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Movement and control > Epilepsy and management of convulsions > Flashcards

Epilepsy and management of convulsions Flashcards

1
Q

Seizure

A

sudden change in behaviour caused by electrical hypersyncrhonisation of neuronal networks in cerebral cortex

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2
Q

Provoked seizures

A

occurs at the time of a systemic or brain insult - metabolic derangements, alcohol/drug withdrawal, acute neurological disorders (stroke, encephalitis, head injury)

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3
Q

Unprovoked seizure

A

unknown aetiology, pre-existing brain lesion

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4
Q

Focal seizures

A

occur in one hemisphere - simple focal (retain awareness), focal evolving (convulsions) and focal dyscognitive ( consciousness impaired at onset)

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5
Q

Generalised seizures

A

both hemispheres - absence, myoclonic (one jerking movement), atonic, clonic, tonic, tonic-clonic (stiff then shaking)

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6
Q

Epilepsy

A

> 2 seizures >24h apart, 1 unprovoked seizure and probability of further seizures similar to general recurrence risk after two unprovoked seizures over next 10 years

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7
Q

Temporal lobe seizure

A 
Sudden sense of fear or joy 
Deja vu 
Strange odour or taste
Roller coaster sensation in abdomen
Memory
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8
Q

Gelastic seizure

A

Bouts of uncontrolled laughing or giggling

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9
Q

Occipital seizure

A

Multi-coloured flashing lights

Nysgamus

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10
Q

Parietal seizure

A 
Paraesthesia 
Disorientation
Hallucinations 
Language impairment
Jacksonial march
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11
Q

Frontal seizures

A

Jacksonian march
Todds paralysis
Fencing posture

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12
Q

Tonic-clonic seizure

A
  • Loss of consciousness with epileptic cry
  • Tonic phase (<1min): arms, legs, chest, back stiff, eyes open with dilated pupils, elbows flexed, arms pronated and legs extended, teeth clenched - caused by rapid neuronal discharge
  • Clonic phase (1-2min): muscles jerk, tongue biting and incontinence, bloody sputum/froth, eyes roll backwards and forwards - caused by slow neuronal discharge
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13
Q

Absence seizure

A
  • Occur in childhood (4-12 yo)
  • 5-10 seconds of vacant staring
  • Brought on by hyperventilation
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14
Q

Myoclonic seizure

A
  • Sudden generalised muscle contractions
  • Occur in morning
  • Develop tonic/clonic seizures
  • Lifelong treatment with anti-epileptics
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15
Q

Provoked seizures

A 
Stroke
Bleed
Brain injury 
Meningitis
Drugs
Alcohol withdrawal
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16
Q

Aetiology of seizures - VITAMINS

A 
V vascular
I infections
T trauma/toxins
A autoimmune
M metabolic imbalance
I idiopathic
N neoplasm
S syndromes
17
Q

Red flag sx seizures

A

Eyes open
Tongue biting
Cyanosis
Strenuous breathing

18
Q

Ddx epilepsy

A
  • Syncope - fainting
  • Vasovagal syncope - muscle spasm + fainting
  • Cardiac arrythmias - Brugada, HOCM, long QT
  • Non-epileptic attack - not explained by structured pathology
  • Malingering attack - gain from attacks (signed off work etc)
  • Migraine
  • Dissociative attack - out of body
19
Q

Causes of long QTs

A

Antiarrythmic drugs
Antihistamines
Macrolides
Brugada

20
Q

Driving and seizures

A
  • Driving: unprovoked seizure should call DVLA and surrender license
  • 1 seizure = 6 months - 1 year no driving
  • HGV 1 seizure = 10 years off driving
21
Q

SUDEP

A

Sudden Unexplained Death in Epilepsy - must warn pts

22
Q

First aid for seizures

A 
Cushion head and remove glasses
Loosen tight clothing
Turn on side
Time seizure
Don't put anything in mouth
DOn't hold down
23
Q

First line AED for GTC seizure

A

Carbamazepine, sodium valproate

24
Q

First line AED for tonic seizure

A

Sodium valproate - don’t use carbamazepine

25
Q

First line AED for absence seizure

A

Ethosuximide, sodium valproate - don’t use carbamazepine

26
Q

First line AED for myoclonic seizures

A

Levetiracetam, sodium valproate - don’t use carbamazepine

27
Q

First line AED for focal seizure

A

Carbamazepine

28
Q

When shouldn’t you prescribe sodium valproate

A

Women of childbearing age

29
Q

Rescue therapy for a seizure

A

Buccal midazolam

30
Q

Why is midazolam bad ?

A

Rohypnol = date rape drug

31
Q

Status epilepticus

A

Continues seizure

  • > 5 mins of continuous seizure, >2 mins of discrete seizures where there is incomplete recovery between seizures
  • Causes: brain injury, AED non-compliance, withdrawal, metabolic abnormalities, overdose
32
Q

Temporal lobectomy

A

Brain tissue in temporal lobe causing seizure is removed

33
Q

Corpus callosotomy

A

Connections between hemispheres cut, stopping seizure spreading to other side

34
Q

s/e sodium valproate

A

Hepatotoxicity, thrombocytopenia, SLE, pancreatitis, liver inhibitions

35
Q

s/e carbamazepine

A

Headaches, ataxia, nausea, dermatitis, Stevens Johnsons

36
Q

Lamitrigine s/e

A

Steven Johnson’s, allergic reaction

37
Q

Ethosuximide s/e

A

Weight loss, nausea, psychological disturbance

Movement and control (20 decks)

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