Epilepsy & Seizures Flashcards by Imogen Smedley

Define a seizure

unprovoked recurring electrical discharges in brain

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Are seizures predominantly excitatory or inhibitory?

excitatory

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Define epilepsy

tendency to have recurrent unprovoked seizures (not explained by a secondary cause)

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Would a SOL be an example of epilepsy?

yes

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What clinical features help differentiate a seizure from syncope

syncope has rapid recovery
syncope often has provoking factor (e.g. dehydration)
syncope has associated symptoms e.g. pallor

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What clinical features help differentiate a seizure from a non-epileptic attack

non-epileptic attack has coordinated movement e.g. unilateral and patient more aware before

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What is the management of non-epileptic attacks?

anti-depressant / CBT

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Raised intracranial pressure, infections, uraemia, hyponatraemia , benzodiazepine withdrawal and hypoglycaemia can all cause epilepsy. True or false

false, they can all cause seizures

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What are the 2 pathological divisions of seizures?

generalised and focal

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What is the difference between a generalised and a focal seizure?

focal affects only 1 area of the brain

generalised affects more than 1 part

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A focal seizure can some present the same as a generalised seizure, true or false.

true, if it affects an area of the brain with a pathway that spreads throughout the brain, the whole pathway could be affected

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What is the name of the period leading up to a seizure

prodromal period

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Symptoms of a seizure can be divided into sensory and motor, what is the term used for sensory symptoms

aura

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What is the name of the period following a seizure, and how long does it last

post-ictal

hours/days

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Aphasic, visual hallucination, memory, déjà vu and depersonalization are all types of what group of seizures?

physic focal seizures

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Are generalised seizures always bilateral

yes i think so

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Are absence seizures focal or generalised

generalised

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What is the aetiology of absence seizures

idiopathic epilepsy in a young person

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Describe a myoclonic generalised seizure

short muscle twitches - conscious during

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What is the name of a generalised seizure where the muscles go flaccid

atonic

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Describe a tonic generalised seizure

stiff rigid hyperflexed muscles

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What is the commonest type of generalised seizure

tonic clonic

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Describe the presentation of the post-ictal period

headache, confusion, myalgia, weakness etc.

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Which antibiotics lower the seizure threshold

penicillin, cephalosporins, quinolones

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Which pain killers lower the seizure threshold

opioids e.g. tramadol

Which antipsychotic lowers the seizure threshold

prochlorperazine

Which CNS stimulant lowers the seizure threshold

amphetamines

What investigations should be done for a PTx with a PC of seizure/s

ECG U&Es, BG MRIb/CTb not EEG

What arrhythmia should you be suspicious of in a PTx with PC seizures

long QT synd

When is an EEG appropriate in relation to seizures

conforming convulsive status seeing if generalised/focal pre-surgery

In the acute scenario with a PC seizure, when is an MRIb/CTb appropriate?

GCS <15 4hr after focal sign eg. stroke evidence skull fracture evidence SAH

How long must a PTx wait before being able to drive a car after a seizure if it was their first seizure and they have no recurrence risk

6 months

How long must a PTx wait before being able to drive a HGV after a seizure if it was their first seizure and they have no recurrence risk

5 years

What pathological consequence of febrile convulsions increases the risk of epilepsy

hippocampal sclerosis

Why do head injuries increase the risk of epilepsy

cortical scarring

Name some risk factors for childhood epilepsy

febrile convulsions developmental delay birth problem SOL

What is the general pathology of epilepsy

structural abnormality OR acquired/congenital ion channel synapse mutation

Are focal or generalised seizures more likely to be genetic-childhood-onset epilepsy

generalised

Name some seizure triggers for a person with epilepsy

alcohol, infection, stress, flashing lights

How long must a person wait after a seizure before being allowed to drive a car if they have controlled epilepsy

1 year

How long must a person wait before being allowed to drive a car if they have nocturnal epilepsy

3 years

How long must a person wait before being allowed to drive a HGV if they have epilepsy

10 years off their medication seizure free

What drug is 1st line the management of generalised epilepsy

1st sodium valproate CI female of childbearing age

Why is sodium valproate used over phenytoin in the acute management of a generalised seizure

less side effects

What drug should always be avoided in the acute management of a generalised seizure

carbamazepine

Name 2 drug options for absence seizures

sodium valproate or ethosuximide

Name some side effects of sodium valproate

increase wt, teratogen, hair loss, fatigue

Name 2 drug options for myoclonic seizures

sodium valproate | levetriacetam

Name a side effect of levetriacetam

mood swings

Name the drug options for tonic clonic, atonic and tonic seizures

sodium valproate or lamotrigine

What is the disadvantage of lamotrigine

takes a while for effect

Carbamazepine, phenytoin and topiramate induce hepatic enzymes which can leads to specific complications for one group of the population ... what is this? (GUY GIVING THE LECTURE SAID IT COULD BE AN EXAM QUESTION!)

alter combined OPC efficacy make progesterone non-effective make morning after pill require higher dose

What is the management of a focal seizure

carbamazepine or lamotrigine

Define status epilepticus

recurrent epileptic seizures without full recovery of consciousness lasting >30min

Name some precipitants of status epilepticus

``` giving carbamazepine in an absence seizure SAH metabolic infection head trauma AED withdrawal ```

What is the commonest type of seizure in status epilepticus

frontal lobe tonic-clonic

What is epilepsia partialis continua

type of status epilepticus where PTx conscious and having focal motor seizures

Outline the basic management of status epilepticus

``` ABC BG EEG 1st benzo buccal midazolam then bloods ECG ```

What is the relevance of an EEG in status epilepticus

establish convulsive status

What are the major side effects to be cautious of when administering buccal midazolam

respiratory depression | hypotension

What additional steps should you take in the management plan of status epilepticus if you suspect the patient is malnourished or an alcoholic

IV thiamine

How much glucose should you administer in the management of status epilepticus if the patient is hypoglycaemic

50ml 50%

What bloods tests should you get in status epilepticus

FBC, ABG, U+E, Ca

In status epilepticus if seizures continue after giving buccal midazolam what drug should you chose next

IV phenytoin

How should you monitor the patient following status epilepticus

ECG, BP

Should you continue the PTx's usual AEDs following status epilepticus

yes, by NG if necessary