Epilepsy - PMKT Flashcards
Which are the features commonly comprising the auras preceding temporal lobe seizures? [3]
Viscerosensory symptoms such as a rising epigastric sensation and
Experiential phenomena such as fear, déjà and jamais vu, visceral and auditory illusions, and complex auditory/ visual/gustatory/olfactory hallucinations.
Core features of true generalised epileptic seizures include? [5]
Sudden onset with injury.
Convulsions, with eyes open typically lasting < 5 minutes.
Lateral tongue biting.
Urinary and faecal incontinence.
Post-ictal dowsiness, confusion or weakness (Todd’s paresis).
What is the next appropriate treatment in a status epilepticus patient who has not responded to two boluses of Lorazepam? [1]
Phenytoin infusion.
Describe the pharmacokinetics of Phenytoin? [1]
Phenytoin has saturable metabolism so at therapeutic ranges (around 300mg/d) has non-linear kinetics - small increases in dose can lead to large changes in plasma concentration.
What is the most dangerous side effect of Lamotrigine? [1]
Stevens-Johnson syndrome or Toxic Epidermal Necrolysis
What is the difference between simple and complex seizures? [1]
Consciousness is impaired in complex seizures but not in simple seizures
What are the clinical features of a myoclonic seizure? [1]
Sudden jerk of a limb, trunk, or face.
What are the local features of a parietal lobe seizure? [1]
Sensory symptoms such as tingling and numbness; motor symptoms - due to spread of electrical activity to the pre-central gyrus in the frontal lobe.
Which anti-epileptic medication is associated with increased risk of developing kidney stones? [1]
Topiramate
What is the first-line treatment of myoclonic seizures? [1]
Sodium Valproate
What is the first-line treatment of absence seizures? [2]
Sodium Valproate or Ethosuximide.
Which factor can precipitate absence seizures? [1]
Hyperventilation
What is the first-line treatment of focal seizures [2]
Carbamazepine or Lamotrigine.
Which drug worsens myoclonic seizures? [1]
Carbamazepine.
What is the first-line treatment of status epilepticus in a patient in hospital? [1]
IV Lorazepam.
First line antiepileptic for generalised seizures in young women? [1]
Lamotrigine (or levateracetam)
focal impaired awareness seizure
Psychogenic non-epileptic seizures
What is the first-line treatment for tonic or atonic seizures (male patient)?
Sodium valproate
benzodiazepines
Most commonly first-line medication for focal seizures - lamotrigine or levetiracetam
Ethosuximide
tonic-clonic generalised seizure
focal impaired awareness seizure
Increased appetite and weight gain, alopecia, P450 enzyme inhibitor
P450 enzyme inducer, dizziness and ataxia, drowsiness, agranulocytosis, SIADH
Is most associated with which drug? [1]
carbamazepine
Benign rolandic epilepsy - a child has partial seizures that occur at night
infantile spasms
febrile convulsion
Carbamazepine - P450 enzyme inducer, dizziness and ataxia, drowsiness, agranulocytosis, SIADH
P450 enzyme inducer, dizziness and ataxia, drowsiness, gingival hyperplasia, coarsening of facial features
Lamotrigine - Stevens-Johnson syndrome
A young man with a history of epilepsy and learning difficulties is noted to areas of depigmented skin on his torso. He also has roughened patches of skin over the lumbar spine - tuberous sclerosis
