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Y4: Neurology > Epilepsy & seizures > Flashcards

Epilepsy & seizures Flashcards

1
Q

What is a seizure?

A

Occurence of signs/symptoms due to abnormal, excessive neuronal activity

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2
Q

What is epilepsy?

A

The tendency to have unprovoked seizures

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3
Q

What are the 2 major categories of seizures?

A
  • Generalised
  • Focal
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4
Q

Describe the types of Generalised seizures?

A
  • Tonic-clonic
  • Tonic
  • Atonic
  • Clonic
  • Absence
  • Myoclonic
  • Myoclonic absence
  • Eyelid myoclonia
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5
Q

Describe the different types of Focal seizures?

A
  • Without impairment of consciousness or awareness
  • With impairment of consciousness of awareness
  • Evolving to a bilateral, convulsive seizure
    • Tonic, clonic, tonic-clonic
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6
Q

Describe the pathophysiology of seizures?

A
  • Imbalance between excitation and inhibition
    • GABA is the inhibitory transmitter
    • Glutamate and aspartate are the excitatory transmitters
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7
Q

How does GABA act as the inhibitory transmitter in the brain?

A
  • Enhances chloride inflow
  • Reduces chances of AP formation
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8
Q

How do glutamate and asparate act as the excitatory transmitters in the brain?

A
  • Excitatory amino acids
  • Allow influex of sodium and calcium
  • Increase the chances of AP formation
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9
Q

Name some common triggering factors for seizures?

A
  • Alcohol
  • Flickering lights
  • Sleep deprivation
  • Recreational drug use
  • Missed antiepileptic doses
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10
Q

What positive neurological symptoms will occur with an occipital onset of generalised tonic-clonic seizures?

A
  • Visual changes
    • Lights and blobs of colour
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11
Q

What positive neurological symptoms will occur with a temporal onset of generalised tonic-clonic seizures?

A
  • False recognition
    • Deja vu
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12
Q

Describe Focal seizures?

A
  • Localised cortical activity
    • Simple = retained awareness
    • Complex = impaired awareness
  • Localisation determined by symptoms
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13
Q

Describe Focal seizures with impairment of consciousness or awareness?

(Previously complex partial)

A
  • Seizure spreads to temporal lobes which impairs awareness
  • Patients stop and spare blankly +/-
    • Blinking repetitively
    • Smacking of lips
    • Picking at clothes
  • Period of drowsiness in post-ictal period
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14
Q

Causes of Focal seizures?

A
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15
Q

Describe Generalised tonic-clonic seizures?

A
  • Initial aura
  • Then patient becomes rigid and unconscious
    • ‘Fall like a log’
  • Jerky movements occur
    • Tongue biting and urinary incontinece may occur
  • Flaccid state of deep coma
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16
Q

What are the causes of generalised tonic-clonic seizures?

A
17
Q

Describe Absence seizures?

A
  • (petit mal)
  • Start in childhood
  • Shorter than focal seizures
  • Can occur frequently during the day
18
Q

Describe Myoclonic seizures?

A
  • Brief, jerky movements in the arms
  • Provoked by fatigue, alcohol or sleep deprivation
19
Q

Describe Atonic Seizures?

A
  • Brief loss of muscle tone
    • Without loss of consciousness
  • Result in falls
  • Only occur in conjungation with other forms of seizure
20
Q

Describe Tonic seizures?

A
  • Increased tone and loss of awareness
  • Usually part of an epilpesy syndrome
21
Q

Describe Clonic seizures?

A
  • Similar to tonic-clonic seizures
  • With no preceding tonic phase
22
Q

What are the common generalised epilepsy syndromes?

A
23
Q

Describe the investigations which should be performed for someone who has experienced a single seizure?

A
  • 12-lead ECG
  • Cranial imaging
    • CT/MRI
  • EEG
    • Where is the epilepsy arising?
    • Standard and sleep EEGs
    • Assesses prognosis after diagnosis confirmed
  • Investigations for toxic, infective and metabolic causes
24
Q

What are the indications for brain imaging in epilepsy?

A
  • Epilepsy starting after 16
  • Seizures with focal features
  • Difficulty controlling seizures
  • EEG showing focal seizure source
25
Q

Describe first aid for someone having a seizure?

A
  • Move person away from dnager
  • Put in recovery position after convulsions cease
  • Ensure the airway is clear
  • If convulsions last > 5 minutes, seek additional medical help
26
Q

Describe some lifestyle advice for someone with epilepsy?

A
  • Avoid known precipitants of seizures
  • Only have shallow baths
  • Avoid prolonged cycle journeys
  • Comply with driving regulations
27
Q
  • Describe UK driving regulations for epilepsy:
    • Single seizure?
    • Epilepsy?
    • Withdrawal of anti-epileptic drugs?
A
  • Single seizure
    • Cease driving for 6 months
  • Epilepsy
    • Cease driving
    • Licence restored after 1 seizure free year
    • Licence renewal every 3 years until seizure free for 10 years
  • Withdrawal of anti-epileptic drugs
    • Cease driving during withdrawal period and for 6 months thereafter
28
Q

Describe the guidelines for anti-epileptic drug therapy?

A
  • Start with one drug
    • Low dose then gradually increase until control achieved or side effects
29
Q

Describe the treatment for focal onset and secondary generalised tonic-clonic seizures?

A
  • 1st:
    • Lamotrigine
  • 2nd:
    • Carbamazepine
    • Levetiracetam
30
Q

Describe the treatment for Generalised tonic-clonic seizures?

A
  • 1st line:
    • Sodium valproate
    • Levetiracetam
  • 2nd line:
    • Lamotrigine
31
Q

Describe the treatment for Absence seizures?

A
  • 1st line:
    • Ethosuximide
  • 2nd line:
    • Sodium valproate
32
Q

Describe the treatment for myoclonic seizures?

A
  • 1st line:
    • Sodium valproate
  • 2nd line:
    • Levetiracetam
33
Q

Describe some options for epilepsy surgery if pharmacological therapy fails?

A
  • Surgical resection of epileptogenic tissue
  • Vagal nerve stimulation
  • Deep brain stimulation
34
Q

Describe the withdrawal of anti-epileptic therapy?

A
  • Considered after seizure-free period for > 2 years
  • Most successful if epilepsy onsets in childhood
35
Q

Describe the relation of anti-epileptics to contraception?

A
  • Some AEDs induce hepatic enzymes which metabolise contraceptives
  • Carbamazepine, phenytoin, barbiturates carry greatest risk
  • Lowest risk in sodium valproate and levetiracetam
36
Q

Describe epilepsy in pregnancy?

A
37
Q

Describe Status epilepticus?

A
  • Seizures which do not resolve spontaneously
  • Recurrent seizures without complete recovery in between
38
Q

Management of status epilepticus

A
  • Benzodiazepines
    • Diazepam

Y4: Neurology (11 decks)

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