Epilepsy & Seizures Flashcards
Define a seizure
unprovoked recurring electrical discharges in brain
Are seizures predominantly excitatory or inhibitory?
excitatory
Define epilepsy
tendency to have recurrent unprovoked seizures (not explained by a secondary cause)
Would a SOL be an example of epilepsy?
yes
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
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
What is the management of non-epileptic attacks?
anti-depressant / CBT
Raised intracranial pressure, infections, uraemia, hyponatraemia , benzodiazepine withdrawal and hypoglycaemia can all cause epilepsy. True or false
false, they can all cause seizures
What are the 2 pathological divisions of seizures?
generalised and focal
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
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
What is the name of the period leading up to a seizure
prodromal period
Symptoms of a seizure can be divided into sensory and motor, what is the term used for sensory symptoms
aura
What is the name of the period following a seizure, and how long does it last
post-ictal
hours/days
Aphasic, visual hallucination, memory, déjà vu and depersonalization are all types of what group of seizures?
physic focal seizures
Are generalised seizures always bilateral
yes i think so
Are absence seizures focal or generalised
generalised
What is the aetiology of absence seizures
idiopathic epilepsy in a young person
Describe a myoclonic generalised seizure
short muscle twitches - conscious during
What is the name of a generalised seizure where the muscles go flaccid
atonic
Describe a tonic generalised seizure
stiff rigid hyperflexed muscles
What is the commonest type of generalised seizure
tonic clonic
Describe the presentation of the post-ictal period
headache, confusion, myalgia, weakness etc.
Which antibiotics lower the seizure threshold
penicillin, cephalosporins, quinolones
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
