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Year 4 - PAN > Neurology - Epilepsy > Flashcards

Neurology - Epilepsy Flashcards

1
Q

Definition of epilepsy

A

Paroxysmal electrical discharge of cerebral neurons causing a variety of clinical seizure patterns

Single seizure is NOT epilepsy - diagnosis requires recurrent seizures

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2
Q

How are epileptic seizures classified?

A

2 types of seizure:

  • Focal (partial) - seizures that start locally
  • Generalized - no evidence of focal onset
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3
Q

Can focal (partial) seizures be sub-classified?

A

Yes

  1. ) Simple partial seizures - consciousness retained throughout the attack
  2. ) Complex partial seizures - consciousness is impaired at any stage
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4
Q

Secondary generalization

A

Partial seizure becomes generalized

Patient loses consciousness with clinical evidence of spread across the cerebral cortex

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5
Q

Aetiology

A
  1. ) Idiopathic - majority of patients
    - includes patients who have suffered intrauterine, perinatal or neonatal insults or genetic

2.) Symptomatic - cause can be found

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6
Q

Causes of symptomatic epilepsy in neonates

A

(Cerebral disorders, metabolic, drug intake)

  1. ) Birth trauma
  2. ) Intracranial haemorrhage
  3. ) Hypoxia
  4. ) Hypoglycaemia
  5. ) Hypocalcaemia or hypomagnesaemia
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7
Q

Causes of symptomatic epilepsy in children

A

(Cerebral disorders, metabolic, drug intake)

  1. ) Congenital anomalies - e.g. hippocampal sclerosis
  2. ) Tuberous sclerosis
  3. ) Metabolic storage disease
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8
Q

Causes of symptomatic epilepsy in young adults

A
  1. ) Post- traumatic (e.g. head injury)
  2. ) Drugs - amphetamines, TCAs, phenothiazines
  3. ) Alcohol - head injury whilst intoxicated, severe intoxication
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9
Q

Causes of symptomatic epilepsy in middle aged adults

A

Cerebral tumour

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10
Q

Causes of symptomatic epilepsy in the elderly

A

Cerebrovascular disease

Degenerative diseases - e.g. Alzheimer’s, Huntington’s

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11
Q

What infections can cause epilepsy?

- what should you especially consider in AIDs patients and travelers?

A

Encephalitis
Bacterial meningitis
Cerebral abscess
Toxoplasmosis (consider in AIDs)
Cysticercosis (parasitic tapeworm infection)
Syphilis
Falciparum malaria (consider in travellers)

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12
Q

What are the differential diagnosis to exclude in epilepsy?

A

Consider other causes of loss of consciousness - “CRASH”

  1. ) Cardiac - bradycardia (e.g heart block - Stokes-Adams attack), tachycardia (e.g. AF, WPW), structural (i.e. causing low cardiac output states - LVF, Aortic stenosis, HOCM, myxoma, PE)
  2. ) Reflexes - either vagal overactivity or sympathetic under activity
  3. ) Arterial - e.g. vertebrobasilar insufficiency (TIA, CVA, subclavian steal); Shock; hypertension
  4. ) Systemic - e.g. metabolic (hypoglycaemia), respiratory (hypoxia or hypercapnia), blood (anaemia or hyper viscosity)
  5. ) Head - e.g. epileptic attacks, non epileptic attacks, drop attacks
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13
Q

Distinguishing faints from seizures

A

Epileptics are:

  • stiff, not floppy
  • staring open eyes rather than half open
  • no memory of the fall
  • tongue biting
  • take over 30s to recover
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14
Q

How many people die from epilepsy per year?

A

2 per 100,000

Most common cause of death is status or accidental head injury following a seizure

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15
Q

Primary generalized epilepsy - features

- what is the most common type of seizure in this syndrome?

A

Adult epileptic syndrome
Tonic-clonic or grand mal is most typical seizure type
- 50% cases preceded by aura
- Loss of consciousness and tonic phase (approx 30s)
- Clonic phase follows in all limbs (micturition and tongue biting)
- Patients normally sleep for 1-2 hours after

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16
Q

Temporal lobe epilepsy - features

A 
Partial epilepsy (adult epileptic syndrome)
Aura may consist of psychic symptoms (e.g. fear or deja vu), hallucinations, or rising sensation in epigastrium

Patient may be confused and anxious and exhibit automatisms (organised stereotyped movements) - e.g. chewing, lip smacking

17
Q

Jacksonian epilepsy - features

- what is this type of epilepsy normally associated with?

A

Focal motor attacks
Begin in corner of mouth, toe or index finger and spread to the face or ascend the limb (Jacksonian march)

Normally associated with organic brain disease - e.g. tumour

18
Q

What is Todd’s paralysis?

A

Muscles affected by Jacksonian seizure may be weak for several hours after

19
Q

Epilepsia partialis continua

A

Rare form of Jacksonian epilepsy where seizures persist for prolonged periods of time - e.g. days or weeks

20
Q

Key features of febrile convulsions

A

Usually brief and generalized (last less than 15 minutes)
Occur as an isolated attack without recurrence in 70% of cases
Carry a risk of subsequent epilepsy in 5% of cases
Generally do NOT require treatment with prophylactic anti convulsants

21
Q

Absence seizures (petit mal)

A

Generalized seizure (childhood epilepsy)
Features are “ABSENCES”
- ABrupt onset and offset
- Short

22
Q

Do absence seizures progress beyond puberty?

A

Most stop during puberty

5-10% develop adult seizures

23
Q

Infantile spasms (West’s syndrome)

A 
Childhood epilepsy 
Brief spasms ("shock like" - arm flexion, drawing up of knees) associated with progressive learning difficulties
24
Q

Juvenille myoclonic epilepsy

A

Childhood primary generalized epilepsy
Typical onset in teenagers
Infrequent generalised seizures, daytime absences and myoclonus (sudden limb, face or trunk jerk)

25
Q

Investigations in epilepsy

A

Bloods - U&E’s (alcohol, sodium, calcium)
Urine toxicology
ECG
Imaging

26
Q

Indications for an EEG in epilepsy

A

Use to support the diagnosis (cannot exclude or prove)

Helps classification and prognosis

27
Q

Indications for neuroimaging in epilepsy

A

Not routine for idiopathic epilepsy
Adult onset seizures
Any evidence of focal onset (localizing features)
Seizures continuing despite 1st line Rx

28
Q

Localised functions of the frontal lobe

A
  • Higher intellectual function
  • Personality, mood
  • Social conduct
  • Motor areas (primary motor area)
  • Frontal eye fields (conjugate eye movements)
  • Language, dominant hemisphere (Broca’s area/ expressive)
29
Q

What are the functions of the temporal lobe?

A
  • Memory
  • Language (dominant hemisphere)
  • Visual pathway (optic radiation)
30
Q

Localised functions of the occipital lobe

A
  • Visual cortex and visual association areas
31
Q

What are the functions of the parietal lobe?

A

Dominant hemisphere:

  • Language, dominant hemisphere (Wernike’s area/ receptive)
  • Calculation
  • Praxis (complex motor tasks)

Non dominant hemisphere:
- Visuo-spatial function

Both hemispheres:

  • Higher sensory function
  • Visual pathway (optic radiation)

Year 4 - PAN (43 decks)

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