Epilepsy NOT FINISHED Flashcards
How do you determine the class of seizure
location of onset, type of discharge, pattern of spread
describe the 2 types of seizures
partial( starts in a focus and spreads) and generalised (boths hems)
list the type of generalised seizures
typical absence, myoclonus, tonic clonic, atypical absence tonic, atonic
describe an absence seizure
mainly childhood onset frequent short lived brief attacks sudden loss and return of consciousness no aura no post ictal some involuntary movement eg walking around, gaze everted
describe a myoclonus
sudden bilateral arm jerking, often worse in the mornings, precipitated by sleep deprivation and alcohol
when does myoclonus occur
epilepsy syndromes and certain non epileptic causes
describe tonic clonic seizures
sudden onset fall. tonic phase - muscles stiffen
clonic phase limbs jerk. tongue bitten and incontinence, noisy breathing. headache and muscle pain after
describe an atonic seizure
muscles suddenly lose strength and you drop
very short and common in children
what does atonic seizure often occur in
learning disability
name the 3 categorise of partial seizures
simple - aware
complex - areness lose
2y generalised - evolves to TC
Describe a temporal lobe seizure
AURA - epigastric rising, olfactory gustation, deja vu
SEIZURE - blank stare, oral + manual automatisms (lip smacking and movements)
POST ICTAL
describe a frontal lobe seizure
wild vocalisation, quick recovery, movement (twisting grimicing) upper limbs tonic clonic
process of a seizure in relation to a neurone
- initiation - increased frequency ossilations
- depolarisation
- oscillation
- synchronisation - local and long range effect (synaptic and non synaptic e.g. gap junctions)
- termination - synaptic inhibition
What goes wrong in absence seizures?
bursts of abnormal activity from the cortex –> thalamus
reticular nucleus inhibiting TC relay
drugs that can worsen absence seizures
carbamezapine, phenytoin, baclofen
what causes some epilepsys
mutations in Na channels therefor increased function
Name 4 mechanisms of epilepsy treatments
promote inhibition (benzodiazepines) reducing gaba reuptake - longer inhibition increasing potassium channels blocking AMPA receptors
difference between idiopathic epilepsy and symptomatic epilepsy + how they respond to treatment
Idiopathic - no associated neurological damage
responds well to treatment
Symptomatic - treatment resistant - neurological deficit?
name some causes of symptomatic epilepsy
cerebal palsy, stroke, tumors, trauma, hoppocampal sclerosis
what must you do when starting epilepsy treatment
start low dose and explain side effects and interactions
main treatment for general epilepsy and partial epilepsy
G - sodium valproate
P - carbamazepine
describe carbamazepine
what is it NOT helpful for
1 -ve
acts on sodium channels to suppress bursts
absence and myoclonus
causes enzyme induction
Which seizure is valproate used for
1-ve
myoclonus, absence and photosensitive seizures
important side effect, especially women ( affects fertility)
phenytoin
not helpful for
not good for myoclonus and absence, inhibs Na channels, causes some enzyme induction
what is lamotrigine
new first line for G and P
which seizures should you use for 1 valproate, ethosuzimide, lamotrigine, benzos 2 valproate, benzos, levetricetam 3 CBZ, valproate, pheytoin, topiraminde 4 carbamazepine, lamotrigine, topiramate
- absence
- myoclonus
- GTC
- partial
