Epilepsy Flashcards
1
Q
Conditions associated with epilepsy:
A
- cerebral palsy
- tuberous sclerosis
- mitochondrial disease
2
Q
Febrile convulsions:
A
- children 6mo - 5yo
- usually early in viral infection as temp rises rapidly
- brief and generalised tonic/tonic-clonic
3
Q
Alcohol withdrawal seizures:
A
- after suddenly stopping with drinking
- chronic alcohol enhances GABA mediated inhibition of CNS and inhibits NMDA glutamate receptors
- withdrawal - decreased inhibitory GABA and increased NMDA glutamate transmission
- peak incidence at 36 hours
- benzodiazepines to reduce risk
4
Q
Psychogenic non-epileptic seizures:
A
- pseudoseizures
- no characteristic electrical discharges
- history of mental health problems or personality disorder
5
Q
How are seizures classified?
A
- where they begin in brain
- level of awareness during seizure
- other features
6
Q
Focal seizures:
A
- previously partial seizures
- specific area on one side of brain
- level of awareness varies: focal aware, focal impaired awareness and awareness unknown
- motor (e.g. Jacksonian march), non motor (e.g. deja vu, jamais vu) or features such as aura
7
Q
Generalised seizures:
A
- both sides of brain at onset
- consciousness lost immediately
- motor (e.g. tonic-clonic) and non-motor (e.g. absence)
8
Q
Specific types of generalised seizures:
A
- tonic clonic (grand mal)
- tonic
- clonic
- typical absence (petit mal)
- myoclonic: brief, rapid muscle jerks
- atonic
9
Q
Focal to bilateral seizure:
A
- starts on one side of brain in specific area before spreading to both lobes
- perviously secondary generalised seizures
10
Q
Special epilepsy forms in children:
A
- Infantile spasms (West’s syndrome)
- Lennox-Gastaut syndrome
- benign rolandic epilepsy
- Juvenile myoclonic epilepsy (Janz syndrome)
11
Q
Infantile spasms:
A
- brief spasms in first few months
- flexion of head, trunk limbs and tension of arms (Salaam attack): 2 seconds repeated up to 50 times
- progressive mental handicap
- hypsarrythmia on EEG
- usually secondary to neuro abnormality and may be cryptogenic
- poor prognosis
12
Q
Lennox-Gastaut syndrome:
A
- extension of infantile spasms
- onset 1-5yrs
- atypical absence, falls, jerks
- 90% moderate-severe mental handicap
- EEG: slow spike
- keratogenic diet may help
13
Q
Benign rolandic epilepsy:
A
-paraesthesia (e.g. unilateral face) usually on waking up
14
Q
Juvenile myoclonic epilepsy (Janz syndrome):
A
- onset teens
- more girls
- infrequent generalised seizures often in morning
- daytime absences
- sudden, shock like myoclonic seizure
- usually good response to sodium valproate
15
Q
Phase after seizure where patient feel drowsy and tired for 15 min:
A
postictal phase
16
Q
1st line investigations with seizures:
A
- EEG
- neuroimaging
17
Q
How long after a seizure can people not drive?
A
- 6 months
- established epilepsy: fit free for 12 mo
18
Q
Which drug particularly do antiepileptics interact a lot with?
A
warfarin
19
Q
Antiepileptics in pregnancy:
A
- generally teratogenic
- especially sodium valproate
- breastfeeding safe except barbiturates
20
Q
Sodium valproate (MOA, indications, ADR)
A
- increases GABA activity
- first line for generalised seizures
- ADR: increased appetite and weight gain, alopecia: regrowth may be curly, P450 enzyme inhibitor, ataxia, tremor, hepatitis, pancreatitis, thrombocytopaenia, teratogenic
21
Q
Carbamazepine (MOA, indications, ADR)
A
- binds to sodium channels to increase refractory period
- second line for focal seizures
- P450 enzyme inducer, dizziness and ataxia, drowsiness, leucopenia and agranulocytosis, syndrome of inappropriate ADH secretion, visual disturbances (especially diplopia)
22
Q
Lamotrigine (MOA, indications, ADR)
A
- sodium channel blocker
- 1st for generalised in women; 1st line focal seizures
- ADR: Steven-Johnson syndrome
23
Q
Phenytoin (MOA, indications, ADR)
A
- binds to sodium channels to increase refractory period
- no longer 1st line due to ADR
- ADR: P450 enzyme inducer, dizziness and ataxia, drowsiness, gingival hyperplasia, hirsutism, coarsening of facial features, megaloblastic anaemia, peripheral neuropathy, enhanced vit D metabolism causing osteomalacia, lymphadenopathy
24
Q
Acute management of seizures:
A
- single seizure >5 minutes or 2 seizures in 5 minutes = status epileptics
- Pre-hospital: PR diazepam/buccal midazolam
- Hospital: IV lorazepam (repeat after 5-10 minutes)
- on-going: levetiracetam, phenytoin, sodium valproate
- no response after 45 minutes: GA/phenobarbital
25
Temporal lobe (HEAD) typical seizure type:
- hallucinations
- epigastric rising.emotional
- automatism
- deja vu/dysphasia postictal
26
Frontal lobe (motor) typical seizure type:
- head leg movements
- posturing
- post-ictal weakness
- Jacksonian march
27
Parietal lobe (sensory) local seizure type:
-paraesthesia
28
Occipital lobe (visual) local seizure type:
-floaters/flashes
29
When should antiepileptics be started?
-after second
after first if:
-patient has a neurological deficit
-brain imaging shows structural abnormality
-EEG shows unequivocal epileptic activity
-patient or family or carers consider risk unacceptable
30
Treatment generalised tonic-clonic seizures:
- males: sodium valproate
- females: lamotrigine or levetiracetam
31
Treatment absence seizures:
1st line: ethosuximide
2nd line:
- male: sodium valproate
- female: lamotrigine or levetiracetam
32
Treatment myoclonic seizures:
- males: sodium valproate
- female: levetiracetam
33
Treatment focal seizures:
- lamotrigine or levetiracetam
- second line: carbamazepine, oxcarbazepine, zonisamide
