Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 > Epilepsy (N) > Flashcards

Epilepsy (N) Flashcards

1
Q

Define epilepsy.

A

Common neurological condition characterised by recurrent seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How many seizures are needed for a diagnosis of epilepsy?

A

Need to have had 2+ seizures (>24 hours apart) for a diagnosis of epilepsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define a seizure.

A

Excessive activity of cortical neurons resulting in transient neurological symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some causes of epilepsy? (7)

A
  • primary epilepsy is idiopathic
  • secondary causes:
    • tumour
    • meningitis
    • vasculitis
    • alcohol withdrawal
    • haemorrhage
    • metabolic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What conditions have association with epilepsy? (3)

A
  • cerebral palsy (around 30% have epilepsy)
  • tuberous sclerosis
  • mitochondrial diseases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some causes of non-epileptic seizures? (3)

A
  • febrile convulsions - children (3%), early in viral infection as temperature rises rapidly, seizures brief and generalised tonic/tonic-clonic
  • alcohol withdrawal seizures - peak incidence 36h after alcohol cessation, due to decreased GABA+increased NMDA glutamate, patients given BZs to reduce risk
  • psychogenic non-epileptic seizures (pseudoseizures) - Hx mental health problems/personality disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the pathophysiology of epilepsy.

A
  • result from an imbalance in inhibitory and excitatory currents or neurotransmission in the brain
  • precipitants include anything that promotes excitation of cerebral cortex
  • often unclear why the precipitants cause seizures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What 3 key features is the basic seizure classification (epilepsy) based on?

A
  1. where seizures begin in the brain
  2. level of awareness during a seizure (important as can affect safety)
  3. other features of seizures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the two main types of seizure?

A
  • focal (previously termed partial)
  • generalised
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the features of focal seizures.

A
  • start in a specific area, on one side of the brain
  • level of awareness can vary:
    • focal aware (previously termed simple partial)
    • focal impaired awareness (previously termed complex partial)
    • awareness unknown
  • further to this focal seizures can be classified as being:
    • motor (e.g. Jacksonian march)
    • non-motor (e.g. deja vu, jamais vu)
    • other features e.g. aura
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are examples of focal seizures? (4)

A
  • frontal lobe seizure
  • temporal lobe seizure
  • occipital lobe seizure
  • parietal lobe seizure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the features of generalised seizures.

A
  • engage or involve networks on both sides of the brain at onset
  • consciousness lost immediately (level of awareness classification not needed)
  • generalised seizures can be further subdivided into motor (e.g. tonic-clonic) and non-motor (e.g. absence)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the specific types of generalised seizures? (6)

A
  • tonic-clonic (grand mal) - limbs stiffen (tonic), jerking (clonic)
  • tonic
  • clonic
  • atonic - sudden loss of muscle tone = fall
  • myoclonic - brief, rapid muscle jerks of limb/face/trunk
  • typical absence (petit mal) - brief pauses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is status epilepticus?

A

Seizure lasting >5 minutes, or 2+ seizures within a 5-minute period without the person returning to normal between them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

In status epilepticus, what do we rule out with investigations?

A

Hypoxia and hypoglycaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do we treat status epilecticus? (2)

A

IV lorazepam or PR diazepam (treatment initiated after 5-10min of seizure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the most common type of focal seizure?

A

Temporal lobe seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What information should we collect from witnesses about seizures? (9)

A
  • rapidity of onset
  • duration of episode
  • alteration in consciousness
  • tongue-biting/incontinence
  • rhythmic synchronous limb jerking
  • triggers
  • post-ictal abnormalities - exhaustion, confusion
  • drug Hx - alcohol/recreational
  • Jacksonian march - aware, focal seizure, moves around body
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the features of a frontal lobe (focal) seizure? (4 + 1)

A
  • motor features - head/leg movements
  • posturing
  • post-ictal flaccid weakness (Todd’s palsy)
  • Jacksonian march (clonic movements starting in 1 extremity and moving proximally through body) - usually starts as twitching/tingling of little toe/finger
  • frontal impaired awareness seizure - loss of consciousness, involuntary actions, rapid recovery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the features of a frontal lobe impaired awareness seizure? (3)

A
  • loss of consciousness
  • involuntary actions/disinhibition
  • rapid recovery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the most common type of focal seizure?

A

Temporal lobe seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the features of a temporal lobe (focal) seizure? (4)

A
  • aura - weird smells, involuntary movements, deja vu, abdominal pain
  • lip smacking/plucking/grabbing (automatisms)
  • post-ictal dysphasia
  • hallucinations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How long do temporal lobe (focal) seizures usually last?

A

Around one minute - with automatisms (e.g. lip smacking/plucking/grabbing)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the features of an occipital lobe (focal) seizure?

A

Visual disturbances - floaters/flashes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the features of a parietal lobe (focal) seizure?

A

Sensory issues - paraesthesia

27
Q

What are the features of tonic-clonic seizures? (6)

A
  • vague symptoms before attack e.g. irritability
  • tonic phase (generalised muscle spasm - goes stiff + falls to floor)
  • clonic phase (repetitive synchronous jerks)
  • urinary incontinence
  • tongue biting
  • post-ictal phase - impaired consciousness, lethargy, confusion
28
Q

What are the features of an absence seizure? (6)

A
  • onset in childhood
  • loss of consciousness but maintained posture (do not fall down)
  • no post-ictal phase
  • begins abruptly without warning + ends abruptly
  • patient has no recollection of episode
  • stares blankly into space
29
Q

What would EEG show for absence seizure?

A

3 Hz spike and wave

30
Q

How do we treat absence seizures?

A

Ethosuximide

31
Q

What are the features of myoclonic seizures? (2)

A
  • convulsions without muscle tensing (no tonic phase)
  • sudden jerking of limb, trunk or face with preserved consciousness
32
Q

What are the features of atonic seizures? (3)

A
  • sudden muscle relaxation causing patients to fall to the ground and lay motionless
  • can also result in incontinence
  • can result in post-ictal confusion
33
Q

What are the features of tonic seizures?

A

Muscle tensing without convulsions (no clonic phase)

34
Q

What are the features of convulsive status epilepticus?

A

Prolonged or repeated tonic-clonic seizures with an altered level of consciousness

35
Q

What are the features of non-convulsive status epilepticus? (3)

A
  • acute confusional state
  • often fluctuating
  • difficult to distinguish from dementia
36
Q

How is diagnosis of epilepsy usually made?

A

Clinical diagnosis - 2 or more unprovoked seizures 24h apart

37
Q

What scans do we do for epilepsy? (2)

A
  • electroencephalogram (EEG) - to confirm diagnosis and classify epilepsy - generalised epileptiform activity or focal, localising abnormality
  • MRI - look for structural, space occupying or vascular lesions that may cause midline shift, possible if non-epileptic patient presenting with seizures
38
Q

What type of EEG is useful in epilepsy?

A

Ictal EEG - during seizure

39
Q

What bloods do we do for epilepsy and why? (3)

A
  • capillary blood glucose - exclude hypoglycaemia
  • electrolytes - to look for hypocalcaemia and hyponatraemia
  • prolactin - to tell difference between seizures and pseudoseizures (transient increase in prolactin after seizures)
40
Q

What are some risk factors for epilepsy? (8)

A
  • poor anticonvulsant therapy adherence
  • alcohol-use disorder
  • stroke
  • toxic/metabolic causes
  • Fx of generalised-onset epilepsy
  • previous CNS infection
  • head trauma
  • prior seizure events or suspected seizure events
41
Q

What are some differential diagnoses for epilepsy? (6)

A
  • syncope
  • psychogenic non-epileptic status (normal prolactin, long duration, fluctuating course)
  • cardiac arrhythmia
  • TIA
  • delirium (can mimic non-convulsive status epilepticus)
  • coma (can mimic non-convulsive status epilepticus)
42
Q

What is the 1st-line management for status epilepticus (acute repetitive seizures)?

A

Benzodiazepine - IV lorazepam (hospital) or PR diazepam (community)

(Progression: repeat in 10min if does not work –> IV phenytoin with ECG monitoring –> general anaesthesia + intubation + mechanical ventilation)

43
Q

What are some side effects of phenytoin? (3)

A
  • P450 enzyme inducer
  • gingival hypertrophy
  • peripheral neuropathy
44
Q

What is the maximum dose of IV benzodiazepines that we can give for epilepsy?

A

Max of 2 doses (hence we then move on to IV phenytoin)

45
Q

What is the general medication escalation pattern for epilepsy?

A
  • 1st line - anticonvulsant monotherapy
  • 2nd line - alternative anticonvulsant monotherapy
  • 3rd line - anticonvulsant dual therapy
46
Q

What is the general rule in epilepsy about starting anticonvulsants?

A

Only start after >2 unprovoked seizures

47
Q

Which anticonvulsant should not be used in females of reproductive age?

A

Sodium valproate - teratogenic (neural tube defects)

48
Q

When do NICE suggest starting antiepileptics after first seizure (rather than the second as in most cases)? (4)

A
  • patient has neurological deficit
  • brain imaging shows a structural abnormality
  • EEG shows unequivocal (without doubt) epileptic activity
  • patient/family/carers consider the risk of having a further seizure unacceptable
49
Q

What is the 1st-line treatment for generalised tonic-clonic seizures in males vs females?

A
  • M - sodium valproate
  • F - lamotrigine or levetiracetam
50
Q

What is the 1st and 2nd-line treatment for absence seizures?

A
  • 1st line - ethosuximide
  • 2nd line:
    • M - sodium valproate
    • F - lamotrigine or levetiracetam
  • carbamazepine may exacerbate absence seizures
51
Q

What is the 1st-line treatment for myoclonic seizures in males vs females?

A
  • M - sodium valproate
  • F - levetiracetam
52
Q

What is the 1st-line treatment for tonic or atonic seizures in males vs females?

A
  • M - sodium valproate
  • F - lamotrigine
53
Q

What is the 1st and 2nd-line treatment for focal seizures?

A
  • 1st line - lamotrigine or levetiracetam
  • 2nd line - carbamazepine, oxcarbazepine or zonisamide
54
Q

What are some side effects of lamotrigine? (2)

A
  • Stevens-Johnson syndrome
  • large blistering rash throughout body
55
Q

What are some side effects of carbamazepine (2nd line for focal seizures)? (5)

A
  • SIADH
  • drowsiness
  • Stevens-Johnson syndrome
  • neutropenia
  • osteoporosis
56
Q

What is important to keep in mind about carbamazepine for epilepsy?

A

May exacerbate absence seizures

57
Q

What are some side effects of sodium valproate? (3)

A
  • weight gain
  • alopecia (regrowth may be curly)
  • teratogenic (avoid in women)
58
Q

What is the general 1st-line treatment for generalised seizures in men vs women?

A
  • M - sodium valproate
  • F - lamotrigine (levetiracetam if myoclonic seizures)
  • (absence - ethosuximide; above are 2nd line options)
59
Q

What does DVLA do in epilepsy? (3)

A
  • 1st unprovoked seizure = 6 months off driving
  • if abnormal brain imaging/EEG = 12 months off driving
  • no formal diagnosis of epilepsy after just 1 seizure
60
Q

What do we educate patients about in epilepsy? (4)

A
  • avoiding triggers
  • using seizure diaries
  • particular consideration for women of childbearing age due to sodium valproate being teratogenic - take folic acid and use lamotrigine instead
  • be careful of drug interactions e.g. antiepileptics can reduce efficacy of OCP
61
Q

When do we consider surgery for epilepsy?

A

If refractory focal epilepsy

62
Q

What are some complications of epilepsy? (4)

A
  • fractures from tonic-clonic seizures
  • behavioural problems
  • sudden death in epilepsy
  • complications to anti-epileptic drugs:
    • phenytoin - gingival hypertrophy
    • carbamazepine - neutropenia and osteoporosis
    • lamotrigine - Steven-Johnson syndrome
63
Q

Describe the prognosis of epilepsy.

A

50% remission at 1 year

Year 3 (148 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions