Epilepsy II Flashcards by patrick ellis

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What advice do you give to patients with epilepsy in case they have a seizure? [5]

Take showers rather than baths
Don’t lock the door when showering / bathroom
Be very cautious with swimming unless seizures are well controlled and they are closely supervised
Be cautious with heights
Be cautious with traffic
Be cautious with any heavy, hot or electrical equipment

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Describe the notable side effects of:
- Sodium Valproate [4]
- Carbamazepine [3]

Sodium Valproate:
* Teratogenic, so patients need careful advice about contraception
* Liver damage and hepatitis
* Hair loss
* Tremor

Carbamazepine:
* Agranulocytosis
* Aplastic anaemia
* Induces the P450 system so there are many drug interactions

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What are notable side effects of:
- Phenytoin [3]
- Ethosuximide [2]

Phenytoin
* Folate and vitamin D deficiency
* Megaloblastic anaemia (folate deficiency)
* Osteomalacia (vitamin D deficiency)

Ethosuximide
* Night terrors
* Rashes

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What are notable side effects of Lamotrigine [2]

Stevens-Johnson syndrome or DRESS syndrome. These are life threatening skin rashes.
Leukopenia

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Which of the following causes hyponatraemia [2]

Carbamazepine
Lamotrigine
Levetiracetam
Sodium valproate
Topiramate

Which of the following causes hyponatraemia

Carbamazepine
Lamotrigine
Levetiracetam
Sodium valproate
Topiramate

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Which of the following can cause secondary angle closure glaucoma

Carbamazepine
Lamotrigine
Levetiracetam
Sodium valproate
Topiramate

Which of the following can cause secondary angle closure glaucoma

Carbamazepine
Lamotrigine
Levetiracetam
Sodium valproate
Topiramate

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Which of the following can cause alopecia

Carbamazepine
Lamotrigine
Levetiracetam
Sodium valproate
Topiramate

Which of the following can cause alopecia

Carbamazepine
Lamotrigine
Levetiracetam
Sodium valproate
Topiramate

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Which of the following can cause tremor and ataxia?

Carbamazepine
Lamotrigine
Levetiracetam
Sodium valproate
Topiramate

Which of the following can cause tremor and ataxia?

Carbamazepine
Lamotrigine
Levetiracetam
Sodium valproate
Topiramate

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Which antiepileptic can cause Dupuytren’s contracture? [1]

Phenytoin

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Describe the monitoring needed when prescribing phenytoin for epilepsy? [3]

Phenytoin levels do not need to be monitored routinely but trough levels, immediately before dose should be checked if:
* Adjustment of phenytoin dose
* Suspected toxicity
* Detection of non-adherence to the prescribed medication

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Describe chronic common side effects of phenytoin use [+]

gingival hyperplasia
hirsutism
coarsening of facial features, drowsiness
Megaloblastic anaemia
Peripheral neuropathy
Enhanced vitamin D metabolism causing osteomalacia
Lymphadenopathy
Dyskinesia

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What are acute initial [5] and later [2] associated effects of phenytoin use for epilepsy

Acute
Initially:
- dizziness, diplopia, nystagmus, slurred speech, ataxia

Later:
- confusion, seizures

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Which of the following can cause - Stevens-Johnson syndrome?

Carbamazepine
Lamotrigine
Levetiracetam
Sodium valproate
Topiramate

Which of the following can cause - Stevens-Johnson syndrome?

Carbamazepine
Lamotrigine
Levetiracetam
Sodium valproate
Topiramate

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When taking a history for a patient with epilepsy, which questions should you specifically ask? [2]

Description of seizure - before, during and after
- Before: Feeling unwell? Activities that were doing before seizure? Playing?
- During: head movements / jerking / stiffness / injury
- After: how long did it take to return to normal self?

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What are risk factors for developing epilepsy? [5]

Age < 1
Birth Hx (pre-term more likely)
Development delay
FHx epilepsy, consanguinity
Medication

How do you differentiate daydreaming from childhood absence epilepsy? [1]

What spike wave frequency on an EEG would indicate CAE? [1]

In daydreaming can distract a person out of daydreaming, in CAE can’t stop them

Spike wave at frequency of 2.5-3Hz

Describe the triad of features seen in infantile epileptic seizures [3]
Describe how a mum might describe baby presentation [2]

1-24 months

Triad:
- Epileptic spasms
- Hypsarrhthmia on EEG
- Developmental plateauing or regression

baby used to smile and now doesn’t really, episodes where flex arms and drop head

What are treatment options for IESS? [3]

Steroids
Vigabatrin
+/- ACTH

Describe what is meant by self-limited epilepsy with centrotemporal spikes (SeLECTS)

Describe the presentation

Describe the EEG

Presentation:
- 4-10 years old
- Focal seizures are brief, typically < 2/3 mins, few from sleep, associated with somatosensory symptoms

EEG:
- High amplitude centrotemporal sharp and slow wave complexes

Describe the tx for SeLECTS [2]

Offer NO tx - most resolves by puberty

If severe - Lamotrigine or levetiracetam

How do you distinguish between TIAs and dissociative seizures [2]

TIA associated with negative symptoms (lack of activity, loss of vision)

Epilepsy is associated with positive symptoms (e.g. tingling / burning / positive visual symptoms)

Describe how you can distinguish seizures from epilepsy to Psychogenic non-epileptic seizure [+]

Describe the difference between seizures and syncope [+]

Describe what is meant by an acute symptomatic seizure [+] Why is this important clinically? [1]

**Clinical seizure** occurring at the time of a **systemic insult or in close temporal association with a documented brain insult** - Can be **focal or generalised** **Events within 1 week of:** * Stroke * TBI * Anoxic encephalopathy * Intracranial surgery * First identification of subdural hematoma * Presernce of an acute CNS infection **Events within 24 hours of:** * severe metabolic derangements * drug or alcohol intoxication and withdrawal * exposure to well-defined epileptogenic drugs ## Footnote NB: Important clinically because if it's an acute symptomatic seizure you **don't** start treatment

# Lecture What is important to know aboout acute ( < 48 hr metabolic / toxic) ir ( < 7 days stuctural), remote ( > 7days from brain insult) with regards relationship with reoccurence and to epilepsy? [2]

Describe the difference in timing of focal seizure with and without loss of awareness [2]

**Focal seizure with loss of awareness:** - Can be prolonged - up to 10 minutes **Focal seizure without loss of awareness** - Usually short < 30 seconds

What are non-medication treatments for epilepsy [+]

**Epilepsy surgery:** - open resection craniotomy - disconnection surgeries - Stereo EEG - SEEG guided radiofrequency **Neurostimulation**: - Vagus nerve stimulation - Responsive neurostimulation - DBS

Lecture: - Behavioural changes are common with which drug? [1]

**Levetiracetam**

Lecture: - Kidney stones are common with which drugs? [2]

**Topiramate or Zonisamide**

Carbamazapine/lamotrigine/phenytoin all have a 5% risk of what important AE ?[1]

**SJS**

Describe the feature of a dissociative seizure [+]

* **Not epilepsy**, common misdiagnosis (up to 20%) * **Functional neurological disorder** * Semiology varies, although often recognisable * **No associated EEG changes** * **May** be **prolonged** (>10 mins) * Often **comorbidity with epilepsy** * **Arms and legs not co-ordinated** * **Extreme back arching** * **Can return from tonic to clonic to tonic** etc (unlike generalised tonic-clonic which is always in that order)