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Neurology > Epilepsy: Seizures, Syndromes and Management > Flashcards

Epilepsy: Seizures, Syndromes and Management Flashcards

1
Q

what kind of questions would you ask about onset of fall?

A

what were they doing?

light-head or other syncopal symptoms?

what did they look like? eg pallor, breathing, posturing of limbs, head turning

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2
Q

what kind of questions would you ask about the event itself?

A

types of movements - tonic phase, clonic movements, carpopedal spasms, rigor

responsiveness and awareness throughout

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3
Q

what kind of questions would you ask about after the fall?

A

speed of recovery
sleepiness / disorientation
deficits

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4
Q

what are the risk factors for epilepsy?

A 
birth 
development 
seizures in past (inc febrile fits)
head injury (including LOC)
family history 
drugs and alcohol
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5
Q

what drugs are most known to precipitate epileptic seizures?

A

aminophylline / theophylline

analgesics eg tramadol

antibiotics eg penicillins, cephalosporins, quinolones

anti-emetics eg prochlorperazine

opioids eg diamorphine, pethidine

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6
Q

you don’t usually examine patients in 1st seizure clinic as it has little benefit but when would an examination be important?

A

syncope - cardio exam and L + SBP

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7
Q

who with a fall gets a CT scan acutely?

A 
clinical or radiological skull fracture
deteriorating GCS
focal signs 
head injury with seizure 
failure to be GCS15/15 after 4 hours
suggestion of other pathology eg SAH
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8
Q

what investigations take place for the fallen?

A

ECG - mandatory

Imagine - MRIb vs CTb

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9
Q

what is EEG used for?

A

classification of epilepsy
confirmation of non-compulsive status
surgical evaluation
confirmation on non-epileptic attack

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10
Q

when should you never use EEG?

A

just because someone has collapsed and you are unsure about the cause

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11
Q

seizure does not always mean epilepsy - true or false?

A

true

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12
Q

how long should you wait until driving after 1st seizure?

A

6 months for car

5 years for HGV / PCV

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13
Q

how long should you wait until driving when you have epilepsy?

A

1 year seizure free
or 1 year with seizures that you still retain consciousness
or 3 years seizures only during sleep
10 years off medication for HGV/PCV

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14
Q

do most people have a genetic predisposition to generalised epilepsy?

A

yes

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15
Q

when does generalised epilepsy normally present?

A

in childhood and adolescence

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16
Q

what is the pattern on EEG in generalised epilepsy?

A

generalised spike wave abnormalities

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17
Q

what can be seen on ECG which is fatal and makes patients prone to seizures?

A

long QT

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18
Q

raising a limb and turning of the head indicates a seizure in what part of brain?

A

frontal lobe seizure phenomenon

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19
Q

tongue biting and loss of urinary continence are specific features of generalised seizures - true or false?

A

false

these symptoms are not seizure specific - patient can lose urinary continence during vaso-vagal episode

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20
Q

what are the differential diagnoses for epilepsy?

A

syncope
non-epileptic attack disorder
panic attacks
sleep phenomena

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21
Q

what is the treatment of choice for primary generalised epilepsy?

A

sodium valproate treatment of choice but is teratogenic

lamotrigine as alternative

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22
Q

describe the usual symptoms of juvenile myoclonic epilepsy?

A

early morning jerks

generalised seizures

23
Q

what are the risk factors for juvenile myoclonic epilepsy?

A

sleep deprivation

flashing lights

24
Q

describe the pathophysiology of focal onset epilepsy?

A

due to underlying structural cause (bran injury / haemorrhage)
area around this becomes irritated
causes abnormal discharges of energy - seizures

25
Q

focal seizures can also become generalised - true or false?

A

true - if a focal seizure excited a neighbouring pathway which can spread activity around the brain, then seizures can become generalised

26
Q

what treatment is first line for focal epilepsy?

A

carbamazepine (interacts with basically all drugs) or lamotrigine

sodium valproate works as well but not first line due to SE

27
Q

what is the most common cause of focal / partial epilepsy in patients <30?

A

complex partial seizures due to hippocampal sclerosis

28
Q

why should carbamazepine not be used for generalised seizures?

A

it can make them worse

29
Q

what are the different types of generalised seizures?

A 
myoclonic - jerks 
atonic - loss of tone 
tonic 
tonic / clonic 
absence - pt goes black
30
Q

why is lamotrigine sometimes unsuitable at the beginning of generalised epilepsy treatment?

A

it can take around 2-3 months to reach peak action

31
Q

what other treatment with less side effects than sodium valproate can be used in generalised epilepsy is lamotrigine is taking too long to work?

A

levetiracetam (keppra)

32
Q

what age group is more likely to get focal seizures?

A

> 50 as they are more likely to have structural damage

33
Q

carbamazepine is a well tolerated - true or false?

A

false - not well tolerated, patients feel dizzy and unsteady

34
Q

why should sodium valproate and lamotrigine be given together with caution?

A

sodium valproate makes the lamotrigine dose higher, therefore a lower dose of lamotrigine should be prescribed if dural therapy used

35
Q

what anticonvulsant medications are considered old?

A

phenytoin
sodium valproate
carbamazepine

36
Q

what anticonvulsants are considered new?

A

lamotrigine
levetiracetam
topiramate
gabapentin / pregabalin (not widely used anymore)

37
Q

what side effects can occur from older anticonvulsants?

A

phenytoin - unwanted cosmetic change

sodium valproate - above but also teratogenic

carbamazepine - dizzy / unsteady

38
Q

what side effects can occur from newer anti-convulsants?

A

lamotrigine - steven johnson syndrome (check for rash)

levetiracetam - mood swings

topiramate - sedation, dysphasia and weight loss

gabapentin / pregabalin - addictive

39
Q

when should anti convulsants be prescribed?

A

if patient has epilepsy - not just seizures

unless extremely high risk of seizure recurrent in non epileptic seizures

40
Q

what anticonvulsants affect hepatic enzymes and therefore causing problems for females?

A 
carbamazepine 
oxcarbazepine 
phenobarbitol 
phenytoin 
primidone 
topiramate
41
Q

what contraceptives are affected by anticonvulsant drugs?

A

combined OCP

DONT use progesterone only pill

depot progesterone injection needs more frequent dosing

progesterone implants not effective

42
Q

morning after pill dose should be increased or decreased in those on anticonvulsants?

A

increased

43
Q

why should all females of child bearing age be given pre-conceptual counselling?

A

allows them to balance risk of uncontrolled seizures if not taking medication or teratogenicity if continue with medication

44
Q

if females with epilepsy do wish to conceive, what medication must they start 3 months prior to conception?

A

folic acid and vitamin K

45
Q

what is status epilepticus?

A

recurrent epileptic seizures without full recovery of consciousness between them
can last for over 30 mins

46
Q

what are the different types of status epilepticus?

A

generalised convulsive

non convulsive status - conscious but in altered state

epilepsia partialis continua (continual conscious focal seizures)

47
Q

what can precipitate a status epilepticus?

A

severe metabolic disorders - hyponatraemia, pyridoxine deficiency

infection

head trauma / sub arachnoid haemorrhage

abrupt withdrawal of anti-convulsants

48
Q

generalised convulsive status epilepticus can cause what further effects on body?

A

respiratory insufficiency and hypoxia
hypotension
hyperthermia
rhabdomylosis

49
Q

how should status epilepticus be investigated?

A

ABCDE

identify cause - emergency blood tests +/- CT

if suspicious of hypoglycaemia give 50mls 50% glucose

50
Q

how is status epilepticus treated?

A

benzodiazepines x2 doses (10 mins, then 15 mins) - usually buccal midazolam

phenytoin if unresolving
+ sodium valproate
+ levetiracetam (keppra)

51
Q

when should you consider transferring a patient in status epilepticus into ITU?

A

when requiring to give phenytoin as it has been unresolved for a prolonged period

52
Q

how would you confirm a patient with acute confusion is in partial status epilepticus?

A

EEG

53
Q

how do benzodiazepines work to reverse status epilepticus?

A

they suppress the area of the brain which is over-excited and impairing consciousness

consciousness returns when electrical activity is sedated

Neurology (32 decks)

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