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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
primary generalised seizures
Tonic-clonic seizure phases
26
phases of primary generalised seizures
1. abrupt loss of consciousness 2. epileptic cry 3. tonic phase 4. clonic phase 6. postictal
27
what is the epileptic cry?
tonic contraction of respiratory muscles
28
what happens in the tonic phase?
``` 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 ```
29
what happens in the clonic phase?
``` 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 ```
30
what happens in the post ictal phase?
deep sleep confusion agitation
31
absence seizures features
``` usually during childhood 5-10 seconds of vacant staring often occur in clusters 95% remission during adolescence affect education ```
32
what can bring on an absence seizure?
hyperventilation | phonic stimulus
33
myoclonic seizure
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
34
pathophysiology of provoked seizures
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
35
what brain injuries can cause provoked seizures?
- stroke – haemorrhagic - subdural haematoma - subarachnoid haemorrhage - traumatic brain injury - hypoxic ischaemic injury - brain abscess - meningitis - encephalitis - neoplasm - vascular malformations
36
medical illnesses that cause provoked seizures
- 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
37
what drugs can cause provoked seizures?
cocaine amphetamines MDMA tricyclic antidepressants
38
aetiology of seizures
``` vascular infections trauma/ toxins autoimmune metabolic imbalances idiopathic neoplasm syndromes ```
39
how to diagnose epilepsy?
presenting features history investigations differential diagnostic investigations - ECG to ensure blackout is not cardiac
40
history taking for a seizure
``` description of events and circumstances video footage if possible what happened beforehand - tiredness/ triggers etc. past medical history drug history ```
41
what drugs can cause a seizure?
``` tramadol neuroleptics vasodilators older anti-depressants amitriptyline - prolongation of QT interval ```
42
red flags of seizures
``` 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 ```
43
post-ictal state
pain injuries exhaustion
44
investigations for seizures
``` may be absent of clinical findings look for structural or metabolic causes eliminate differential diagnoses MRI EEG CT scan lumbar puncture ```
45
Fever fit
doesn't normally develop into epilepsy
46
fainting vs seizure
fainting can appear like a seizure but recovery tends to be much quicker
47
EEG tracing
done over 24-48 hours to eliminate non-epileptic episodes caused by psychosocial factors
48
what are the differential diagnoses for seizures/ epilepsy
``` syncope vasovagal syncope with reflex anoxic event cardiac arrhythmia non-epileptic attack/ pseudoseizures maligering migraine dissociative attack ```
49
vasovagal syncope with reflex anoxic event
short burst of activity occurs alongside syncope
50
cardiac arrhythmias causing syncope
brugada syndrome hypertrophic obstructive cardiomyopathy prolonged QT interval disorders
51
non-epileptic attacks
functional neurology | not explained by structural or organic pathology
52
what is maligering
alternative motive for a seizure - mimicing
53
what causes dissociative attacks?
psychological causes
54
QT elongation
can cause a blackout
55
what drugs prolong the QT interval?
antiarrhythmic drugs certain non-sedating antihistamines - terfenadine macrolide antibiotics psychotropic medications gastric motility agents/ anti-emetics - cisapride and domperidone
56
what is brugada syndrome?
``` prolonged PR interval RBBB can be fatal ST elevation inherited condition causes a blackout that appears like a seizure requires defibrillator insertion ```
57
principles of epilepsy treatment
epilepsy nurse specialist education of patient and the family first aid antiepileptic - given on 2nd seizure
58
when to treat someone on the first seizure?
60% risk over 10 years if: - abnormal EEG - structural lesion - abnormal neurological examination - first fit occurs during sleep
59
driving and epilepsy
everyone who has suffered an unprovoked seizure should contact DVLA and surrender their licence
60
how much time do people have to have off driving after a seizure?
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
precautions for epileptics
shower not bath, if bathing keep door open and ask someone to be aware swimming either accompanied or let lifeguard know avoid triggers
62
SUDEP
sudden unexplained death in epilepsy
63
sudden unexplained death in epilepsy
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
common seizure triggers
``` sleep deprivation alcohol drugs missed anticonvulsants pregnancy infections illness vomiting/ diarrhoea ```
65
when does alcohol cause seizures
on withdrawal
66
what drugs can cause seizures?
amphetamine ecstasy cocaine enzyme inducers
67
why does pregnancy cause seizures?
enlarged volume of distribution reduces efficacy of anticonvulsants or separately as eclampsia
68
what infections commonly cause seizures?
UTIs | URTIs
69
why does illness cause seizures?
poor absorption of anticonvulsants
70
first aid for seizures
``` 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
when is hospital admission needed?
>5mins long seizures anyone with or without epilepsy needs hospital admission
72
principles for epilepsy treatments
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
pregnancy and epilepsy drugs
sodium valporate cannot be used in child-bearing aged women carbamezapine is tetragenic polypharmacy increases risk of tetragenicity
74
what do anticonvulsants cause in fetuses?
psychomotor abnormalities | developmental delay
75
what are the treatments for generalised tonic clonic seizures?
carbamezapine lamotrigine sodium valporate
76
what drug can be used for epilepsy during pregnancy?
lamotrigine
77
what are the treatments for tonic/ atonic seizures?
sodium valporate | don't use carbamezapine
78
treatment for absence seizures
ethosuximide lamotrigine sodium valporate don't use carbamezapine
79
treatment for myoclonic seizures
levetiracetam sodium valporate don't use carbamezapine
80
treatment for focal seizures
carbamezapine sodium valporate lamotrigine levetiracetam
81
side effects of sodium valporate
``` hepatic toxicity thrombocytopenia weight gain systemic lupus erythematosus pancreatitis decreased bone marrow density liver inhibition ```
82
side effects of carbamezapine
``` dose related headaches ataxia nausea allergic reaction hyponatraemia dermatitis stevens johnsons syndrome liver inducer ```
83
side effects of lamotrigine
stevens johnsons syndrome | allergic reaction
84
side effects of ethosuximide
weight loss nausea psychological disturbance
85
anticonvulsants interactions
carbamezapine, sodium valporate and phenytoin can itnerfere via liver induction or inhibition with oral contraceptives and anticoagulants
86
monitoring of anticonvulsants
requires LFT monitoring | blood test before starting treatment and then repeat afterwards
87
rescue therapy for seizures
buccal midazolam - can be administered by family if trained for emergency purposes rectal diazepam IV lorazepam in hospitals for severe seizures
88
midazolam
rohypnal - date rape drug | causes drowsiness and amnesia
89
what is status epilepticus?
>5mins of continuous seizures or more than 2 discrete seizures between which there is incomplete recovery of consciousness
90
risks associated with status epilepticus
risk of brain damage due to hypoxia and cytotoxicity from chemicals released during seizure can be fatal
91
causes of status epilepticus/ seizures
``` structural brain injury anti-epileptic non-compliance withdrawal metabolic abnormalities overdose of medication that can lower seizure threshold ```
92
what overdose can cause seizures?
insulin
93
other treatments for epilepsy
``` ketogenic diet sativex cannabinoid acetazolamide epidiolex - cannabinoid CBD oil vagal nerve stimulator neurosurgery ```
94
ketogenic diet
helpful for children and likely adults as well
95
sativex
cannabinoid used for MS spasticity not funded
96
acetazolamide
anti-diuretic | used for menstrual related seizures
97
epidiolex
cannabinoid | used in childhood for complex epileptic syndromes
98
vagus nerve stimulator
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
epilepsy neurosurgery
resection of the area if focal
100
what are the types of epilepsy neurosurgery?
``` temporal lobectomy extratemporal resection lesionectomy hemispherectomy corpus callostomy multiple subpial transection ```
101
temporal lobectomy
cutting away of brain tissue in temporal lobes that cause seizures
102
extratemporal resection
removal of parts of the brain other than temporal lobe that causes seizures
103
lesionectomy
tumours, abscesses or other damage causing seizures can be removed
104
if resection is not possible
disconnect parts of the brain from each other to prevent spreading of seizures
105
hemispherectomy
outer layer of 1 half of brain removed
106
corpus callostomy
connections between hemispheres are cut to stop seizures spreading from 1 hemisphere to the other
107
multiple subpial transection
nerve fibres in the outer layers of the brain are cut | stops seizures spreading
108
how does sodium valporate work?
blocks voltage gated sodium ion channels | increases availability of GABA

2nd year (48 decks)

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