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Y3 Neurology > Epilepsy & Seizures > Flashcards

Epilepsy & Seizures Flashcards

1
Q

Define a seizure

A

unprovoked recurring electrical discharges in brain

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2
Q

Are seizures predominantly excitatory or inhibitory?

A

excitatory

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3
Q

Define epilepsy

A

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

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4
Q

Would a SOL be an example of epilepsy?

A

yes

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5
Q

What clinical features help differentiate a seizure from syncope

A

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

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6
Q

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

A

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

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7
Q

What is the management of non-epileptic attacks?

A

anti-depressant / CBT

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8
Q

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

A

false, they can all cause seizures

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9
Q

What are the 2 pathological divisions of seizures?

A

generalised and focal

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10
Q

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

A

focal affects only 1 area of the brain

generalised affects more than 1 part

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11
Q

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

A

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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12
Q

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

A

prodromal period

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13
Q

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

A

aura

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14
Q

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

A

post-ictal

hours/days

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15
Q

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

A

physic focal seizures

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16
Q

Are generalised seizures always bilateral

A

yes i think so

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17
Q

Are absence seizures focal or generalised

A

generalised

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18
Q

What is the aetiology of absence seizures

A

idiopathic epilepsy in a young person

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19
Q

Describe a myoclonic generalised seizure

A

short muscle twitches - conscious during

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20
Q

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

A

atonic

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21
Q

Describe a tonic generalised seizure

A

stiff rigid hyperflexed muscles

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22
Q

What is the commonest type of generalised seizure

A

tonic clonic

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23
Q

Describe the presentation of the post-ictal period

A

headache, confusion, myalgia, weakness etc.

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24
Q

Which antibiotics lower the seizure threshold

A

penicillin, cephalosporins, quinolones

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25
Q

Which pain killers lower the seizure threshold

A

opioids e.g. tramadol

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26
Q

Which antipsychotic lowers the seizure threshold

A

prochlorperazine

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27
Q

Which CNS stimulant lowers the seizure threshold

A

amphetamines

28
Q

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

A

ECG
U&Es, BG
MRIb/CTb
not EEG

29
Q

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

A

long QT synd

30
Q

When is an EEG appropriate in relation to seizures

A

conforming convulsive status
seeing if generalised/focal
pre-surgery

31
Q

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

A

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

32
Q

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

A

6 months

33
Q

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

A

5 years

34
Q

What pathological consequence of febrile convulsions increases the risk of epilepsy

A

hippocampal sclerosis

35
Q

Why do head injuries increase the risk of epilepsy

A

cortical scarring

36
Q

Name some risk factors for childhood epilepsy

A

febrile convulsions
developmental delay
birth problem
SOL

37
Q

What is the general pathology of epilepsy

A

structural abnormality OR acquired/congenital ion channel synapse mutation

38
Q

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

A

generalised

39
Q

Name some seizure triggers for a person with epilepsy

A

alcohol, infection, stress, flashing lights

40
Q

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

A

1 year

41
Q

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

A

3 years

42
Q

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

A

10 years off their medication seizure free

43
Q

What drug is 1st line the management of generalised epilepsy

A

1st sodium valproate

CI female of childbearing age

44
Q

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

A

less side effects

45
Q

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

A

carbamazepine

46
Q

Name 2 drug options for absence seizures

A

sodium valproate or ethosuximide

47
Q

Name some side effects of sodium valproate

A

increase wt, teratogen, hair loss, fatigue

48
Q

Name 2 drug options for myoclonic seizures

A

sodium valproate

levetriacetam

49
Q

Name a side effect of levetriacetam

A

mood swings

50
Q

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

A

sodium valproate or lamotrigine

51
Q

What is the disadvantage of lamotrigine

A

takes a while for effect

52
Q

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!)

A

alter combined OPC efficacy

make progesterone non-effective

make morning after pill require higher dose

53
Q

What is the management of a focal seizure

A

carbamazepine or lamotrigine

54
Q

Define status epilepticus

A

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

55
Q

Name some precipitants of status epilepticus

A 
giving carbamazepine in an absence seizure
SAH
metabolic
infection
head trauma
AED withdrawal
56
Q

What is the commonest type of seizure in status epilepticus

A

frontal lobe tonic-clonic

57
Q

What is epilepsia partialis continua

A

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

58
Q

Outline the basic management of status epilepticus

A 
ABC
BG
EEG 
1st benzo buccal midazolam
then bloods
ECG
59
Q

What is the relevance of an EEG in status epilepticus

A

establish convulsive status

60
Q

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

A

respiratory depression

hypotension

61
Q

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

A

IV thiamine

62
Q

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

A

50ml 50%

63
Q

What bloods tests should you get in status epilepticus

A

FBC, ABG, U+E, Ca

64
Q

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

A

IV phenytoin

65
Q

How should you monitor the patient following status epilepticus

A

ECG, BP

66
Q

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

A

yes, by NG if necessary

Y3 Neurology (23 decks)

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