Neuro Flashcards
3 of the main epilepsy subtypes
(a) Focal (partial) seizures - one side of brain
- focal aware (simple partial)
- focal impaired awareness (complex partial)
- motor - Jacksonian march
- non-motor - deja vu, aura
(b) Generalised seizures - both sides of brain
- all of these have LOC
- motor - tonic clonic
- non-motor - absence
(c) Focal to bilateral seizures - on one side of brain and spreads to both lobes
Treatment for typical (petit mal) absence seizures
Onset 4-8years
1st line: ethosuximide
2nd line: sodium valproate (or lamotrigine/ levetiracetam if child bearing age)
Treatment for generalised tonic-clonic seizures, myoclonic, tonic/atonic seizures
Sodium valproate
Child bearing women are likely to have: lamotrigine or levetiracetam
Treatment for focal seizures
1st line: lamotrigine or levetiracetam
2nd line: carbamazepine, oxcarbazepine or zonisamide
What anti-epileptic medication can exacerbate absence seizures
Carbamazepine
n.b. carbamazepine is used to treat partial seizures, trigeminal neuralgia and bipolar disorder
Anti-epileptic that is associated with:
(a) neural tube defects
(b) cleft palate
(a) sodium valproate
(b) phenytoin
For women with epilepsy, if a COCP is chosen, it should contain a minimum of how much ethinylestradiol
30 µg
For women taking phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine, which contraceptives are UKMEC 1-3?
UKMEC 3: COCP, POP
UKMEC 2: implant
UKMEC 1: Depo-provera, IUD, IUS
For lamotrigine, which contraceptives are UKMEC 3 and UKMEC 1?
UKMEC 3: COCP
UKMEC 1: POP, implant, Depo-Provera, IUD, IUS
Medications that worsen seizure control are alcohol, drugs, theo/aminophylline, bupropion, methlpenidate, mefanamic acid.
What 2 antibiotics can worsen seizure control in patients with epilepsy?
ciprofloxacin
levofloxacin
Infantile spasms, or West syndrome, is a type of childhood epilepsy which typically presents in the first 4-8 months of life in M>F.
Prognosis is poor but what is the management?
1st line = vigabatrin and high dose prednisolone
Donepezil (ACh-esterase inhibitor) side effects
Sleep disorders - insomnia
Bradycardia
What are the most important anti-epileptic drugs to prescribe by brand
Phenytoin
Carbamazepine
Hoover’s sign
pressure is felt under paretic leg when lifting the non-paretic leg against pressure, this is due to involuntary contralateral hip extension
Lhermitte’s sign
sudden electric shock sensation that occurs when bending the head forward towards the chest in patients with multiple sclerosis
Uhthoff’s sign
multiple sclerosis where the patient’s symptoms can be worsened with heat
Treatment of cluster headaches (acute and prophylactic)
Acute:
1. 100% oxygen
2. Subcutaenous triptans
Prophylaxis:
1. Verapamil
4 main features of PTSD symptoms
- Hypervigiliance
- Flashbacks
- Avoidance
- Emotional numbing
If taking warfarin / heparin, what SSRIs should be considered
NICE guidelines recommend avoiding SSRIs and considering mirtazapine
Reed-Sternberg cells are associated with what cancer
Hodgkin’s lymphoma
What type of lyphoma has alcohol induced lymph node pain
Hodgkin’s lymphoma
What haem cancer is likely to cause:
Painless, non-tender, asymmetrical lymph nodes in the neck (cervical/supraclavicular) > axillary > inguinal
Pel-Ebstein fever
Hodgkin’s lymphoma
Depression (variable appetite, poor sleep) with excess alcohol use may benefit from which antidepressant
Mirtazapine
Difference between viral labyrinthitis vs vestibular neuronitis
viral labyrinthitis = hearing loss and tinnitus are more likely to be present in
vestibular neuronitis = only vestibular nerve is involved so hearing is fine