Epilepsy, Migraine and Multiple Sclerosis. Flashcards
What are paroxysmal disorders also known as?
Episodic disorders.
Define- Paroxysmal disorders.
Disorders where the nervous systems functions normally between attacks.
Name some examples of paroxysmal disorders.
Seizures
Headaches
Fainting
What do paroxysmal disorders often have?
They often have a strong genetic component- starting in childhood or adolescence & improving with age.
Apart form genetics what can paroxysmal disorders be triggered by?
Stress, fatigue and some dietary factors.
It is important to know about _________ disorders as we will experience them so it is good to have an ________ of them.
paroxysmal
understanding
Define- Seizure.
A paroxysmal hyper-synchronous abnormal activity of neurons.
Explain what a seizure is.
It is a sudden and transient interruption of brain function due to disruption of electrochemical processes in transmitting information from one nerve cell to another.
Name the most common neurological disorder in Scotland.
Epilepsy.
What is epilepsy?
At least 2 unprovoked/idiopathic (no known cause) more than 24 hours apart.
70% of seizures are _______________.
cryptogenic. Meaning we don’t know what caused them!
What is another cause of seizures? (15%)
Vascular disease of brain.
Name some less common causes of seizures.
Head trauma Infection Alcohol or drug misuse Medication Acute Illness (meningitis) Tumours.
What is another word for vascular disease of the brain?
Stroke.
Stroke is most common in people aged over _____.
60.
What percentage of people who have strokes have a resulting seizure?
5-10%
Order these 1 to 3 with 1 being the highest risk of having a seizure:
- Ischaemic stroke
- Subarachnoid bleed
- Cerebral bleed
- Subarachnoid bleed
- Cerebral bleed
- Ischaemic stroke.
75% of people with ______ ____________ will have seizures within the 1st year.
Head Trauma
You have 15% chance of seizure if you have a _______ ____________ fracture.
sepressed skull
Intracranial haematoma = ___% risk of seizure.
30%
The later the the ____ of the seizure the _________ the __________________. What does it suggest?
Onset.
poorer, prognosis
That there are other underlying changes in the brain.
Name 3 infections you could possibly get seizures from.
Viral encephalitis (1-25%) Bacterial meningitis (3-10%) Viral Meningits (v. small risk in uncomplicated cases)
In terms of alcohol name the causes of seizure.
Withdrawal (mainly withdrawal)
Metabolic/ electrolyte
Toxic effects
Give a bit more information about alcohol withdrawal seizures.
They can occur 6 to 72 hours after stopping drinking
Peak at 24 hours :)
How are seizures classified?
- Partial/focal seizures
2. Generalized seizures
What should we do when someone has a seizure.
Get them on the floor
lie them in recovery position
maintain airway- make sure they can breathe
keep head safe- make sure they are not banging it on things.
What type of seizure makes up two thirds of seizures?
Focal Seizures.
Focal seizures can be simple or complex- what does this mean?
Simple- consciousness preserved
complex- altered consciousness (might not be conscious, or can’t remember seizure etc.)
What is a focal seizure?
a seizure that starts in one part of the brain eg. temporal, frontal, occipital or parietal lobe.
What is a cure to help severe seizures?
To cut the corpus callosum so the seizure can’t spread to the other hemisphere of the brain.
Describe a temporal lobe seizure.
- Epigastric aura (feel sick/nausea prior to seizure)
- Fear
- Deja vu
- Staring, unresponsive (transe like state)
- Ictal/post ictal speech affected (disturbed, slurring or repetitive speech)
What does ictal mean?
Seizure.
Describe a frontal lobe seizure.
Sudden, short, rapid recovery
Sleep related
Multiple events each night
kicking, thrashing (motor area)
Describe an occipital lobe seizure.
Visual hallucinations
Visual field defects
Ictal Blindness (lose vision during seizure)
Eye deviation
Head deviation (changes in signals going to the vestibular system)
Describe a parietal lobe seizure.
Rare Somatosensory aura (strange smell or strange sensation) Contralateral numbness/tingling Vertigo (dizziness) Speech disturbance can occur
Name a seizure that distorts electrical activity of whole or larger portions of the brain.
Primary Generalised seizures.
What happens when having a primary generalised seizure?
Tonic-clonic
tonic phase= stiffening, rigidity, cries, breathing & cyanosis (go blue)
clonic phase= rhythmic generalised jerking (fit)
Decreased consciousness
what happens post-primary generalised seizure?
Post Ictal phase- confusion and automatic behaviour (repetitive actions)
Full consciousness after 15 to 60 minutes
Generalised aches and pains
Headache
Lethargy (desire to sleep)
What’s important when deciding what kind of seizure was had?
- eye witness account
- patient account eg. how does it start and evolve, were you conscious, how long does it last, how does it stop, what happens after, how long does it take to return to normal?
What is used to investigate seizures?
EEG
MRI brain scan
EEG helps to support ______.
diagnosis
Scans aren’t very ______ for people having seizures because they ______.
practical, move
There are mobile devices to investigate seizures however these are more ____________.
expensive
How is epilepsy treated?
By the use of a drug called AED.
There are 14 different ones, often it takes time to find the right one to help suppress seizures.
With AED people with epilepsy have an overall _____ _________.
good prognosis.
Name some conditions that can mimic epilepsy, often causing confusion between them.
Sleep disorders Hyperventilation Hypoglycaemia (low blood sugar) Migraine Panic attacks Syncope (fainting)
A migraine is a _________ headache disorder.
paroxysmal disorder
What is the most common type of headache disorder?
Migraine.
Migraine has a strong ______ _____________.
family disorder
Migraines vary in _______, _______, ________, patterns of _____ and degree of ________.
frequency intensity duration symptoms disability
What can be affected by migraines?
Speech.
Some patients experience one migraine attack ______ whereas others experience it _______ ______ a week.
annually
several times
Anything can trigger a migraine, but name some triggers.
Sleep Patterns
Foods - chocolate, sugar etc.
Smells
Stress
Name 3 types of migraine.
Migraine without aura (just headache)
Migraine with aura (headache & flashing lights,smells etc.)
Aura without headache (just lights & smells, no headache)
Chronic Migraine affects 2% of the population- what is it?
Headaches on at least 15 days a moth with at least 8 being migraines.
When having a migraine, you can often be _____ to the _______.
sensitive, light.
Name ways to treat migraines.
Avoid Triggers (eg. don’t eat choc)
Acute symptomatic- drugs eg. NSAIDS, aspirin, paracetemol
Triptans - drugs eg. serotonin receptor agonists
Migraine treatments are given as a __________, there is no long term cure as yet.
prophylaxis (preventative)
A change in ____ _____ production affects signal transmission.
myelin sheath
what doe MS stand for?
Multiple Sclerosis.
What is MS?
- MS is a complex autoimmune disease, it is a life long condition
- Repeated episodes of inflammation of nervous tissue in brain and spinal cord causes the loss of insulating myelin sheath
- The loss of myelin sheath slows/blocks transmission of signals to and from the brain and spinal cord
- This impairs movement and sensation
Multiple areas of scar tissue is called ______.
Sclerosis.
Name the 3 MS Patterns.
Relapsing-remitting MS
Secondary Progressive MS
Primary progressive MS
What is Relapsing-Remitting MS?
Periods of good health (remission) followed by sudden symptoms (relapses).
80% of people at onset have _______ ________ MS.
Relapsing-Remitting.
What MS follows on from Relapsing-Remitting MS?
Secondary Progressive MS
What is Secondary Progressive MS?
Gradually more/worse symptoms with fewer remissions.
About 50% of people with relapsing- remitting MS develop _____ ______ ____ during the first 10 years of illness.
Secondary progressive MS.
What is Primary Progressive MS?
From the beginning symptoms gradually develop and worsen over time.
10-15 % of people at onset have _________ __________ ____.
Primary progressive onset.
What does aetiology refer to?
The cause of the disorder.
Name some causes and possible causes of MS.
- if a relative has it = increased chance genetically
- viral infection eg. Epstein-Barr virus
-possibly lack of sunlight and vitamin D
In the UK where has the highest prevalence of MS?
Scotland (its less sunny)
When does MS start?
It starts in early life e.g. 40-50 years.
does MS affect more women or men?
Women (70% of cases are women).
Globally MS increases with distance _______ or _______ from the ____________.
North
South
Equator.
___________ have the highest risk of MS.
Causcasians.
MS signs and symptoms are extremely _________.
Variable.
Name some common symptoms of MS.
Numbness, Tingling Fatigue Muscle Spasms Walking Difficulty Pain Depression Dizziness Cognitive dysfunction Headache
How can MS visually affect you?
- demyelination of optic nerve can cause blindness or hemianopia (decrease in vision)
- Optic neurititis: acute, sometimes painful, reduction or loss of vision in one eye
- Eye movements (nystagmus) = double vision (eyes flick back and forth)
MS can also cause ______ weakness.
Facial.
Name some facial weakness a person with MS could present with.
Bell’s palsy (temporary weakness or paralysis of the muscles in the face)
Trigeminal neuralgia (pain)
Paroxysmal dysphagia and ataxia
Other paroxysmal symptoms eg. itching, coughing, painful spasms etc.
In MS how’s hearing and balance affected?
Deafness
Feelings of unsteadiness, vertigo, ataxia and headache.
What can be some cognitive symptoms of MS?
Visual and auditory attention problems
Memory Loss
What is the psychological symptom of MS?
Depression
In MS, some people get unpleasant ___________. List a few of these.
Sensations.
Tightness
Burning
Twisting
Tearing/pulling
In MS what sensation can be lost?
Loss of thermal and pain sensation.
MS can cause _________ and __________ which is the loss of sensation in arms/legs as well as altered _______ function.
Paraethesia
Numbness
Sphincter
What symptoms of MS affect the cranial nerves?
pseudobulbar symptoms.
MS can cause difficulty ______, _______ or ____________.
Speaking,swallowing, breathing.
In MS there’s no single specific _________ test.
diagnostic.
What is MS diagnosis based on?
Neurological Examination
MRI of brain and spinal cord
Visual Evoked Potential Test (using EEG)
Lumbar puncture to test CSF (cerebrospinal fluid)
Currently there is no _____ for MS, but a number of treatments can help _____ the condition.
Cure
Control
Treatment depends on ____ _____:
- Treating ______ of symptoms
- Treatment to _________ the _____ of relapses
- Treating specific ________.
Relapses
Reduce, number
symptoms
What is the general prognosis for MS?
Its rarely fatal (but there can be some complications from severe MS)
Average life expectancy lowers by 5 to 10 years.
Disease progression varies-
25% of patients have ___________ form of MS
15% of patients are _________ ____________ within a short period
5% of patients have frequently recurring ______ without recovery, rapidly causing disability and ____ __________.
non-disabling
severely disabled
relapses
early death
If you have a ____ form of MS you have a poorer prognosis.
progressive
What are people with MS prone to?
People with MS are prone to other illness/disorders.
Approximately 40% of people with MS have speech problems- what do SLTS help with?
Therapy for mixed spastic-ataxic speech- this is the most common problem (there are others)
Loudness and pitch control
Articulation
As well as speech what else are SLTs involved with for pateints with MS?
Swallowing - need to check if corticobulbar tracts or lower brainstem nuclei involved.
