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YA - Interactive seminars/University lectures > NEURO - Epilepsy > Flashcards

NEURO - Epilepsy Flashcards

1
Q

Define:

  • ictus
  • seizure
  • epilepsy
A
  • Ictus: Sudden neurological event
  • Seizure: Abnormal, hypersynchronous neural activity
  • Epilepsy: Tendency to repeated, spontaneous seizures
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2
Q

Common seizure types

  • (3) generalised
  • (2) focal
A

Generalised
•Generalised Tonic-Clonic (GTCS)
•Absence
•Myoclonus

Focal
•Dyscognitive
•Evolving to a bilateral, convulsive seizure (Secondarily generalised)

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3
Q

Discuss generalised tonic clonic seizure

  • 2 phases
  • duration
  • injury
  • post event
A
  • Tonic phase: Arms down, Eyes open, Cry
  • Clonic phase
  • Apnoea: Cyanosis or plethora
  • Last 1-5 minutes
  • Minor injury common: Tongue biting
  • Aftergoing confusion: Wake up in the ambulance or ED
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4
Q

Describe absence (generalised) seizure

  • Px
  • duration
  • epidemiology
A
  • Alteration of consciousness: Stay upright, No warning, Difficult to detect
  • Facial twitch: 3Hz Blink, Oral myoclonias, Eyes often drift open
  • Last 2-10 seconds
  • Present in children or teenagers
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5
Q 
Describe myoclonus (generalised) seizure
- Px
A
  • Sudden, involuntary muscle twitch
  • Not specific to seizure: Sleep myoclonus, Common in metabolic encephalopathy
  • Myoclonic seizures: Action related, Appear as prodrome to GTCS
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6
Q

Describe focal seizures

  • area of brain
  • consciousness involvement
  • Px depending on location
  • duration
A 
•Single area of brain
•Without alteration of consciousness
•Features depend on location
- Temporal – Smell, deja-vu
- Motor strip – Localised clonus
- Occipital – Visual hallucinations etc...

•Usually brief

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7
Q

Describe focal dyscognitive seizures

  • area of brain
  • consciousness involvement
  • comparison to absence seizure
A
  • Localised region
  • Affects consciousness: Bilateral temporal lobes involved

•Similar to absence but…

  • Longer
  • Less distinct offset
  • Automatisms
  • Less frequent
  • Preceding simple seizure
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8
Q

Describe childhood absence epilepsy (Petit Mal)

  • onset
  • seizure types
A

•Onset 4-8 years, up to 12

Seizure types
–Absence seizures: Frequent - many / day
–Generalized Tonic-Clonic Seizures: 40%, Adolescence

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9
Q

Describe juvenile absence epilepsy

  • onset
  • seizure types
A

•Onset: adolescence
•Seizure types
–Generalized Tonic-Clonic Seizures
–Absence seizures: infrequent, Absence Status

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10
Q

Describe juvenile myoclonic epilepsy (Janz)

  • onset
  • seizure types
  • other associated features
  • prognosis
A 
•Onset 12 - 18 years
•Seizure types
–Myoclonus
–GTCS (general tonic clonic seizure)
–Absences in 30%
•Photosensitive
•Sleep-wake cycle
•May evolve from CAE
•Prognosis
–Not often refractory
–Spontaneous remission rare
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11
Q

Difference between seizure type & epilepsy syndrome

A

Seizure type:

  • clinical characteristics (Seizure, pts)
  • EEG features

Epilepsy syndrome:

  • seizure types
  • age
  • clinical course
  • interictal EEG
  • MRI
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12
Q

(3) DDx of a seizure

A
  • Syncope
  • TIA
  • Psychogenic pseudoseizure
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13
Q

Discuss syncope

  • causes
  • Px
A

•Cause: Insufficient cerebral blood flow

  • Neurocardiogenic
  • Orthostatic
  • Cardiac

•Collapse and LOC

  • Convulsion
  • Urinary incontinence
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14
Q

Hx of a syncope

  • before
  • during
  • after
A

Before:

  • predisposition
  • trigger
  • pre-syncope (prodrome)

During:

  • Px
  • convulsion?
  • other associated features to DDx causes of syncope/seizure

After:

  • recovery
  • confusion?
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15
Q

(5) Typical predispositions of syncope

A
  • Dehydration
  • Anti-hypertensives
  • Prolonged standing
  • Stressful situation
  • Recent awakening
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16
Q

(4) Triggers of syncope

A
  • Emotional
  • Valsalva
  • Pain
  • Postural change
17
Q

(3) pre-syncope Px (prodromes)

A 
•“Dizziness”
•Feeling of distance
•Visual disturbance
–Silver flickers
–Greying of vision
18
Q

(3) Predisposition & triggers of seizure

A

–Sleep deprivation
–Hang-over or abrupt abstinence
–Flicker

19
Q

What (2) medications can induce seizures?

A

–Clozapine

–Tramadol

20
Q

What should you ask in a syncope pt?

A

•Previous syncope and presyncope
•Recent medication changes
•Drugs
–Amphetamines

21
Q

Features of psychogenic pseudoseizure

A
  • Fluctuating intensity
  • Very long
  • Eyes closed: Pseudo-sleep
  • Non-anatomical tremor
  • Reactive
  • Consciousness retained: Usually denied
22
Q

Difference between epilepsy & seizure

A

Epilepsy is a disorder characterized by recurring seizures (also known as “seizure disorder”)

A seizure is a brief, temporary
disturbance in the electrical activity of the brain

23
Q

Comment on ictal & interictal EEG

A

Ictal EEG:
•Almost always abnormal in seizure
•Perfect for pseudoseizure

Interictal EEG:
•Diagnostic test for epilepsy, not seizure
–Prognosis
–Epilepsy syndrome diagnosis
•Most abnormal patterns also seen in normals
–Normal patterns often interpreted as abnormal

24
Q

Prognosis of single seizure presentation

  • % recurrence at one year
  • % recurrence long term
A
  • Most recurrence early
  • 40% recur at one year
  • Just over 50% long term
25
Q

Can early treatment change prognosis in seizures?

A

–Better early seizure freedom if treated early

–BUT By five years outcome identical

26
Q

Is not treating the first seizure dangerous?

A

No.

Only elevated due to underlying condition

Recurrent seizures not a big mortality risk

27
Q

How do you diagnose epilepsy?

A
  • History of minor seizures: Focal, Myoclonus
  • Await recurrence
  • Epileptiform EEG
  • Epileptogenic MRI lesion
28
Q

What should you educate the pt on with diagnosis of epilepsy?

A 
Safety
•Swimming
•Heights
•Work
•Triggers: Alcohol, Sleep

Conditions on driving (Allowed after 6-12 months of seizure free)

29
Q

Discuss the basics of treating epilepsy

A

Do not treat unless prolonged & recurrent.

Acute seizures
•Almost always self limiting
•Only need to treat acutely if;
–Prolonged
–Recurrent
•Seizure termination
–Benzodiazepines
•Acute prophylaxis
–Benzodiazepines
–Phenytoin (Levetiracetam, Valproate)
30
Q

What (2) medications are seizure-prophylactics?

A

Benzodiazepines

Phenytoin (Levetiracetam, Valproate)

31
Q

What (1) medication can help terminate an acute seizure?

A

Benzodiazepines

32
Q

Discuss SUDEP (Sudden Unexpected Death in Epilepsy)

  • rate in epilepsy
  • likely due to..
  • related factor
A

•High rate of sudden death in epilepsy
–1-2 per 1000 patient years. 20-fold increase in 18-35yo
–Likely cardio-respiratory arrest: Often in sleep

•Related to seizure frequency
–Risk much reduced by seizure freedom
–6-9 per 1000 patient years in refractory focal epilepsy

YA - Interactive seminars/University lectures (87 decks)

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