrhythmia 
non-epileptic attack/ pseudoseizures 
maligering 
migraine
dissociative attack
49
Q

vasovagal syncope with reflex anoxic event

A

short burst of activity occurs alongside syncope

50
Q

cardiac arrhythmias causing syncope

A

brugada syndrome
hypertrophic obstructive cardiomyopathy
prolonged QT interval disorders

51
Q

non-epileptic attacks

A

functional neurology

not explained by structural or organic pathology

52
Q

what is maligering

A

alternative motive for a seizure - mimicing

53
Q

what causes dissociative attacks?

A

psychological causes

54
Q

QT elongation

A

can cause a blackout

55
Q

what drugs prolong the QT interval?

A

antiarrhythmic drugs
certain non-sedating antihistamines - terfenadine
macrolide antibiotics
psychotropic medications
gastric motility agents/ anti-emetics - cisapride and domperidone

56
Q

what is brugada syndrome?

A 
prolonged PR interval 
RBBB 
can be fatal
ST elevation 
inherited condition 
causes a blackout that appears like a seizure 
requires defibrillator insertion
57
Q

principles of epilepsy treatment

A

epilepsy nurse specialist
education of patient and the family
first aid
antiepileptic - given on 2nd seizure

58
Q

when to treat someone on the first seizure?

A

60% risk over 10 years if:

  • abnormal EEG
  • structural lesion
  • abnormal neurological examination
  • first fit occurs during sleep
59
Q

driving and epilepsy

A

everyone who has suffered an unprovoked seizure should contact DVLA and surrender their licence

60
Q

how much time do people have to have off driving after a seizure?

A

1st seizure = 6 months- 1 year off depending on other factors
HGV driving = 10 years off driving after 1 seizure
established epileptics have to be seizure free for 12 months before being allowed to drive

61
Q

precautions for epileptics

A

shower not bath, if bathing keep door open and ask someone to be aware
swimming either accompanied or let lifeguard know
avoid triggers

62
Q

SUDEP

A

sudden unexplained death in epilepsy

63
Q

sudden unexplained death in epilepsy

A

very rare
risk reduced with anticonvulsants
generalised seizure spreading through brainstem and life-maintaining areas
need to educate and reassure patients that it is rare

64
Q

common seizure triggers

A 
sleep deprivation 
alcohol
drugs 
missed anticonvulsants 
pregnancy 
infections 
illness 
vomiting/ diarrhoea
65
Q

when does alcohol cause seizures

A

on withdrawal

66
Q

what drugs can cause seizures?

A

amphetamine
ecstasy
cocaine
enzyme inducers

67
Q

why does pregnancy cause seizures?

A

enlarged volume of distribution reduces efficacy of anticonvulsants
or separately as eclampsia

68
Q

what infections commonly cause seizures?

A

UTIs

URTIs

69
Q

why does illness cause seizures?

A

poor absorption of anticonvulsants

70
Q

first aid for seizures

A 
protect head 
remove glasses
loosen tight clothing 
turn on side/ recovery position 
don't put anything in their mouth
look for ID and/ or medialert
don't hold them down 
offer support and help after seizure 
not everyone with epilepsy needs hospital admission after seizure
71
Q

when is hospital admission needed?

A

> 5mins long seizures anyone with or without epilepsy needs hospital admission

72
Q

principles for epilepsy treatments

A

aim for monotherapy
start slow and titrate up slowly
50% will be successfully treated with the 1st drug
adjuvant sometimes required
surgical intervention preserved for non-responders
consider tetragenicity

73
Q

pregnancy and epilepsy drugs

A

sodium valporate cannot be used in child-bearing aged women
carbamezapine is tetragenic
polypharmacy increases risk of tetragenicity

74
Q

what do anticonvulsants cause in fetuses?

A

psychomotor abnormalities

developmental delay

75
Q

what are the treatments for generalised tonic clonic seizures?

A

carbamezapine
lamotrigine
sodium valporate

76
Q

what drug can be used for epilepsy during pregnancy?

A

lamotrigine

77
Q

what are the treatments for tonic/ atonic seizures?

A

sodium valporate

don’t use carbamezapine

78
Q

treatment for absence seizures

A

ethosuximide
lamotrigine
sodium valporate
don’t use carbamezapine

79
Q

treatment for myoclonic seizures

A

levetiracetam
sodium valporate
don’t use carbamezapine

80
Q

treatment for focal seizures

A

carbamezapine
sodium valporate
lamotrigine
levetiracetam

81
Q

side effects of sodium valporate

A 
hepatic toxicity
thrombocytopenia
weight gain
systemic lupus erythematosus
pancreatitis
decreased bone marrow density 
liver inhibition
82
Q

side effects of carbamezapine

A 
dose related headaches
ataxia
nausea
allergic reaction
hyponatraemia
dermatitis
stevens johnsons syndrome
liver inducer
83
Q

side effects of lamotrigine

A

stevens johnsons syndrome

allergic reaction

84
Q

side effects of ethosuximide

A

weight loss
nausea
psychological disturbance

85
Q

anticonvulsants interactions

A

carbamezapine, sodium valporate and phenytoin can itnerfere via liver induction or inhibition with oral contraceptives and anticoagulants

86
Q

monitoring of anticonvulsants

A

requires LFT monitoring

blood test before starting treatment and then repeat afterwards

87
Q

rescue therapy for seizures

A

buccal midazolam - can be administered by family if trained for emergency purposes
rectal diazepam
IV lorazepam in hospitals for severe seizures

88
Q

midazolam

A

rohypnal - date rape drug

causes drowsiness and amnesia

89
Q

what is status epilepticus?

A

> 5mins of continuous seizures or more than 2 discrete seizures between which there is incomplete recovery of consciousness

90
Q

risks associated with status epilepticus

A

risk of brain damage due to hypoxia and cytotoxicity from chemicals released during seizure
can be fatal

91
Q

causes of status epilepticus/ seizures

A 
structural brain injury
anti-epileptic non-compliance 
withdrawal
metabolic abnormalities 
overdose of medication that can lower seizure threshold
92
Q

what overdose can cause seizures?

A

insulin

93
Q

other treatments for epilepsy

A 
ketogenic diet 
sativex cannabinoid
acetazolamide 
epidiolex - cannabinoid 
CBD oil
vagal nerve stimulator
neurosurgery
94
Q

ketogenic diet

A

helpful for children and likely adults as well

95
Q

sativex

A

cannabinoid
used for MS spasticity
not funded

96
Q

acetazolamide

A

anti-diuretic

used for menstrual related seizures

97
Q

epidiolex

A

cannabinoid

used in childhood for complex epileptic syndromes

98
Q

vagus nerve stimulator

A

electrodes attached to vagus nerve which send impulses up vagus nerve to grey matter to terminate the seizure
can be activated by patient or someone else if the patient feels a seizure coming on
can work through a feedback sensor
expensive

99
Q

epilepsy neurosurgery

A

resection of the area if focal

100
Q

what are the types of epilepsy neurosurgery?

A 
temporal lobectomy
extratemporal resection
lesionectomy 
hemispherectomy 
corpus callostomy 
multiple subpial transection
101
Q

temporal lobectomy

A

cutting away of brain tissue in temporal lobes that cause seizures

102
Q

extratemporal resection

A

removal of parts of the brain other than temporal lobe that causes seizures

103
Q

lesionectomy

A

tumours, abscesses or other damage causing seizures can be removed

104
Q

if resection is not possible

A

disconnect parts of the brain from each other to prevent spreading of seizures

105
Q

hemispherectomy

A

outer layer of 1 half of brain removed

106
Q

corpus callostomy

A

connections between hemispheres are cut to stop seizures spreading from 1 hemisphere to the other

107
Q

multiple subpial transection

A

nerve fibres in the outer layers of the brain are cut

stops seizures spreading

108
Q

how does sodium valporate work?

A

blocks voltage gated sodium ion channels

increases availability of GABA

2nd year (48 decks)

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