Epilepsy (Zero to Finals) Flashcards
What is epilepsy?
An umbrella term for a condition where there is a tendency to have seizures.
What are seizures?
Transient episodes of abnormal electrical activity within the brain.
Investigations for epilepsy?
EEG - to show typical patterns in different forms of epilepsy and to support the diagnosis.
MRI brain - to visualise the structure of the brain. Used to diagnose structural problems that may be associated with seizures and other pathology i.e. tumours.
Other investigations can be used to exclude other pathology, particularly on ECG to exclude heart problems.
What are tonic clonic seizures?
- Loss of consciousness and tonic (muscle tensing) and clonic (muscle jerking) episodes.
- Typically the tonic phase comes before the clonic phase.
- May have associated tongue biting, incontinence, groaning and irregular breathing.
- After seizure there is a post-ictal period where the person is confused, drowsy and feels irritable or depressed.
Tonic clonic seizure management?
First line: sodium valproate
Second line: lamotrigine or carbamazepine
What are focal seizures?
Originate in the temporal lobes. They affect hearing, speech, memory and emotions.
What do focal seizures present with?
Hallucinations
Memory flashbacks
Deja vu
Doing strange things on autopilot
Management of focal seizures?
First line: lamotrigine or carbamazepine
Second line: sodium valproate or levetiracetam
TREATMENT IS THE REVERSE OF TONIC - CLONIC SEIZURES
Absence seizures typically happen in children. True/false?
True. The patient becomes blank, stares into space and then abruptly turns back to normal.
During absence seizures. Patients are completely aware of surroundings and are responsive. True/false?
False, patients are unaware of surroundings and won’t respond.
Absence seizures lasts around 10-20 seconds. True/false?
True
Management of absence seizures?
Sodium valproate or ethosuximide
What are atonic seizures characterised by?
Characterised by brief lapses in muscle tone. Don’t usually last more than 3 minutes. Typically begins in childhood.
Another name for atonic seizures?
“Drop attacks”
Management of atonic seizures?
First line: sodium valproate
Second line: lamotrigine
How do myoclonic seizures present and what is treatment?
Present as sudden brief muscle contractions, like a sudden “jump”. Patient is usually wake during the episode.
First line: sodium valproate
other options: lamotrigine or topiramate
What are infantile spasms?
AKA “west syndrome”. Characterised by clusters of full body spasms.
Infantile spasm have a good prognosis. True/false?
False, has a poor prognosis. 1/3 of patients die by age 25. 1/3 are seizure free.
First line treatments for infantile spasms?
Prednisolone
Vigabatrin
What is status epilepticus?
Classified as a medical emergency
Defined as seizures lasting longer than 5 minutes or more than 3 seizures in 1 hour.
Management of status epilepticus in hospital?
Take an ABCDE approach:
Secure the airway
Give high-concentration oxygen
Assess cardiac and respiratory function
Check blood glucose levels
Gain intravenous access (insert a cannula)
IV lorazepam 4mg, repeated after 10 minutes if the seizure continues
If seizures persist: IV phenobarbital or phenytoin
Status epilepticus medical options in the community:
Buccal midazolam
Rectal diazepam
What anti-epileptic drug can cause peripheral neuropathy (numbness and tingling in extremities)?
Phenytoin
Side effects of lamotrigine?
Skin reactions (including potentially serious ones i.e. SJS)
Dizziness
Ataxia (loss of full control of body movements).
Blurred vision
Side effects of sodium valproate?
GI disturbances (nausea and vomiting), tremor, weight gain and hair loss.
Side effects of ethosuximide?
Mainly used for absence seizures, can also lead to GI disturbances.
