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Movement and Control > Epilepsy & management of convulsions / anticonvulsants > Flashcards

Epilepsy & management of convulsions / anticonvulsants Flashcards

1
Q

what is a seizure

A

Seizure is a sudden change in behaviour caused by electrical hyper synchronization of neuronal networks in the cerebral cortex

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2
Q

difference between provoked and unprovoked seizure

A

unprovoked is unknown

provoked is drug or alcohol, stroke, encephalitis and acute head injury

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3
Q

encephalitis
what is it
symptoms

A

Encephalitis is inflammation of the active tissues of the brain caused by an infection or an autoimmune response. The inflammation causes the brain to swell, which can lead to headache, stiff neck, sensitivity to light, mental confusion and seizures.
vomiting

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4
Q

what is epilepsy

A

Epilepsy is more than 2 unprovoked seizures occurring within a 24 hour apart

1 unprovoked seizure and a problability of further seizure similar to general recurrence risk after 2 unprovoked ( eg more than 60%) occurring over the next 10 years
Diagnosis of an epilepsy syndrome

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5
Q

two main types of seizures

A

focal

generalsied

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6
Q

what is a focal seizure

very small area

A

origin in one hemisphere

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7
Q

first line for focal seizures

A

carbamazepine

Binds to sodium channels increases their refractory period

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8
Q

what is a generalised seizure

bigger

A

both hemipspheres - bilateral discharges involve subcortical structures
impairment of conciseness

examples include , absence, myoclonic, atonic( lose muscle power) , clonic, tonic( stiff) and tonic/clonic

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9
Q

first line for generalised seizures

A

sodium valproate

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10
Q
  • Case 1 Mr Myshkin experiences episodes of epigastric discomfort (‘like riding a rollercoaster’)
  • He has episodes of staring into the middle distance. He smacks his lips during the events. (Automatism)
  • He is sometimes confused for a minute after the event.

what seizure

A

temporal lobe seizure

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11
Q

Case 2
• Mrs Black has suffered from ‘giggling’ fits all her life
• She had an episode where this giggling led to her head jerking to the right
• Her right arm then jerked and then her right leg
• This lasted 1/2 min
• Afterwards her right arm and leg felt weak for a couple of hours

A

gelastic seizure

- starts with giggling

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12
Q
  • Mr White has had 2 minute episodes of seeing multi-coloured flashing colours
  • This is self limited and his vision returns to normal afterwards
A

simpel oral occipital seizure

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13
Q

Mrs Yellow gets episodes where her whole left side tingles and she feels pins and needles.
• This lasts for a few seconds and is then gone.
• Sometimes she cannot use her left side and it feels weak afterwards.

A

focal onset right sided parietal seizure

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14
Q

occipital seizure features

A

unformed images
flashing light to complex visual hallucinations
can go blindd
vision return to normal though

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15
Q

temporal

A 
complex aura
visceral disturbance 
memory 
supernatural 
automatism - stares into distance and loses himself
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16
Q

frontal

A

Jacksonian march
todds paralysis
fencing posture with contraleteal head movement
arm extension with flexion of ipsilateral arm

17
Q

pariteal

A

Jacksonian march

paraethsia or tingling - all one side

18
Q

generalise tonic clonic seizures present as

A

abrupt loss of consciousness
everything becomes stiff - tonic phase - eyes open and pupils dilated and teeth clenched and breath held

muscles then begin to jerk after the 1st minute - tongue biting and blood sputum and eyes rolled back

19
Q

absence seizures usually during childhood 4-12

5-10 seconds of staring and Brough on by what

A

hyperventilation or phonic stimulus

20
Q

myoclonic seizures - juvenile

are sudden generalised muscle contractions and arm jerks when do they occur

A

in the morning

lifelong treatment of antiepiletpics - develop tonic and clonic seizures

21
Q

pneumonic for aetiology ( cause) of seizures

A

VITAMINS

Vascualr infections, trauma/toxins, autoimmune, metabolic imbalance, idiopathic , neoplasm, syndromes

22
Q

diagnosis

A

presenting features investigations and Ddi- ECG
CCTv footage of it

Drug history – tramadol, neuroleptics, vasodilators, older anti-depressants and prolongation of QTc – amitriptyline

23
Q

red flags to probable seizure events

A

Eyes open – eyes closed titely non epileptic

Tongue biting on side – indication of seizure

Cyanosis

Stertuous breathing- cannot breathe properly

Incontinence of urine (faeces)

Post Ictal recovery time - long

Post ictal state – all over pain, injuries, exhaustion

24
Q
  • 1 year old presents with;
  • Single episode where the baby went limp and then shook all 4 limbs
  • Has been having ‘sniffles’
  • Lasted 20 minutes
  • Had a temperature of 38.8

is this an epileptic fit

A

no pyrexial fit

25
Q
  • 12 year old was standing in assembly
  • Felt hot and sleepy and had been standing for 30 minutes
  • Fainted to the floor
  • All limbs shook whilst on the floor
  • Felt ok and back to normal afterwards

epileptic fit ?

A

no went back to normal very quickly

26
Q
  • 23 year old with a history of episodes where;
  • Feel them come on as see flashing lights
  • Get a bad headache at the back of her head
  • Associated with visual disturbances (flashing lights and zigzags)
  • Lasts hours and then goes
  • Feels tired afterwards
  • Has happened several times, normally with alcohol or poor sleep.

epileptic siezure ?

A

no classic migraine

27
Q

• A 39 year old man walks up to the doctors station and says he is feeling like he is about to have a fit

  • Slowly falls to the floor backwards
  • Teeth clenched and eyes shut with all 4 limbs extended
  • Shakes all 4 limbs and then clenches their teeth again

• Opens eyes to check if staff are attending

  • Pelvic thrusting
  • Bites the tip of the tongue
  • Lasts 20 minutes
  • Feels tearful afterwards
A

no psychical circumstance

attention seeking

28
Q

differential diagnosis

A 
syncope 
cardiac arrhymias 
non-epileptic attack 
malingering attack 
migraine
29
Q

what segment of PQRST complex can indicate seizure

A

long QT - blackout

30
Q

what drugs cause long QT interval

A
  • Antiarrhythmic drugs
  • Certain non-sedating antihistamines (eg, terfenadine and astemizole)
  • Macrolide antibiotics
  • Certain psychotropic medications
  • Certain gastric motility agents (eg, cisapride, domperidone).

Usually give antiepileptic on 2nd seizure

31
Q

driving what should happen if epileptic fit

A

Driving – everyone who has suffered an unprovoked seizure should contact the DVLA – and surrender their license until allowed to drive again
1st seizure – 6 months – 1 year off driving
HGV 1 seizure – 10 years off driving
Establish epilepsy – need to be seizure free for 12 months

32
Q

SUDEP

A

sudden unexplained death in epilepsy

33
Q

triggers of epilepsy

A 
Alcohol (withdrawal)
Drugs – Amphetamine, Ecstasy, Cocaine
Drugs – enzyme inducers – can trigger quicker metabolism of anticonvulsantds so less essentially so seizure could occur 
Missed Anticonvulsants
Pregnancy
(part of eclampsia, 2 and third trimester
(Enlarged volume of distribution)
Infections – UTI/URTI
Illness –
poorly absorbed Anticonvulsants

prescriptions – amk

34
Q

what should you during a fit

A

cushion head and remove glasses, lossen tight clothing , recovery position afterwards, record time of seizure , don’t put anything in mouth not even to hold tongue , look for ID , don’t hold down ,as seizure ends offer help

35
Q

recuse therapy for epilepsy

A

buccal midszolam ( date rape drug) or rectal diazepam

36
Q

status epilepticus

A

over 5 mins of continuous seizures or over 2 discrete seizures between which there is an incomplete recovery of consciousness

37
Q

what do you give during status epilepticus

A

diazepam 10-20mg repeated once 15 mins later - pre hospital

if easy lorazepam IV
established phenytoin infusion

38
Q

for seizures you can always have surgery

A

hemispherectomy - outer layer of brain removed
corpus collostomcy
lobe removals or lobectomy bits of it

Movement and Control (18 decks)

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