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Phase 2a Neuro > Epilepsy and seizure 3A > Flashcards

Epilepsy and seizure 3A Flashcards

1
Q

What is the acronym for the many causes of seizures?

A

VITAMIN DE

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2
Q

What does Vitamin DE stand for?

A

Vascular
Infection
Trauma
Autoimmune eg. SLE
Metabolic diseases
Idiopathic –> EPILEPSY
Neoplasms (cancer)
Dementia + drugs (cocaine)
Eclampsia + everything else

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3
Q

RF for seizures?

A

Congenital (NFM 1, tuberous sclerosis, CP)

Acquired (meningoencephalitis, febrile convulsions)

Dementia

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4
Q

What is the pathology behind seizures/epilepsy?

A

Normal balance between GABA (-) & Glutamate (+) shifts towards glutamate

Neurones synchronously active (at same time)
More excitatory = Increased glutamate stimulation = Increased GABA inhibition

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5
Q

what meds / conditions decrease seizure threshold?

A

Hypoglycaemia
alcohol
stress
Meds : TCA, Lithium, ciprofloxacin, Clozapine, AED non adherence, tramadol, antipsychotics

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6
Q

What is epilepsy?
What classifies epilepsy from a one off seizure?

A

Idiopathic cause of seizures
>2 episodes more than 24hr apart

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7
Q

2 RF for epilepsy?

A

Familial inherited
Dementia (10x more likely)

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8
Q

What 3 things differ an epileptic and non epileptic fit?

A

eyes OPEN
synchronous movements
can occur in sleep

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9
Q

How long do epileptic seizures last?

A

less than 2 mins

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10
Q

What are the different phases before/after a seizure?

A

Prodrome
Aura
Ictal event
Post ictal

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11
Q

What happens in prodrome?

A

mood changes
days before

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12
Q

What happens in Aura?

A

Mins before
Deja Vu and Automatisms (lip smacking and rapid blinking)

Not always present, mostly seen in temporal lobe epilepsy

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13
Q

What is the ictal event?

A

Seizure

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14
Q

What happens in the post ictal period?

A

headache
Confusion and reduced GCS
Amnesia (what the heck happened)
Todd’s paralysis
Dysphasia
Sore Tongue - only in epileptic seizures, not in syncope (tongue often bitten)

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15
Q

What are the 2 classifications of epileptic seizures?

A

Generalised
Focal

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16
Q

Generalised seizures
Unilateral or bilateral?
LOC?

A

Bilateral (both hemispheres)
Always Loss of consciousness

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17
Q

What are the diff types of Generalised seizures?

A

Tonic
Atonic
Tonic Clonic
Myoclonic
Absence

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18
Q

What happens in tonic clonic seizures?

A

Bilateral, LOC

No aura
Tonic phase = rigid/stiff, fall to floor
Clonic = Jerking of limbs, convulsions

+ up gazing open eyes, incontinence, tongue bitten

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19
Q

What happens in absence seizures?
Which age group?

A

Childhood
Stare off blankly for a few moments (secs - mins) then carry on where they left off

3 Hz spike on EEG

20
Q

What is Tonic seizures?

A

Just rigid

21
Q

What happens in myoclonic seizures?

A

Short muscle twitches

22
Q

What happens in Atonic seizures?

A

Relaxed, sudden floppy limbs and muscles

23
Q

What are focal seizures?
Which part of brain do they effect?

A

Features confined to one region of brain eg. temporal
May progress to 2^ generalised

24
Q

What are the 2 types of focal seizures?

A

simple focal
complex focal

25
Q

What happens in simple focal?
LOC?

A

No LOC, Px aware + awake
Just uncontrollable muscle jerking

26
Q

What is complex focal?
LOC?

A

LOC, Px unaware, post ictal period

27
Q

What do the Sx depend on?

A

where the focal neurology is

28
Q

What Sx are seen if frontal lobe affected?

A

Jacksonian march - Starts in one part of the body and spreads

Todd’s palsy - motor cortex affected - temporary paralysis and muscle weakness after

29
Q

What Sx are seen if parietal lobe affected?

A

Parasthesia (sensory loss)

30
Q

What Sx are seen if occipital lobe affected?

A

Visual change

31
Q

What Sx are seen if temporal lobe affected?

A

Aura (mood change)
Dysphasia
Post ictal period
Hearing disturbances

32
Q

What requirement must be to consider epilepsy?

A

must have had 2 or more seizures 24hr apart

33
Q

What investigations are done?

A

Bloods - rule out metabolic cause, infection, electrolytes or hypoglycaemia

ECG

Lying and standing BP (LSBP)

CT head + MRI
(examine hippocampus, check bleeds, SOL)

GS = EEG - 3Hz wave in absence

34
Q

what is high in a true epileptic seizure? Not in mimics

A

Prolactin and lactate are high

35
Q

Tx for epilepsy?

A

Sodium valproate to all (increases GABA)

36
Q

Tx for seizures:
Focal?
Gen tonic clonic?
Absence?
Myoclonic?

A

Focal = Lamotrigine or Levetiracetam

Gen tonic clonic =
M = Sodium valproate
F = Lamotrigine or Levetiracetam

Absence = Ethosuxamide

Myoclonic =
M = Sodium valproate
F = Levetiracetam (Keppra)

37
Q

Who is sodium valproate not given to and why?

A

Females of child bearing age (15-45)
It is teratogenic

38
Q

What is given instead?

A

Lamotrigine

39
Q

What is a complication?

A

status epilepticus (neuro emergency)

40
Q

What happens in status epilepticus?

A

Epileptic seizures without a break back to back
or
Seizure lasting more than 5 mins

41
Q

Tx for status epilepticus?

A
  1. Lorazepam (4mg IV) or buccal midazolam or rectal diazepam
  2. IV Lorazepam 4mg
  3. IV phenytoin / sodium valproate / carbamezapine
  4. IV phenobarbital under specialist guidance + ITU
42
Q

SE of Sodium valproate?
mechanism?

A

GABA - Ergic
- Teratogen (spina bifida, cleft palate)
- Hepatotoxic in kids

43
Q

SE of Lamotrigine?

A

Stevem Johnson syndrome - flu Sx + purple/red rash

44
Q

SE of carbamezapine?
mechanism?

A

P450 inducer
SIADH
Ataxia

45
Q

SE of ethosuximide?

A

Agranulocytosis
erythema nodosum

46
Q

SE of phenytoin?

A

-Gingival hyperplasia
-Teratogenic (fetal hydantoin syndrome - CHD, cleft lip, limb hypoplasia, hirsutism)
-Hirsutism
-Lymphadenopathy

Phase 2a Neuro (17 decks)

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