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Neurology - Nihal > Epilepsy + Seizures > Flashcards

Epilepsy + Seizures Flashcards

1
Q

management of unprovoked generalised tonic-clonic seizures

A
  1. FIRST LINE : Sodium valporate

2. SECOND LINE : Carbamazepine / Iamtrigine

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2
Q

4 major types of seizures called

A
  1. Partial/focal seizures
  2. generalised
  3. unknown onset
  4. focal to bilateral seizures
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3
Q

status epilepticus

A
  1. patient continues to fit despite medication being administered
  2. further benzos medication
  3. infusions of anti epileptic medication or general anaesthetic agents
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4
Q

nature of movements in epileptic seizures

A
  1. Stiff/ Rigid/Shaking
  2. Synchronous movements
  3. No resistance to eye opening
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5
Q

acute management of seizures

A

most seizures terminate spontaneously but if the seizure doesn’t terminate after 5 - 10 minutes
if not;

1. ABC
A - anaesthetist to secure the airway
B -  check sats and put patient on high flow oxygen
C - IV access + Cannula
- Check;
* Blood glucose levels
*Alcohol + Cocaine
*Electrolyte imbalances - Low levels of magnesium/calcium/sodium can cause seizures
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6
Q

focal seizures

A

first line : carbamazepine or lamotrigine

second line: levetiracetam, oxcarbazepine or sodium valproate

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7
Q

Absence seizures/Petit mal

A
  1. sodium valproate or ethosuximide

2. sodium valproate particularly effective if co-existent tonic-clonic seizures in primary generalised epilepsy

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8
Q

Acute medical management of seziures

A

-2. FIRST LINE - Benzodiazepines :

Lorazepam ( IV) / Diazepam (rectal) are used
- admin : rectally or intranasally under the tongue

-3. Admin Benzodiazepines again - further lorazepam if seizure persists

  1. Iv infusion of antiepileptic
    - phenytoin
  2. Status epilepticus - if patient continues to fit despite administeration of medication
  3. General anaesthetic - Profolol/Modazelan to sedate patient and stop physical manifestation of the seizure
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9
Q

associated symptoms with epileptic seizures

A
  1. Postictal period - tired and drowsy ( may not remember ambulance coming or period straight after )
  2. Todd’s Paresis - seziure in the motor cortex causes temporary muscle weakness and paralysis
  3. Bowel incontinence is more likely in epilepsy
  4. Tongue biting - specific areas of the tongue bitten such as side of tongue or inside of cheek indicate epileptic seizure
  5. Auras
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10
Q

myoclonic seizures

A
  1. short muscle twitches
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11
Q

nature of movements in non epileptic seizures

A
  1. contorted movements
  2. backarching
  3. pelvic thrusting movements
  4. resistance to eye opening
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12
Q

Psychogenic non-epileptic seizures

A
  1. previously termed pseudoseizures, this term describes patients who present with epileptic-like seizures but do not have characteristic electrical discharges
  2. patients may have a history of mental health problems or a personality disorder
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13
Q

focal to bilateral seziure

A
  1. starts on one side of the brain in a specific area before spreading to both lobes
  2. previously termed secondary generalized seizures
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14
Q

tonic seizures

A
  1. a type of generalised seizure

2. all muscles become stiff and flexed

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15
Q

pathophysiology of epilepsy

A
  1. Excess excitation
    - Excess levels of glutamate released to bind onto NMDA receptor channels resulting in long term activation
  2. Too little inhibition
    - too little of GABA neurotransmitter binds to GABA receptor and causes opening of CL- ion channels
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16
Q

Temporal lobe seizure symptoms

A
  1. Hallucinations (auditory/gustatory/olfactory),
    - Epigastric rising/Emotional - refers to stomach sensation that starts in the stomach and rises in waves up the chest to throat or head
  2. Automatisms (lip smacking/grabbing),
  3. Deja vu/Dysphasia post-ictal)
17
Q

duration of epileptic seizure

A
  1. shorter

2. less than 5 minutes

18
Q

definition of epilepsy

A

a common neurological condition characterised by recurrent seizures.

19
Q

Febrile convulsions

A
  1. typically occur in children between the ages of 6 months and 5 years
  2. around 3% of children will have at least one febrile convulsion
  3. usually occur early in a viral infection as the temperature rises rapidly
    seizures are typically brief and generalised tonic/tonic-clonic in nature
20
Q

conditions associated with epilepsy

A
  1. cerebral palsy: around 30% have epilepsy
  2. tuberous sclerosis - rare genetic condition that causes non cancerous, benign tumors to develop in different parts of the boody
  3. mitochondrial diseases
21
Q

atonic seizures

A
  1. all muscles suddenly relax and become floppy
22
Q

myoclonic seizures

A

FIRST LINE - sodium valproate

SECOND LINE: clonazepam, lamotrigine

23
Q

management

A

following the patients first seizure, patients have an;

  • EEG
  • Neuroimaging - MRI
  1. Most neurologists start anti epileptics following a second epileptic seizure
24
Q

other common causes of recurrent seizures apart from epilepsy;

A
  1. febrile convulsions
  2. alcohol withdrawl seizures
  3. psychogenic non epileptic seizures
25
Q

tonic - clonic seizures

A
  1. tonic phase is when muscles tense up followed by clonic phase where muscles contract and relax
26
Q

basic classification of seizures

A

. Where seizures begin in the brain

  1. Level of awareness during a seizure (important as can affect safety during seizure)
  2. Other features of seizures
27
Q

colour changes in non epileptic seizures

A
  1. flushed
28
Q

colour changes in epileptic seizures

A
  1. Cyanosed
29
Q

Generalised sezuires

A
  1. engage both sides of the brain on onset
  2. can be further divided into
    - motor :
    * tonic/clonic
    * atonic
    * clonic
    * myoclonic
    - non motor : absence sezuire
30
Q

clonic seziures

A
  1. violent muscle contractions known as convulsions
31
Q

focal/ partial seizures

A
  1. start in a specific site of the brain
  2. level of awareness can vary;
    - focal awareness/simple partial - no lack of awareness
    - focal impaired awareness/complex partial - complete lack of awareness
    - awareness unknown
  3. Can be further classified into motor/non motor
    - motor : Jacksonian march
    - non motor : deja vu, jamais vu, or aura
32
Q

signs and symptoms

A

patients who have had a generalised seizure also

    1. bite their tongue
    1. experience incontinenece of urine
    1. following a seizure have ‘postictal phase’ where they feel tired and drowsy for 15 mins
33
Q

frontal lobe seizure symptoms

A
  1. head and leg movements
  2. posturing
    3 post
34
Q

duration of non epileptic seizure

A
  1. longer

2. waxes and wanes

35
Q

Alcohol withdrawl seizures

A
  1. occur in patients with a history of alcohol excess who suddenly stop drinking, for example following admission to hospital
  2. chronic alcohol consumption enhances GABA mediated inhibition in the CNS (similar to benzodiazepines) and inhibits NMDA-type glutamate receptors.
  3. Alcohol withdrawal is thought to be lead to the opposite (decreased inhibitory GABA and increased NMDA glutamate transmission)
  4. the peak incidence of seizures is at around 36 hours following cessation of drinking
  5. patients are often given benzodiazepines following cessation of drinking to reduce the risk

Neurology - Nihal (31 decks)

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