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Year 3: Neuro > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

define epilepsy?

A

a tendency to recurrent unprovoked seizures

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2
Q

criteria of diagnosing epilepsy?

A

> 2 seizures

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3
Q

what are the types of seizure?

A
  • focal impaired awareness
  • focal aware
  • generalised
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4
Q

what are the types of generalised seizure?

A
  • Tonic-clonic
  • Absence
  • Myoclonic
  • Atonic
  • Tonic
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5
Q

what are some causes of secondary seizures?

A

o Tumour
o Infection (e.g. meningitis)
o Inflammation (e.g. vasculitis)
o Toxic/Metabolic (e.g. sodium imbalance)
o Drugs (e.g. alcohol withdrawal)
o Vascular (e.g. haemorrhage)
o Congenital abnormalities (e.g. cortical dysplasia)
o Neurodegenerative disease (e.g. Alzheimer’s disease)
o Malignant hypertension or eclampsia
o Trauma

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6
Q

which conditions can be easily mixed up with seizures?

A

o Vasovagal syncope
o Migraine
o dissociative disorder

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7
Q

epidemiology of seizures?

A
  • COMMON
  • 1% of the general population
  • Typical age of onset: CHILDREN and ELDERLY
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8
Q

features of temporal lobe seizure?

A

Hallucinations (auditory/gustatory/olfactory),
Epigastric rising/Emotional,
Automatisms (lip smacking/grabbing/plucking),
Deja vu/Dysphasia post-ictal)

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9
Q

features of a frontal lobe seizure?

A 
Head/leg movements, 
posturing, 
post-ictal weakness,
Jacksonian march
Can have secondary generalisation
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10
Q

features of parietal lobe seizure?

A

Paraesthesia

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11
Q

features of occupital lobe seizure?

A

Floaters/flashes

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12
Q

features of tonic clonic seizures?

A
  • Vague symptoms before attack (e.g. irritability)
  • Tonic phase (generalised muscle spasm)
  • Clonic phase (repetitive synchronous jerks)
  • Faecal/urinary incontinence
  • Tongue biting
  • Post-ictal phase: impaired consciousness, lethargy, confusion, headache, back pain, stiffness
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13
Q

features of absence seizures?

A
  • Onset in CHILDHOOD
  • Loss of consciousness but MAINTAINTED POSTURE
  • The patient will appear to stop talking and stare into space for a few seconds
  • NO post-ictal phase
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14
Q

features of non convulsive status epilecpticus?

A
  • Acute confusional state
  • Often fluctuating
  • Difficult to distinguish from dementia
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15
Q

what might the bloods show?

A
  • prolactin might increase post-ictal
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16
Q

what might an EEG achieve?

A

o Helps to confirm diagnosis
o Helps classify the epilepsy
o Ictal EEGs are particularly useful

17
Q

what might a CT/MRI show?

A

o Shows structural, space-occupying or vascular lesions

18
Q

what is status epilepticus?

A

a seizure lasting > 30 mins or repeated seizure without recovery and regain of consciousness in between

19
Q

how to manage status epilepticus?

A

o Check GLUCOSE
o IV lorazepam OR IV/PR diazepam - REPEAT again after 10 mins if seizure does not terminate
o If seizures recur following the next dose of lorazepam or diazepam, consider IV phenytoin
o If this also fails, consider general anaesthesia
o Treat the CAUSE

20
Q

how to treat newly diagnosed epilepsy?

A

o Only start anti-convulsant treatment after > 2 unprovoked seizures
o FOCAL Seizure 1st Line: carbamazepine
o GENERALISED Seizure 1st Line: sodium valproate

21
Q

what does one have to be careful about when giving sodium valporate?

A

o Sodium Valproate cannot be given to females of child bearing age – offer lamotrigine as a back-up

22
Q

how to stop AED?

A

o Medication can be stopped over 2-3 months if seizure free for >2 years.

23
Q

what advice can be given to patients?

A

o Avoid triggers
o Use seizure diaries
o Particular consideration for women of child-bearing age because the sodium valproate can have teratogenic effects
o Be careful of drug interactions
• Surgery may be considered for refractory epilepsy
• Ketogenic diets can be helpful in children with epilepsy

24
Q

what are the complications of epilepsy?

A
  • Fractures from tonic-clonic seizures
  • Behavioural problems
  • Sudden death in epilepsy (SUDEP)
  • Complications of anti-epileptic drugs:
25
Q

prognosis of epilepsy?

A

• 50% remission at 1 year

Year 3: Neuro (27 decks)

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