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J Neuro > Epilepsy and seizures > Flashcards

Epilepsy and seizures Flashcards

1
Q

if epilepsy isn’t idiopathic, what is the likely cause (2)

A

tumour or stroke

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2
Q

definition of epilepsy

A

someone who has a lesser threshold for seizures than average

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3
Q

is focal epilepsy more common in children or elderly

A

elderly

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4
Q

is generalized epilepsy more common in children or elderly

A

children

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5
Q

how do focal seizures differ from generalized seizures

A

focal seizures occur in one area of the brain - so present with specific symptoms

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6
Q

how does a focal sensory seizure present

A

no physical seizure

loss of somatosensory/gustatory/olfactory/visual/auditory sensation

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7
Q

where does a focal motor seizure (most common type) occur (Which part of the brian)

A

frontal lobe

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8
Q

where does a focal sensory seizure occur (which part of brain)

A

parietal lobe

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9
Q

how may a temporal lobe seizure present (2)

A

dyscognitive seizure - twitching of hands, excessive blinking
psychic seizure - abnormal memories, depersonlisation, complex hallucinations

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10
Q

how does an occipital lobe seizure present

A

visual phenomena eg flashing lights, spots

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11
Q

what type of hallucinations do uncal fits present with

A

olfactory hallucinations

uncal area of brain = part of temporal lobe covering uncus

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12
Q

what type of hallucinations does temporal lobe epilepsy present with

what symptom specifically

A

olfactory hallucinations

can smell burning rubber

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13
Q

what do 2/3 of focal seizures lead on to

how does this happen

A

2/3 of focal seizures cause a secondary generalized seizure

the focal seizure hits the cortical network = triggers a generalized seizure

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14
Q

what is the network (area of brain) called that is affected in generalized seizures

A

cortical network

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15
Q

what type of seizure lasts <10s and presents as someone stopping talking midsentence

are they generalized or focal seizures

A

absence seizures

generalized seizures - occur in children

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16
Q

what type of seizure presents as someone dropping something as a result of a sudden jerk of limb/face etc

are they generalized or focal seizures

A

myoclonic seizures

generalized seizures

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17
Q

by what mode of inheritance is myoclonic epilepsy with ragged red fibres passed on

A

mitochondrial inheritance

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18
Q

what type of seizure presents with sudden loss of muscle tone causing a fall

are they generalized or focal seizures

A

atonic seizure (muscles have no tone = fall)

generalized seizure

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19
Q

what type of seizure presents with rigid arms that are flexed

are they generalized or focal seizures

A

tonic seizure

generalized seizure

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20
Q

what type of seizure presents with rigidity of the arms then shaking

are they generalized or focal seizures

A

tonic clonic seizure
(clonic = rhythmic jerking/twitching of muscles)

generalized seizure

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21
Q

triggers of seizures (4)

A

alcohol
drugs
sleep deprivation
flashing lights

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22
Q

what is the change in mood that ‘pre warns’ someone that they are about to have a seizure

A

prodrome

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23
Q

what is the part of the seizure called when someone is still conscious

may experience strange smells or de ja vu

A

aura

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24
Q

other differentials of seizure (status epilepticus) that aren’t epilepsy (7)

A 
post syncope 
hypoglycaemia 
hyponatraemia
hypoxia 
drugs 
head trauma 
subarachnoid haemorrhage

only 25% are epileptics!

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25
Q

how long do seizures last for

A

secs-mins (<10mins)

26
Q

what type of seizure is most common

A

tonic clonic seizure

27
Q

what down below problem is common during fits

A

urinary incontinence

28
Q

what mouth problem is common during fits

A

tongue biting

29
Q

if only one side of someones body is having a seizure, is it focal or generalized

30
Q

how does someone feel after a seizure

A

tired

disorientated

31
Q

is someone is ‘hip thrusting’ whilst having a seizure, what does this indicate

A

its not epilepsy, its non-epileptic attack disorder

32
Q

management of status epilepticus

A

ABCDE
C - get IV access! even if bp and hr normal, want to do FBC, U&Es, LFTs, Ca, Mg, glucose, CRP, toxology, lactate
ECG
D - check blood glucose! EEG

anti convulsant - benzodiazepine

33
Q

management of status epilepticus if cause is hypoglycaemia

34
Q

management of status epilepticus if cause is alcoholism/malnutrition

A

IV thiamine

35
Q

if a known epileptic is having a status epilepticus what should you give them

A

sodium valproate

36
Q

how is benzodiazepine given in status epilepticus

A

IV 4mg lorazepam
2 doses 10ml buccal midazolam - not good if tongue biting
PR diazepam 10mg if no IV access eg at home

37
Q

?epilepsy in kids must include which other differential

A

gratification disorder (infantile masturbation)

38
Q

status epilepticus complication if CK >1000

A

rhabdomyolysis (renal failure)

39
Q

what is the mortality like in status epilepticus

40
Q

first line treatment for primary generalized epilepsy

A

sodium valproate

41
Q

contraindications for sodium valproate

A

woman of child bearing age (teratogenic) - if the want it NEED to be on contraception (coil)

42
Q

alternative first line treatment for primary generalized epilepsy for women of child bearing age

A

lamotrigine

43
Q

side effects of sodium valproate (2)

A

teratogenic (kills babies)
weight gain
hair loss

44
Q

side effects of lamotrigine (used in females of child bearing age)

A

steven Johnson syndrome (SJS) if given too quickly

45
Q

first line drug for focal seizures/secondary generalized epilepsy (cause by focal seizures)

A

carbamazepine

46
Q

second line treatment for focal seizures/secondary generalized epilepsy (cause by focal seizures)

A

lamotrigine

47
Q

consideration of using carbamazepine for focal seizures/secondary generalized epilepsy

A

it makes other drugs less effective eg pill, morning after pill, chemo

hence females need effective contraception if on it (coil)

48
Q

third line treatment for focal seizures/secondary generalized epilepsy (cause by focal seizures)

A

sodium valproate

49
Q

why is carbamazepine NOT given in primary generalized seizures

A

makes the seizure worse

50
Q

treatment of absent seizures in children (when they stop talking)

A

ethosuxomide

51
Q

you often need to trial several drugs/doses to treat someone epilepsy, but even then not everyone finds a drug that works for them

what % of patients have drug resistant epilepsy

52
Q

what is an alternative treatment to drugs for hippocampal sclerosis

A

surgery

but only if theyre psychologically well

53
Q

how long cant someone drive for once diagnosed with epilepsy

A

1 year seizure free on new medication

54
Q

what happens if your patient doesn’t tell the DVLA that they have epilepsy

A

you have to tell the DVLA on their behalf, just warn them youre going to do it and record in notes

55
Q

after a couple years of taking medication then deciding to trial no medication, what % of patients remain seizure free on no medication

56
Q

what type of drug is a benzodiazepine

A

anti convulsant (stops the seizure)

57
Q

why would you want to do an ECG in a seizure

A

to rule out long QT syndrome (presents as seizure)

58
Q

what is it called when someone has a seizure but their EEG is normal

A

non-epileptic attack disorder

59
Q

classic presentation of non-epileptic attack disorder

A

hip thrusting

60
Q

risk factors for non epileptic attack disorder (4)

A

physical/sexual abuse
stress
anxiety
depression

61
Q

treatment of non epileptic attack disorder

A

NOT anticonvulsants

treat cause - eg with CBT, counselling etc

J Neuro (32 decks)

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