Epilepsy Neuro Revision Flashcards by Joanne McEwan

what is a seizure?

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

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what is epilepsy?

tendency to have recurrent seizures

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2 types of seizure?

focal

generalized

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what is a focal seizure?

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

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what is a generalized seizure?

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

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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symptoms of a focal aware seizures in the frontal lobe?

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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symptoms of a focal aware seizure in the parietal lobe?

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

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

causes visual phenomena such as flashing lights, colours or hallucinations

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symptoms of a focal aware seizures in the temporal lobe?

causes changes in mood or behaviour

rising epigastric sensation is a common manifestation

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

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

hippocampal sclerosis

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3 distinct components of a complex partial seizure?

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

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features of automatism?

lip smacking, chewing, fiddling, walking, whistling etc

patient usually doesnt remember doing it

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what is post ictal confusion?

post seizure confusion

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what is an absence seizure?

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

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features of absence seizures?

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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how long to absence seizures usually last?

around 10 seconds

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when do absence seizures usually develop>

childhood and adolescence

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EEG characteristic of absence seizure?

3 Hz spike wave pattern

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what is a myoclonic seizure?

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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what is juvenile myoclonic epilepsy?

subtype of idiopathic generalised epilepsy

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features of juvenile myoclonic epilepsy?

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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when does myoclonus develop in juveline myoclonic epilepsy?

between 12 and 18 yrs old

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

generalised tonic clonic seizures | usually occur months or years after the onset of myoclonus

how well does juvenile myoclonic epilepsy respond to therapy?

complete response to treatment in 80-90% of cases | lifelong therapy may be needed

what is a clonic seizure?

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

which age group are clonic seizures most common in?

neonates and young children

features of a tonic seizure?

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

most common form of generalised seizure?

tonic-clonic

features of a tonic clonic seizure?

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

how is epilepsy diagnosed?

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

what imaging is used in epilepsy?

generally not used | however, when requested an MRI is first line

when is imaging used in epilepsy?

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

4 principles of anti-epileptic drug treatment?

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

first line drugs in tonic clonic generalised seizures?

sodium valproate | lamotrigine

2nd line in tonic clonic generalised seizures?

levetiracetam topiramate clobozam

first line drug in absence generalised seizures?

ethosuximide | sodium valproate

1st line in myoclonic generalised seizures?

sodium valproate

2nd line in myoclonic generalised seizures?

levetiracetam

first line in focal seizures?

carbamazepine | lamotrigine

first line in unclassified seizures?

sodium valproate

2nd line in unclassified seizures?

lamotrigine | topiramate

general treatment for generalised seizures?

sodium valproate or lamotrigine

mechanism of carbamazepine?

Na channel inactivation

adverse effects of carbamazepine?

diplopia ataxia blood dyscrasias teratogenic hyponatraemia

mechanism of phenytoin?

na channel activation

adverse effects of phenytoin?

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

mechanism of lamotrigine?

blocks voltage gated na channels

side effects of lamotrigine?

rash steven johnson syndrome may exacerbate myoclonic seizures

can lamotrigine be used in pregnancy?

yes

mechanism of ethosuximide?

blocks thalamic T-type calcium channels

side effects of ethosuximide?

``` GI upset fatigue headache urticaria stevens-johnson syndrome ```

mechanism of sodium valproate?

Na channel inactivation with increased GABA concentration

side effects of sodium valproate?

``` GI upset liver failure neural tube defects tremor weight gain ```

who is valproate never used in?

women and girls of child bearing age | can be used if its the only thing that works and theyre definitely not pregnant

what is status epilepticus?

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

first line treatment in status epilepticus in the community?

buccal or rectal midazolam

first line treatment of status epilepticus in hospital?

IV lorazepam

overall treatment for status epilepticus?

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

driving rules for single seizure while awake?

stop driving for 1 year

driving rules for seizure during sleep?

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

driving rules for seizure while awake but not affecting consciousness?

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

HGV rules for epilepsy?

one off seizure = stop driving for 5 years | more than 1 seizure = must be seizure free and medication free for 10 years