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Y2 Neurology > Epilepsy and Seizures > Flashcards

Epilepsy and Seizures Flashcards

1
Q

what is syncope?

A

temporary loss of consciousness caused by a fall in blood pressure.
- a simple faint

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2
Q

what is a hypoxic seizure?

A

when the brain is deprived of oxygen and causes the person to lose consciousness

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3
Q

what is a concussive seizure ?

A

when someone experiences trauma to their head

- for example, RTA and contact sports

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4
Q

give some examples of differential diagnoses for a blackout?

A 
syncope 
first seizure 
hypoxic seizure 
concussive seizure 
cardiac  arrhythmia 
non-epileptic attack
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5
Q

in what age range are cardiac arrhythmias more common?

A

more common in older people

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6
Q

whats two important things to do to get a good idea of whats happened during the seizure ?

A

detailed history from patient

detailed history from witnesses

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7
Q

what questions would you ask the patient about their seizure ?

A
  1. did you have any warning signs?
  2. what happened before the incident?
  3. did you have any injuries?
  4. what were you doing at the time ?
  5. has anything like this happened in the past?
  6. how did you feel afterwards
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8
Q

what sort of questions would you ask the witness about the seizure?

A
  1. what were the patterns of movements ?
  2. what was the colour of the person?
  3. what was the person doing before hand
  4. how fast did the seizure last?
  5. how long until the person came back around and start speaking
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9
Q

what other information about the patient who has had a seizure ?

A 
age 
sex
PMH 
past psychiatric history 
alcohol and drug abuse 
family history
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10
Q

what gender are black outs more common in?

A

females

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11
Q

what is the most common cause of fainting?

A

vasovagal syncope

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12
Q

what are the warning symptoms of syncope?

A
  • light headed
  • nausea
  • hot
  • sweating
  • ringing in ears
  • tunnel vision
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13
Q

what are some causes of vasovagal syncope?

A 
prolonged standing
standing up quickly 
trauma 
watching/experiencing medical procedures eg. venipuncture 
micturition 
coughing
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14
Q

what posture is the person when they have a syncope attack ?

A

upright posture

- as less blood is getting to the brain

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15
Q

what posture is the person when they have a seizure?

A

any posture

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16
Q

does a person turn pale when they have a syncope attack ?

A

yes

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17
Q

are there warning signs with syncope?

A

yes

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18
Q

are there warning signs with a seizure?

A

no

- usually sudden onset

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19
Q

do people who have seizures turn pale?

A

no

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20
Q

is injury common with syncope?

A

no

- usually rare to be injured

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21
Q

is the recovery time for syncope faster compared to a seizure ?

A

yes

- usually recover fast unless they stand up quickly

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22
Q

do people who have seizures recover fast?

A

no

- they have a slow recovery

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23
Q

is incontinence common with people who have syncope attack?

A

incontinence is rare

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24
Q

what position should someone who has had a syncope attack be placed in to recover?

A

lie down with their legs up

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25
Q

where are common places for people to have hypoxic seizures ?

A

air planes

dentist

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26
Q

what can occur if the person who has had a hypoxic seizure stands up too quick?

A

they can have another seizure as not enough blood can get to the brain

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27
Q

state a functional cardiac problem which can cause black outs?

A

long QT syndrome

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28
Q

what is the appearance of non-epileptic attacks?

A

May look bizarre

Can be prolonged

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29
Q

what can a cause of non-epileptic seizures be?

A

history of abuse

  • domestic
  • sexual
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30
Q

are non-epileptic attacks more common in females or males?

A

females

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31
Q

describe what a generalised tonic-clonic seizure looks like

A

when the person goes stiff (tonic) then jerks (clonic)

the jerks are synchronise

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32
Q

are non-epileptic attack patients given anti-epileptics?

A

no

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33
Q

state some bizarre movements people with non-epileptic attacks may do?

A
  • thrust their hips in a history of sexual abuse
  • wipe the work top surface in a kitchen
  • touch the cooker
  • walk about
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34
Q

what investigations should be done if someone has their first seizure ? (4)

A

Blood sugar
ECG
Alcohol/drug in body
CT head (if someone isn’t waking up)

35
Q

when the patient is about to be discharged after their first seizure what advice should be given to them? (4)

A
  1. safety information sheets
  2. check if their employment is affected
  3. check if they are still allowed to drive
  4. explain the driving regulations
36
Q

if someone has their first seizure and their test results are normal. Are they allowed to drive?

A

no

- they can’t drive for 6 months

37
Q

if someone has their first seizure and their test results are abnormal or due to alcohol. Are they allowed to drive?

A

no

- they can’t drive for a year

38
Q

if someone who drives a HGV or PSV has their first seizure and their test results are normal. Are they allowed to drive?

A

no

- they can’t drive for 5 years and can’t be on anti-epileptic medication

39
Q

if a child has minor jerks then when they turn 11yrs they have a seizure. Is it likely they have epilepsy?

40
Q

what are the two main types of epilepsy?

A

primary generalised epilepsy

focal onset epilepsy

41
Q

describe some characteristics of primary generalised epilepsy

A

History of myoclonic jerks, especially first thing in the morning

Absences or feeling strange with flickering lights

42
Q

give an example of myoclonic jerks?

A

hypnic jerks

43
Q

state some characteristics of focal onset epilepsy

A

History of “deja vu”
Rising sensation from abdomen
Episodes of looking blank with lip-smacking
Fiddling with clothes

44
Q

define epilepsy

A

Epilepsy is a condition in which seizures recur, usually spontaneously

45
Q

define epileptic seizure

A

epileptic seizure is an intermittant stereotyped disturbance of consciousness, behaviour, emotion, motor function or sensation which, on clinical grounds, is believed to result from abnormal neuronal discharges

46
Q

what is the incidence of epilepsy per 100,000?

47
Q

who are most affected by epilepsy?

A

children and older people (cardiac problems)

48
Q

what percentage of people with learning difficulties will have epilepsy?

49
Q

what organisation have classified epileptic seizures into different groups?

A

International League Against Epilepsy (ILAE)

50
Q

what are absence seizures ?

A

day dreaming almost

51
Q

what are atonic seizures ?

A

losing all muscle tone and falling to the ground like a puppet

52
Q

what are tonic jerks ?

A

stiffening

53
Q

comparing focal onset and generalised seizures. which seizures do you loose consciousness?

A

generalised seizures

54
Q

what age is most affected by primary generalised epilepsy?

A

<25 yrs, usually diagnosed earlier as they are due to brain function

55
Q

what age is most affected by focal epilepsy?

A

any age, the cause can be any focal brain abnormality such as stroke, brain tumour

56
Q

what abnormality will the EEG have for primary generalised and focal epilepsy?

A

primary generalised = generalised abnormality

focal = focal abnormality

57
Q

which type of epilepsy will show warning signs?

A

focal epilepsy

58
Q

why can epilepsy in people with learning difficulties be difficult?

A

they can have behavioural repetitive movements which can be stereotypical of epilepsy

59
Q

when testing for epilepsy, what there things can be done to the patient to try stimulate epilepsy?

A
  1. hyperventilation
  2. photic stimulation
  3. sleep deprivation
60
Q

what drug is used for absence seizures ?

A

ethosuximide

61
Q

what drugs are used for primary generalised epilepsies ?

A

Lamotrigine

Levetiracetam

62
Q

what epileptic drug is very effective but can cause learning problems in babies ?

A

sodium valproate

63
Q

what drugs are used for focal seizures?

A

Lamotrigine

Carbamazepine

64
Q

what two drugs can be used first line for status epilepticus?

A

Lorazepam

Midazolam

65
Q

what are the side effects of sodium valproate ?

A 
tremor 
weight gain 
ataxia 
nausea 
drowsiness 
transient hair loss 
pancreatitis 
hepatitis
66
Q

what are the side effects of carbamazepine

A 
ataxia 
drowsiness 
nystagmus 
blurred vision 
skin rash 
low serum sodium level
67
Q

what are the side effects of lamotrigine

A

skin rash

difficulty sleeping

68
Q

what are the side effects of levetiracetam

A

irritability

depression

69
Q

what are the side effects of topiramate

A

weight loss
nearly aphasic
tingling hands and feet

70
Q

what are the side effects of zonisamide

A

bowel upset

cognitive problems

71
Q

what are the side effects of lacosamide

72
Q

what are the side effects of pregabilin

A

weight gain

73
Q

what are the side effects of vigabatrin

A

behavioural problems

visual field defects

74
Q

when can epileptic patients have a driving license ?

A
  • seizure free for a year

- established pattern of sleep only related attacks for a year

75
Q

when can an epileptic patient hold a HGV or PSV license ?

A

seizure free for 10 years and not be on anti epileptic drugs

76
Q

what is status epilepticus?

A

Prolonged or recurrent tonic-clonic seizures persisting for more than 30 minutes with no recovery period between seizures

77
Q

is epilepsy a risk factor for status epilepticus ?

78
Q

what is the mortality rate for status epilepticus ?

79
Q

what three drugs can be used first line to treat recurrent tonic-clonic seizures (TCSE)?

A

midazolam
lorazepam
diazepam

80
Q

what three drugs can be used second line to treat recurrent tonic-clonic seizures (TCSE)?

A

phenytoin

valproate

81
Q

what three drugs can be used third line to treat recurrent tonic-clonic seizures (TCSE)?

A

anaesthesia

82
Q

what is the main cause of death following TCSE?

A

from the underlying cause of the TCSE

  • metabolic problem
  • congenital malformations
83
Q

what age ranges have the highest mortality following TCSE ?

A

very young and very old

Y2 Neurology (52 decks)

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