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TCD 24 - TLoC > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What are the risk factors for epilepsy?

A
  • Premature birth
  • Genetic conditions
  • Brain development malformations
  • Family Hx
  • Head trauma, infections (meningitis, encephalitis) or tumours
  • Cerebrovascular disease and strke
  • Dementia and neurodegenerative disorders
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2
Q

How do you investigate epilepsy?

A
  • All patients must be referred to a specialist for assessment and investigation in <2weeks
  • EEG
  • MRI brain
  • ECG
  • U+Es
  • Glucose
  • Urinalysis
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3
Q

What are focal seizures?

A

Localised disturbance in the cortex occurring in one hemisphere

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4
Q

What are generalised seizures?

A

Both hemispheres are involved

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5
Q

What are the divisions of focal seizures?

A
  • Simple partial
  • Complex partial
  • Secondary generalised seizure
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6
Q

What are the divisions of generalised epilepsy?

A
  • Tonic-clonic
  • Absence
  • Absence with special features
  • Myoclonic
  • Atonic
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7
Q

What are simple partial seizures?

A
  • Patient is conscious
  • Focal motor, sensory, autonomic or psychic symptoms
  • No post-ictal symptoms
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8
Q

What are complex partial seizures?

A
  • Awareness is impaired – either at seizure onset or following simple partial aura
  • Most commonly arise in temporal lobe where post-ictal confusion is a feature
  • Automatism (lip smacking or picking at clothes)
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9
Q

What are secondary generalised seizures?

A

Focal seizure that evolves to a bilateral, convulsive seizure

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10
Q

What are the features of temporal lobe involvement?

A

HEAD

H - Hallucinations (auditory/gustatory/olfactory)
E - Epigastric rising/Emotional
A - Automatisms (lip smacking/grabbing/plucking)
D - Déjà vu/dysphasia

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11
Q

What are the features of frontal lobe involvement?

A
  • Motor features
  • Jacksonian march
  • Behavioural disturbances
  • Dysphasia or speech arrest
  • Post-ictal Todd’s palsy
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12
Q

What are the features of parietal lobe involvement?

A
  • Sensory disturbances (tingling, numbness, pain)

- Motor symptoms (due to spread to pre-central gyrus)

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13
Q

What are the features of occipital lobe involvement?

A
  • Visual phenomena (spots, lines, flashes, floaters)
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14
Q

What are tonic clonic seizures?

A

Before:
o May experience an aura

During:
o Loss of consciousness and tonic (muscle tensing) and clonic (muscle jerking) episodes
o May be associated tongue biting, incontinence, groaning and irregular breathing

After:
o Prolonged post-ictal period
o Confused, drowsy, depressed, irritable

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15
Q

What are absence seizures?

A
  • Usually occur in children
  • Blank, stares into space and that lasts 10-20s
  • During: unaware of their surroundings and won’t respond
  • 90% of patients stop having absence seizures as they get older
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16
Q

What are myoclonic seizures?

A
  • Sudden and brief muscle contractions predominating in the arms
  • Patient remains awake during the episode
  • Typically happen in children
17
Q

What are tonic seizures?

A
  • Increase in tone and loss of awareness

* Normally seen as a part of an epilepsy syndrome

18
Q

What are clonic seizures?

A

• Similar to tonic-clonic seizures but without the preceding tonic phase

19
Q

What are atonic seizures?

A
  • Brief loss of muscle tone
  • No loss of consciousness
  • Don’t last >3minutes
  • Begin in childhood
  • The occur in the context of epilepsy syndromes (Lennox-Gadtaut syndrome)
20
Q

What are infantile spasms?

A
  • Commonly associated with tuberous sclerosis
  • Rare disorder starting at 6 months of age
  • Clusters of full body spasms
21
Q

How are infantile spasms managed?

A

o Prednisolone

o Vigabatrin

22
Q

What is status epilepticus?

A

Seizures lasting >5 minutes or >3 seizures in 1 hour

23
Q

What are psychogenic non-epileptic attacks/NEAD/pseudo-seizures?

A

Subconscious/psychological mechanisms

24
Q

When would you suspect psychogenic non-epileptic attacks/NEAD/pseudo-seizures?

A
  • Gradual onset
  • Prolonged duration
  • Abrupt termination
  • Closed eyes +/- resistance to eye opening
  • Rapid breathing
  • Fluctuating motor activity
  • Episodes of motionless or unresponsiveness

TCD 24 - TLoC (4 decks)

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