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Neurology > Epilepsy Neuro Revision > Flashcards

Epilepsy Neuro Revision Flashcards

1
Q

what is a seizure?

A

short episode of symptoms caused by a burst of abnormal electrical activity in the brain

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2
Q

what is epilepsy?

A

tendency to have recurrent seizures

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3
Q

2 types of seizure?

A

focal

generalized

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4
Q

what is a focal seizure?

A

the abnormal electrical activities tend to stay in one part of the brain
patients tend to have focal symptoms

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5
Q

what is a generalized seizure?

A

the burst of electrical activity is generalised to all the brain and unlike focal seizures, awareness is always impaired
can progress from focal seizures

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6
Q

what is an aura in relation to a seizure and what can it indicate?

A

sensation before a seizure
can take various forms such as deja-vu, change in vision, smell or taste etc
when present, regarded as focal aware seizures/simple focal seizures

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7
Q

symptoms of a focal aware seizures in the frontal lobe?

A

causes motor signs such as stiffness, twitching or spasm
jacksonian march = phenomenon where a focal aware seizure spreads from the distal part of the limb towards the ipsilateral face

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8
Q

symptoms of a focal aware seizure in the parietal lobe?

A

causes sensory menifestations which can take the form of tingling or numbness or pain

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9
Q

symptoms of a focal aware seizure seizures in the occipital lobe?

A

causes visual phenomena such as flashing lights, colours or hallucinations

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10
Q

symptoms of a focal aware seizures in the temporal lobe?

A

causes changes in mood or behaviour

rising epigastric sensation is a common manifestation

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11
Q

what is a focal impaired awareness seizure (complex focal seizure)?

A

type of focal seizure where the patient is not aware of his/her surroundings or what they are doing
usually arise in the temporal lobe in most cases

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12
Q

most common cause of mesial temporal lobe epilepsy which is typically associated with complex partial seizures?

A

hippocampal sclerosis

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13
Q

3 distinct components of a complex partial seizure?

A 
the aura
the absence (loss of consciousness)
automatism (repetitive stereotyped movement)
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14
Q

features of automatism?

A

lip smacking, chewing, fiddling, walking, whistling etc

patient usually doesnt remember doing it

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15
Q

what is post ictal confusion?

A

post seizure confusion

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16
Q

what is an absence seizure?

A

abrupt sudden loss of consciousness and of all motor activity
type of generalised seizure

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17
Q

features of absence seizures?

A

loss of consciousness
loss of motor activity
tone preserved
no fall
attack ends as abruptly as it started
previous activity is resumed as if nothing happened with no post-ictal confusion
patient usually unaware of attack afterwards

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18
Q

how long to absence seizures usually last?

A

around 10 seconds

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19
Q

when do absence seizures usually develop>

A

childhood and adolescence

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20
Q

EEG characteristic of absence seizure?

A

3 Hz spike wave pattern

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21
Q

what is a myoclonic seizure?

A

type of generalised seizure

brief contraction of a muscle group or several muscle groups resulting in a small twitch or severe jerk

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22
Q

what is juvenile myoclonic epilepsy?

A

subtype of idiopathic generalised epilepsy

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23
Q

features of juvenile myoclonic epilepsy?

A

characteristic seizures which are brief myoclonic jerks (sudden, shock-like jerks affecting mainly shoulders and arms)
usually occur in the first hour or so after waking

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24
Q

when does myoclonus develop in juveline myoclonic epilepsy?

A

between 12 and 18 yrs old

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25
Q

what also often occurs with juvenile myoclonic epilepsy and when does this happen?

A

generalised tonic clonic seizures

usually occur months or years after the onset of myoclonus

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26
Q

how well does juvenile myoclonic epilepsy respond to therapy?

A

complete response to treatment in 80-90% of cases

lifelong therapy may be needed

27
Q

what is a clonic seizure?

A

type of generalised seizure
seizure involving spasm and jerking of muscles
the elbows, legs and head will flex rapidly

28
Q

which age group are clonic seizures most common in?

A

neonates and young children

29
Q

features of a tonic seizure?

A

type of generalised seizure
causes a brief loss of consciousness
patient falls to the ground and often there is extension of the neck with upturning of the eyes and arching of the back

30
Q

most common form of generalised seizure?

A

tonic-clonic

31
Q

features of a tonic clonic seizure?

A

tonic phase
- patient quickly loses consciousness and skeletal muscles become stiff)
clonic phase
- muscles start to contract and relax rapidly, tongue might be bitten from strong jaw contractions
- may have cyanosis and incontinence

32
Q

how is epilepsy diagnosed?

A

clinical history

EEG is a helpful adjunct to confirm type in some cases however it can be normal in some people

33
Q

what imaging is used in epilepsy?

A

generally not used

however, when requested an MRI is first line

34
Q

when is imaging used in epilepsy?

A

in those who develop epilepsy before age 2
any suggestion of a focal onset
in people who’s seizures continue despite use of first line medication

35
Q

4 principles of anti-epileptic drug treatment?

A

establish diagnosis and epilepsy type
use one drug at a time (monotherapy)
initial titration should be to low maintenance doses and any upward/downward titration should be in slow stepped doses
polytherapy used if 3 types of monotherapy have failed

36
Q

first line drugs in tonic clonic generalised seizures?

A

sodium valproate

lamotrigine

37
Q

2nd line in tonic clonic generalised seizures?

A

levetiracetam
topiramate
clobozam

38
Q

first line drug in absence generalised seizures?

A

ethosuximide

sodium valproate

39
Q

1st line in myoclonic generalised seizures?

A

sodium valproate

40
Q

2nd line in myoclonic generalised seizures?

A

levetiracetam

41
Q

first line in focal seizures?

A

carbamazepine

lamotrigine

42
Q

first line in unclassified seizures?

A

sodium valproate

43
Q

2nd line in unclassified seizures?

A

lamotrigine

topiramate

44
Q

general treatment for generalised seizures?

A

sodium valproate or lamotrigine

45
Q

mechanism of carbamazepine?

A

Na channel inactivation

46
Q

adverse effects of carbamazepine?

A

diplopia
ataxia
blood dyscrasias teratogenic
hyponatraemia

47
Q

mechanism of phenytoin?

A

na channel activation

48
Q

adverse effects of phenytoin?

A 
nystagmus
diplopia
ataxia
sedation
gingival hyperplasia
hirsutism 
peripheral neuropathy
megaloblastic anaemia
teratogenic (cleft palate and cardiac defects)
49
Q

mechanism of lamotrigine?

A

blocks voltage gated na channels

50
Q

side effects of lamotrigine?

A

rash
steven johnson syndrome
may exacerbate myoclonic seizures

51
Q

can lamotrigine be used in pregnancy?

A

yes

52
Q

mechanism of ethosuximide?

A

blocks thalamic T-type calcium channels

53
Q

side effects of ethosuximide?

A 
GI upset
fatigue
headache
urticaria
stevens-johnson syndrome
54
Q

mechanism of sodium valproate?

A

Na channel inactivation with increased GABA concentration

55
Q

side effects of sodium valproate?

A 
GI upset
liver failure
neural tube defects
tremor
weight gain
56
Q

who is valproate never used in?

A

women and girls of child bearing age

can be used if its the only thing that works and theyre definitely not pregnant

57
Q

what is status epilepticus?

A

convulsive seizure which continues for a prolonged time (>5 mins)
or when convulsive seizures occur one after the other with no recovery time in between

58
Q

first line treatment in status epilepticus in the community?

A

buccal or rectal midazolam

59
Q

first line treatment of status epilepticus in hospital?

A

IV lorazepam

60
Q

overall treatment for status epilepticus?

A

10mg benzodiazepines then wait 5 mins
another 10mg if unresolved then wait another 5 mins
if still unresolved then administer IV phenytoin or phenobartital

61
Q

driving rules for single seizure while awake?

A

stop driving for 1 year

62
Q

driving rules for seizure during sleep?

A

can drive but only if there is no awake seizures for 3 years

63
Q

driving rules for seizure while awake but not affecting consciousness?

A

may still qualify for liscence if these are the only type of attack youve ever had and the first one was 12 months ago

64
Q

HGV rules for epilepsy?

A

one off seizure = stop driving for 5 years

more than 1 seizure = must be seizure free and medication free for 10 years

Neurology (53 decks)

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