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ENT, neuro, eyes > Epilepsy/seizure > Flashcards

Epilepsy/seizure Flashcards

1
Q

What is a jacksonian march?

A

Attacks start in one part of body and gradually spread to others

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2
Q

What is Todds palsy?

A

A paresis of affected limb lasting hours after partial seizure - stroke mimic

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3
Q

What is epilepsy? and criteria?

A

Neurological disorder marked by sudden, recurrent episodes of sensory disturbance, LOC or convulsions ass with abnormal electrical activtiy in the brain

-At least two unprovoked seizures more than 24 hours apart

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4
Q

What genetic disorders are more likely to have epilepsy?

A

Downs syndrome - 10%
Angelmans = 80%
Prader-Willi - 20%

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5
Q

Who gets epilepsy?

A

Children or over 60s
More common in learning disability
Genetic disorders
First degree relatives with condition

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6
Q

What drugs can cause epilepsy?

A

Isonazid, tricyclic antidepressants
Binge alcohol drinking
Drug - benzodiazapenes or alcohol withdrawal

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7
Q

What metabolic disorders can cause epilepsy?

A

Hyponatremia/hyper, hyper/ocalcemia
Uraemia, hypoglycaemia

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8
Q

Causes of epilepys - list

A

Idiopathic
Genetic/congenita
Drugs
Metabolic/electrolyte disorders
CNS infections eg meningitis
Autoimmune disease
Brain neoplasm
Head injury/cranial surgery
Neurodegenerative diseases
1/3 - anatomical/sy,ptomatic eg cerbrocascualr disease, tumour, head injury

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9
Q

What is Sodium valproate used ofr? contraindications?

A

generalised seizures
- Teratogenic, lvier damage

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10
Q

What is Carbamazepine used for + contraindications?

A

focal seizures
- Teratogenic, myelosurpession, ataxia, diplopia

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11
Q

What is phenytoiin used for? Containdications?

A
  • Phenytoin
    • Teratogenic, gum hypertrophy, hirstutism, ataxia, diplopia
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11
Q

What is phenytoiin Containdications?

A
  • Teratogenic, gum hypertrophy, hirstutism, ataxia, diplopia
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12
Q

What drug is used fro absence seizures?

A

Ethosuximide

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13
Q

What syndrome is a contraindication for lamotrigine?

A

Steven-Johnson syndrome

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14
Q

Driving advice in epilepsy

A

Driving advice in epilepsy –
Car/ Bike:
Epileptic seizure – no driving for 1 year without seizure
One off seizure – no driving for 6 months without seizure
Bus/ coach:
More than one seizure – no driving for 10 years without seizure and not on AEDs
One off seizure – no driving for 5 years without seizure and not on AEDs

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15
Q

Treatment of status epilepticus

A

1st line = benzodiazapine

  • IV lorazepam 4mg
    • Repeat after 10 mins
    • Consider PR diazepma or buccal midazolam if no IV access

2nd line = AED-20 mins

  • eg Phenytoin, Levetriacetam, valproate
  • Loading dose then infusion

3rd line = anaesthetise + ventialte - 30 mins

  • ITU e/EEG monitoring
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16
Q

First line treatment of myoclonic seizures in males

A

Sodium valproate

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17
Q

What do myoclonic seizures NOT display?

A

LOC
Incontinence
Tongue biting
Post ictal period of fatigue

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18
Q

What seizures is ethosuximide used for?

A

Absence

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19
Q

When is lamotrigine/topirimate used in men?

A

3rd line for myoclonic seizures after sodium valproate and levetriacetam have failed

20
Q

What is first line for women with myoclonic seizures?

A

Levetiracetam

21
Q

Why is sodium valproate not offered to women of child bearing age?

A

It is severely teratogenic - neurodevelopmental delay

22
Q

When do you treat epilepsy?

A

After the second seizure unless meet crtieria for after first one

23
Q

Criteria for epilepsy treatment after first seizure

A

Neurological deficit
Structural abnormality on scan
EEG - unequivocal epileptic activity
Patient or faimly - furture risk of seizure is unacceptable

24
Q

Generalised tonic clonic, tonic or atonic, myclonic first line, absence seizures second line medication?

A

Men - sodium valproate
Women - Lamotrigine (not in myoclonic) or levetiracetam (not in tonic or atonic)

25
Q

Focal seizures treatment 1st line and second line

A

1st - lamotrigine or levetiracetam
2nd - carbamazepine, oxcarbexapine or zonisamide

26
Q

What medication may exacerbate absence seizures?

A

Carbamazepine

27
Q

Differentials for seizures

A

Syncope
Migraine
Transient ischaemic attack
Cardiac arrhythmias
Paroxysmal vertigo
Acute encephalopathy
Sleep disorders e.g. narcolepsy, parasomnias
Transient global amnesia
Involuntary movement disorder
Panic attacks
Non-epileptic seizures

28
Q

Where is a UMN lesion?

A

Above anterior horn cell in spinal cord or motor nuclei in cranial nerves

29
Q

Function of the cerebellum

A
  • Co-ordinates movement
  • Maintains equilibrium + muscle tone
  • complex regulatory + feedback system with many neural cnnections
30
Q

What is myasthenia gravis? What is antibodies test for it’

A

Disorder of neuromuscular transmission
anti-ACHR antibodies

31
Q

What is a non convulsive seizure

A

Non-Convulsive Status Epilepticus (NCSE) is a persistent change in the level of consciousness, behaviour, autonomic function, and sensorium from baseline associated with continuous epileptiform EEG changes, but without major motor signs

32
Q

Features of temporal lobe seizure

A

Lip smacking
Post-ictal dysphasia
With or without consciousness impairment
Aura:
psychic/deja vu
Hallucinations
Rising epigastric snesation

33
Q

Frontal lobe vs occipital vs pariteal lobe features of sezirue s

A

Frontal lobe (motor) Head/leg movements, posturing, post-ictal weakness, Jacksonian march
Parietal lobe (sensory) - Paraesthesia
Occipital lobe (visual) - Floaters/flashes

34
Q

What is epilepsy

A

Epilepsy - disorder of the brain due to tendency to seizures manifested as at least two unprovoked seizures occuring >24 hours apart

OR one unprovoked seizure and a high probability of more occuring due to predisposing factors eg brain lesion

OR diagnosis of epilepsy syndrome

35
Q

What is a partial/focal seziure

A

Simple motor seizure
Often tempiral and frontal lobe
Remain conscious

36
Q

What is simple partial vs complex partial seizure

A

Complex - altered consciousness
No memeory or awareness but can still interact

37
Q

Features of temporal lobe seizure onset and pathology

A

Focal onset 2/3
Deja vu, unfamiliarity, brink of revelation
Medial or hippocampal scarring from childhood febrile convulsions

38
Q

Clinical features of focal sezirue

A

Chewing, bite tongue, work face
Heat, foosebumps, fear
Odd smell often unpleasant eg burning, plastic petrol etc

39
Q

Frontal lobe seizure featres

A

Bizarre, bilateral
Cycling of lef, pelvic thrusting
Brief and frequent
Nocturnal
Head cersions - away from origin
Defnecers postion - one flexed arm other extended

40
Q

What is defencers position in frontal lobe seizure

A

ONe arm flexed one extended

41
Q

Features of occipital lobe seizures

A

Eye symptoms, movements, eyelid flickering, crude visual manifestations often lights
Metabolic conditions and stroke can cause

42
Q

What stroke often causes perception distortion

A

Parietal lobe eg size of hands vs self etc

43
Q

Questions to ask about prodromal symptoms epilepsy

A

Aura
Syncopal
Head injuroes
Drugs - anitHPTN, recreational

44
Q

Investgiations psot seizure

A

Cranial imaging -CT/MRI
EEG

45
Q

Management of epilepsy

A

A-E
AIRWAY
Antiepielptic drug

46
Q

Which antiepileptic is safest in pregnancy

A

Lamotrigine

47
Q

Appearnace of epileptic seizure

A

Pre - deja vu, focal SM
Stiffens - TONIC phase
Red/blue face, eyes open. Sustained convulsion
UL flexed, LL extended
Tonic cry, grunting then stertor post ictal
Prolonged recovery, amnestic phase
Mat have no recollection hours after event

ENT, neuro, eyes (34 decks)

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