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Neurology > Epilepsy and seizures > Flashcards

Epilepsy and seizures Flashcards

1
Q

What is a seizure?

A

Neurological dysfunction caused by abnormal excess activation of the neuronal pathways

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2
Q

What is epilepsy?

A

Recurrent (>2) unprovoked seizures

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3
Q

What is status epilepticus?

A

State of continued/recurrent seizures with no regaining of consciousness in between

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4
Q

What causes seizures in epilepsy?

A

Normal cortical neuronal communication gone wrong, due to one of three things:

  • increased connectivity in neuronal pathways
  • increase excitatory transmission (glutamate)
  • failure of inhibitory mechanisms (GABA)
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5
Q

What are some of the causes in epilepsy?

A
  • stroke
  • meningitis
  • encephalitis
  • malaria
  • tumour
  • drugs: MAOIs, illicit drugs e.g. cocaine
  • alcohol or alcohol withdrawl
  • drug withdrawl
  • congenital/family history
  • vasculitis
  • head trauma
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6
Q

What proportion of epilepsy cases have no cause found?

A

~ 50%

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7
Q

What is a focal seizure?

A

A seizure where the excitation is beginning in a specific area e.g. motor cortex or visual cortex

This gives specific symptoms

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8
Q

What are some of the symptoms that may be seen in a focal seizure?

A

Motor: jerking, twitching, rigidity

Sensory: funny taste, aura, visual changes, smell

Psychological: emotion and memory

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9
Q

What is the difference between a simple focal seizure and a complex focal seizure?

A

Simple - no loss of consciousness

Complex - same as simple but impaired consciousness

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10
Q

What is focal with secondary generalised seizure?

A

A seizure that begins as focal but progresses to loss of consciousness and tonic-clonic seizures

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11
Q

What is a generalised seizure?

A

A seziure involving both hemispheres from the beginning of the seizure

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12
Q

What forms might a generalised seizure take?

A

Tonic-clonic

Tonic

Myoclonic

Abscence

Atonic

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13
Q

What is a tonic-clonic seizure?

A

Muscle rigidity (tonic) with superimposed jerking (clonic)

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14
Q

What is a tonic seizure?

A

Muscle stiffness/rigidity

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15
Q

What is a myoclonic seizure?

A

Sporadic jerking

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16
Q

What is an absence seizure?

A

Blank stare

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17
Q

What is an atonic seizure?

A

Complete loss of tone (drop attacks)

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18
Q

Which generalised seizure does not involve post-ictal confusion?

A

Absence seizures

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19
Q

Do all generalised seizures cause loss of consciousness?

A

Yes

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20
Q

What are the risk factors for developing epilespy?

A

Previous head injury

Febrile convulsions as a child

Meningitis

Encephalitis

Previous stroke

Alcohol abuse

Family history

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21
Q

What are some of the triggers for a seizure?

A

Sleep deprivation

Alcohol

Stress

Recreational drugs

Pregnancy

Flashing lights

Current infection

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22
Q

In a history from a patient with seizure as the presenting complaint, what would you need to know about the ictal phase?

A

Where seizure occured?

How long?

Was there altered or loss of consciousness?

Tongue biting or frothing at mouth?

Urinary incontinence?

Cyanosis?

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23
Q

What is Todd’s paresis??

A

Focal weakness in a part of the body following a focal seizure

24
Q

What are some of the differential diagnosis to epilepsy?

A

Pseudoseizure

Complicated migraine

Carpopedal spasm from hyperventilation

Syncopal episode

25
Q

What are some of the clinical signs of true seizure?

A

Pupil dilation

Hypertension

Tachycardia

Extensor plantar response

Cyanosis/peripheral cyanosis

26
Q

What are some of the biochemical signs of a seizure?

A

Hypoxia/reduced pO2

Acidosis

Increased CK

27
Q

What biochemical abnormalities might cause seizures?

A

Hyponatraemia

Hypocalcaemia

28
Q

How does carbemazepine work in epilepsy?

A

Blocks voltage dependant Na channels to prevent repetitive neuronal discharge

29
Q

When is carbemazepine used?

A

Focal seizures

Secondary generalised seizures

Neuropathic pain

30
Q

What are the side effects of carbemazepine?

A

Sedation

Tremor

Weight gain

LFT abnormalities

Syndrome of inappropriate ADH

31
Q

What monitoring needs to be done with carbemazepine??

A

Plasma levels for theraputic window

32
Q

What are the uses of sodium valproate?

A

All types of seizures

Mood stabiliser in bipolar disorder

33
Q

What is the mechanism of action of sodium valproate?

A

Na channel blocker

34
Q

What are the side effects of sodium valproate?

A

Leucopenia

Skin sensitivity to UV light

Weight gain

Sedation

Teratogenicity

35
Q

What is the mechanism of action of phenytoin?

A

Inhibits the Na channel and prevents spread of seizure activity in the motor cortex

36
Q

When is phenytoin used?

A

Tonic-clonic seizures

Status epilepticus

Prophylactic on post-op neurosurgery

37
Q

What are the side effects of phenytoin?

A

Drowsiness

Ataxia

Nausea

Nstagmus

Hypersensitivity syndrome

38
Q

What is anticonvulsant hypersensitivity syndrome?

A

A drug-induced, multiorgan syndrome which is potentially fatal

39
Q

What are the symptoms of anticonvulsant hypersensitivity syndrome?

A

Fever

Rash

Hepatitis

Hepatorenal syndrome

Haemolysis

40
Q

When is lamotrigine used?

A

All seizure types

Bipolar disorder

41
Q

What are the side effects of lamotrigine?

A

Skin rash

Steven-Johnsone syndrome

Hypersensitivity syndrome

Dizziness

Nausea

42
Q

What drugs can be used to treat focal seizures and/or secondary generalised seizures?

A

Carbemazepine

Sodium valproate

Lamotrigine

43
Q

What drugs can be used to treat generalised seizures?

A

Sodium valproate

Lamotrigine

44
Q

How is acute seizure managed?

A

ABCDE

High flow oxygen/non-rebreather mask

IV access

Midazolam (can be given intranasally/buccally if no IV)

Diazepam (can be given per rectum if no IV)

45
Q

What should be done if patient not responding to initial dose of midazolam/diazepam?

A

Give another dose of midazolam

Still fitting - phenytoin

46
Q

What are the complications if a seizure is left untreated?

A

Hypoxia -> cerebral ischaemia

If >1hr, cerebral oedema

Aspiration pneumonitis

Hyperthermia

Fractures and dislocations (shoulder)

47
Q

What are the properties of levetiracetam?

A

Few interactions with other medications

Well tolerated, though can cause mood swings

48
Q

What considerations for women are there when prescribing antiepileptic drugs?

A

Medications can reduce efficacy of OCP

Reduced efficacy of morning after pill if taking enzyme inducers

Teratogenicity

49
Q

Which drug is extremely teratogenic?

A

Sodium valproate

50
Q

Which drugs reduce the efficacy of the OCP?

A

Carbamazepine

Phenytoin

Oxcarbazepine

51
Q

Which drug can cause Stephens-Johnson syndrome?

A

Lamotrigine

52
Q

Which drug can cause syndrome of inappropriate ADH?

A

Carbamazepine

53
Q

Which drug can cause ataxia and nystagmus?

A

Phenytoin

54
Q

Which drug causes leucopenia and photosensitivity?

A

Sodium valproate

55
Q

What MRI finding is associated with temporal lobe epilepsy?

A

Hippocampal sclerosis

56
Q

What is the most common form of partial seizure?

A

Temporal lobe epilepsy

Neurology (17 decks)

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