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AIP: Seizures > Epilepsy basics > Flashcards

Epilepsy basics Flashcards

1
Q

What is epilepsy?

A

common neurological condition characterised by recurrent seizures

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2
Q

What proportion of patients with epilepsy achieve satisfactory seizure control with antiepileptic medication?

A

two thirds

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3
Q

What are 3 examples of conditions which have an association with epilepsy?

A
  1. Cerebral palsy
  2. Tuberous sclerosis
  3. Mitochondrial diseases
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4
Q

What proportion of patients with cerebral palsy have epilepsy?

A

30%

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5
Q

What are 3 more common causes of recurrent seizures than epilepsy seen in clinical practice?

A
  1. Febrile convulsions
  2. Alcohol withdrawal seizures
  3. Psychogenic non-epileptic seizures
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6
Q

What age of patients are typically affected by febrile convulsions?

A

children 6 months to 5 years

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7
Q

What proportion of children will have at least 1 febrile convulsion?

A

3%

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8
Q

What is typically the cause of febrile seizures?

A

in a viral infection, as temperature rises rapidly

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9
Q

What is the typical nature of seizures that are febrile convulsions?

A

brief, generalised tonic/tonic-clonic

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10
Q

Which patients are affected by alcohol withdrawal seizures?

A

patients with a history of alcohol excess who suddenly stop drinking e.g. following admission to hospital

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11
Q

What is the aetiology of alcohol withdrawal seizures?

A

chronic alcohol consumption enhances GABA mediated inhibition in the CNS (similar to benzodiazepines) and inhibits NMDA-type glutamate receptors

alcohol withdrawal thoguht to be the opposite: decreased inhibitory GABA and increased NMDA glutamate transmission

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12
Q

At what point is the peak incidence of seizures following cessation of drinking?

A

36 hours following cessation

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13
Q

What are psychogenic non-epileptic seizures?

A

epileptic-like seizures without characteristic electrical discharges

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14
Q

What may be associated with psychogenic non-epileptic seizures?

A

history of mental health problems or personality disorder

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15
Q

What are the 3 key features that epilepsy classification is based upon?

A
  1. Where in the brain the seizure affects: focal or generalised
  2. Whether there is awareness or impaired awareness
  3. Other features of seizures
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16
Q

What is meant by focal seizures?

A

start in a specific area, on one side of the brain

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17
Q

What 3 groups can focal seizures further be classified into?

A
  1. Focal aware
  2. Focal impaired awareness
  3. Focal awareness unknown
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18
Q

In addition to categorisation based on awareness, what are 3 further groups that focal seizures can be classed into?

A
  1. Motor e.g. Jacksonian march
  2. Non-motor e.g. deja vu, jamais vu
  3. Having other features e.g. aura
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19
Q

What are generalised seizures?

A

engage or involve networks on both sides of the brain at the onset

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20
Q

What is always the level of consciousness in generalised seizures?

A

consciousness lost immediately - all patients lose consciousness (so this level of classification not needed like it is for focal seizures)

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21
Q

What are the 2 key groups into which generalised seizures can be classified?

A
  1. Motor e.g. tonic-clonic
  2. Non-motor e.g. absence
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22
Q

What are 6 examples of specific types of generalised seizures?

A
  1. Tonic clonic
  2. Tonic
  3. Clonic
  4. Typical absence
  5. Myoclonic: brief, rapid muscle jerks
  6. Atonic
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23
Q

What is meant by an unknown onset seizure?

A

when the origin of the seizure is unknown

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24
Q

What is a focal to bilateral seizure?

A

starts on one side of the brain in a specific area before spreading to both lobes, previously termed secondary generalised seizures

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25
Q

What is the nature of infantile spasms?

A

flexion of head, trunk, limbs and then extension of arms (Salaam) attack; last 1-2 seconds, repeat up to 50 times

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26
Q

When do infantile spasms begin?

A

first few months of life

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27
Q

What is typical of infantile spasms aka West’s syndrome on EEG?

A

hypsarrhythmia

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28
Q

What progressive feature often accompanies infantile spasms (West’s syndrome)?

A

progressive mental handicap

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29
Q

What are 4 causes of infantile spasms?

A
  1. Tuberous sclerosis
  2. Encephalitis
  3. Birth asphyxia
  4. Cryptogenic
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30
Q

What is the prognosis of infantile spasms like?

A

poor

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31
Q

What may Lennox-Gastaut syndrome be an extension of, and in what proportion of patients?

A

infantile spasms, in 50% of patients

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32
Q

What is the typical age of onset of Lennox-Gastaut syndrome?

A

1-5 years

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33
Q

What is the nature of seizures in Lennox-Gastaut syndrome?

A

atypical absences, falls, jerks

34
Q

What proportion of patients with Lennox-Gastaut syndrome have moderate-severe mental handicap?

A

90%

35
Q

What is the EEG appearance of Lennox-Gastaut syndrome?

A

slow spike

36
Q

What treatment option may help Lennox Gastaut syndrome?

A

ketogenic diet

37
Q

What is usually the nature of benign rolandic epilepsy?

A

paraesthesia e.g. unilateral face, usually on waking up

38
Q

At what age is the typical onset of juvenile myoclonic epilepsy (Janz syndrome)?

A

teens

39
Q

In what gender is juvenile myoclonic epilepsy (Janz syndrome) more common?

A

female

40
Q

What are 3 types of seizures that may occur in Juvenile myoclonic epilepsy aka Janz syndrome?

A
  1. Infrequent generalised seizures, often in morning
  2. Daytime absences
  3. Sudden, shock like myoclonic seizure
41
Q

What drug does juvenile myoclonic epilepsy usually have a good response to?

A

sodium valproate

42
Q

What are 3 specific features of seizures to ask about that can distinguish seizures from other causes of collapse/blackout?

A
  1. Tongue biting
  2. Incontinence of urine
  3. Postictal phase - drowsy/tired
43
Q

How long does the postictal phase usually last for?

A

15 minutes

44
Q

What are 2 investigations that patients have following their first seizure?

A
  1. Electroencephalogram (EEG)
  2. Neuroimaging - usually MRI
45
Q

When do neurologists typically start prescribing antiepileptic medications?

A

following second seizure

46
Q

As a general rule what is the first line AED for generalised seizures?

A

sodium valproate

47
Q

As a general rule what is the first line AED for focal seizures?

A

carbamazepine

48
Q

Why are AEDs prescribed by brand rather than generically?

A

slightly different bioavailability can result in lowered seizure threshold

49
Q

How long following a single seizure can patients not drive for?

A

6 months

50
Q

For patients with epilepsy how long following a seizure must they be fit-free before driving?

A

12 months

51
Q

Why must you be aware of other drugs a patient is taking when prescribing AEDs?

A

they can induce/inhibit the P450 system, resulting in varied metabolism of other medications e.g. warfarin

52
Q

Which AED is particularly teratogenic and in what way?

A

sodium valproate - neural tube defects

53
Q

What is the general advice about breastfeeding when taking AEDs?

A

generally considered safe apart from barbiturates

54
Q

What type of medication that women in particular will be taking must you consider the effect of taking with AEDs?

A

contraception: effect of contraceptive on AED and AED on contraceptive

55
Q

What is the mechanism of action of sodium valproate?

A

increases GABA activity

56
Q

What are 10 adverse effects of sodium valproate?

A
  1. Increased appetite and weight gain
  2. Alopecia: regrowth may be curly
  3. P450 enzyme inhibitor
  4. Ataxia
  5. Tremor
  6. Hepatitis
  7. Pancreatitis
  8. Thrombocytopenia
  9. Teratogenic (neural tube defects)
57
Q

What is the mechanism of action of carbamazepine?

A

binds to sodium channels, increasing their refractory period

58
Q

What are 6 adverse effects of carbamazepine?

A
  1. P450 enzyme inducer
  2. Dizziness and ataxia
  3. Drowsiness
  4. Leucopenia and agranulocytosis
  5. Syndrome of inappropriate ADH secretion
  6. Visual disturbances (especially diplopia)
59
Q

What is the mechanism of action of lamotrigine?

A

sodium channel blocker

60
Q

When is lamotrigine used for epilepsy?

A

used second-line for a variety of generalised and focal seizures

61
Q

What is a key adverse effect of lamotrigine?

A

Stevens-Johnson syndrome

62
Q

What is the mechanism of action of phenytoin?

A

binds to sodium channels, increasing their refractory period

63
Q

Why is phenytoin no longer used first line as an AED?

A

side effect profile

64
Q

What are 8 adverse effects of phenytoin?

A
  1. P450 enzyme inducer
  2. Dizziness and ataxia
  3. Drowsiness
  4. Gingival hyperplasia, hirsutism, coarsening of facial features
  5. Megaloblastic anaemia
  6. Peripheral neuropathy
  7. Enhanced vitamin D metabolism causing osteomalacia
  8. Lymphadenopathy
65
Q

What is rescue medication given to patients with epilepsy?

A

benzodiazepines for when seizures last longer than 5 minutes so family members can administer - rectal diazepam or intranasal/under tongue

66
Q

According to NICE guidelines, when should antiepileptics be started after the first seizure? 4 situations

A
  1. If patient has a neurological deficit
  2. Brain imaging shows structural abnormality
  3. EEG shows unequivocal epileptic activity
  4. Patient or family or carers consider risk of having further seizure unacceptable
67
Q

What is the first line for generalised tonic-clonic seizures?

A

sodium valproate

68
Q

What are 2 second-line drugs for generalised tonic-clonic seizures?

A
  1. Lamotrigine
  2. Carbamazepine
69
Q

What are 2 first line options for absence seizures?

A

sodium valproate or ethosuximide

70
Q

When is sodium valproate particularly effective for patients with absence seizures?

A

if co-existent tonic-clonic seizures in primary generalised epilepsy

71
Q

What is the first line treatment for myoclonic seizures?

A

sodium valproate

72
Q

What are 2 second-line options for myoclonic seizures?

A

clonazepam, lamotrigine

73
Q

What are 4 second-line drug options for focal seizures?

A
  1. Lamotrigine
  2. Levetiracetam
  3. Oxcarbazepine
  4. Sodium valproate
74
Q

What are 2 types of seizures that may be exacerbated by carbamazepine?

A
  1. Absence seizures
  2. Myoclonic seizures
75
Q

What are 2 conditions that would mean a patient can not drive for 12 months following a first seizure?

A
  1. Structural abnormalities on brain imaging
  2. Epileptiform activity on EEG
76
Q

What are the driving rules for a patient who has been seizure free for 5 years (with medication if necessary?

A

a ‘til 70 licence is usually restored

77
Q

What are the rules about driving following withdrawal of epilepsy medication?

A

should not drive whilst anti-epilepsy medication being withdrawn and for 6 months after last dose

78
Q

Which AED is a good choice for women of childbearing age?

A

lamotrigine

79
Q

What are 7 things that can trigger seizures in epilepsy?

A
  1. Poor sleep
  2. Alcohol and drugs (and withdrawal)
  3. Stroke
  4. ICH
  5. SOL
  6. Metabolic disturbance
80
Q

What are 4 complications of epilepsy?

A
  1. Status epilepticus
  2. Depression
  3. Suicide
  4. Sudden unexpected death in epilepsy (SUDEP): thought to be due to excessive electrical activity causing a cardiac arrhythmia and death
81
Q

What age of onset are most common in epilepsy and what is the gender split?

A

bimodal age of onset: in children and older people. affect both sexes equally

AIP: Seizures (14 decks)

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