Epilepsy_Status_Epilepticus_Flashcards

Question 1

What is epilepsy characterized by?

Answer 1

A disease characterised by an enduring predisposition to generate epileptic seizures and by the neurobiological, cognitive, psychological and social consequences of the condition.

Question 2

What is a seizure?

Answer 2

A transient occurrence of signs or symptoms due to abnormal excessive or synchronous activity in the brain.

Question 3

What are the two main types of seizures?

Answer 3

Focal (partial) and Generalised.

Question 4

What are the risk factors for epilepsy?

Answer 4

Genetic predisposition, Perinatal asphyxia, Trauma, Structural CNS abnormalities, Metabolic disorders, Complex febrile seizures.

Question 5

What is the new classification according to International League Against Epilepsy 2017?

Answer 5

1. Where seizures begin in the brain, 2. Level of awareness, 3. Other features of seizure.

Question 6

What are the categories under the new classification for where seizures begin in the brain?

Answer 6

Focal and Generalised.

Question 7

What are the categories under the new classification for level of awareness?

Answer 7

Focal aware (awareness intact), Focal impaired, Awareness unknown (unwitnessed), Generalised (presumed to affect awareness), Unknown.

Question 8

What are the categories under the new classification for other features of seizure?

Answer 8

Focal to bilateral, Focal onset (Motor onset and Non-motor onset), Generalised onset (Motor and Non-motor).

Question 9

What are the signs and symptoms of generalised non-motor (absence) seizures?

Answer 9

Brief impairment of consciousness, 5-10 seconds, Behavioural arrest or staring – interrupting normal activity.

Question 10

What are the signs and symptoms of tonic-clonic seizures?

Answer 10

Patient falls unconscious ± preceding aura, Violent muscle contractions and shaking, Eyes may roll back, tongue biting, incontinence, Post-ictal phenomena.

Question 11

What are the signs and symptoms of myoclonic seizures?

Answer 11

Brief arrhythmic muscular jerking movements, Last a few seconds, sudden jerking or twitching.

Question 12

What is Benign Rolandic Epilepsy (BRE)?

Answer 12

Most common childhood epilepsy. Seizures of face/upper limbs during sleep with hypersalivation & speech arrest. Also known as Sylvian seizures. Occurs in childhood (age 3-12yo) and is outgrown at end of puberty.

Question 13

What are the characteristics of Juvenile Myoclonic Epilepsy?

Answer 13

Usually involves neck, shoulders, upper arms, most occur after waking up. Begins around puberty.

Question 14

What are the characteristics of Progressive Myoclonic Epilepsy?

Answer 14

Rare syndromes, Combination of myoclonic and tonic-clonic, Patient deteriorates over time.

Question 15

What is the role of the multidisciplinary team (MDT) in epilepsy management?

Answer 15

Includes paediatrician, neurologist, SN (epilepsy nurse), school nurse, GP.

Question 16

When should a child be referred to a neurologist?

Answer 16

If it is the first fit (‘first fit clinic’).

Question 17

What advice should be given to parents while waiting for a neurologist referral?

Answer 17

How to recognise a seizure, Video record future seizure, Avoid dangerous activities (i.e. swimming), Seek help if another seizure occurs before referral.

Question 18

What factors influence the decision to treat epilepsy with antiepileptic drugs (AEDs)?

Answer 18

Based on seizure types, epilepsy type, frequency. Needs to be weighed against the possibility of side effects from antiepileptics.

Question 19

When is treatment NOT usually given for epilepsy?

Answer 19

Treatment is NOT usually given for Benign Rolandic Epilepsy.

Question 20

How should an appropriate AED be chosen?

Answer 20

Choose an appropriate AED for seizure and epilepsy type (as some can make seizures worse).

Question 21

What is the recommended approach for AED therapy?

Answer 21

Monotherapy at the lowest dose possible to avoid potential adverse side effects. Can use adjuncts to monotherapy but aim for lowest dose possible.

Question 22

What is the rescue therapy for prolonged epileptic seizures?

Answer 22

Buccal midazolam.

Question 23

When can AED therapy be discontinued?

Answer 23

AED therapy may be discontinued after 2 years free of seizures.

Question 24

What are the first-line treatments for generalized tonic-clonic seizures?

Answer 24

Valproate.

Question 25

What are the first-line treatments for absence seizures?

Answer 25

Valproate, ethosuximide.

Question 26

What are the first-line treatments for myoclonic seizures?

Answer 26

Valproate.

Question 27

What are the first-line treatments for focal seizures?

Answer 27

Carbamazepine, lamotrigine.

Question 28

What are some side effects of valproate?

Answer 28

Weight gain, hair loss, rare idiosyncratic liver failure.

Question 29

What are some side effects of carbamazepine?

Answer 29

Rash, neutropoenia, hyponatraemia (SIADH), ataxia, inducer.

Question 30

What are some side effects of lamotrigine?

Answer 30

Severe skin rash (SJS).

Question 31

What are some side effects of levetiracetam?

Answer 31

Sedation (rare).

Question 32

What are other treatment options for children with intractable epilepsies?

Answer 32

Ketogenic diets (low carb, fat based), Vagal nerve stimulation, Surgery (only in children with epilepsy that has a well-localised structural cause).