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Neurology > Patho- Epilepsy > Flashcards

Patho- Epilepsy Flashcards

1
Q

What is epilepsy?

A

A group of CNS disorders in which recurrent seizures occur, due to chronic underlying processes

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2
Q

What are the two main pathologies of epilepsy?

A

Primary/idiopathic

Secondary/symptomatic

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3
Q

What is primary epilepsy?

A

No causative event behind it

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4
Q

What is secondary epilepsy?

A

Epilepsy caused by something else

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5
Q

What can cause secondary epilepsy?

A 
Trauma
Neoplasm
Hydrocephalus
Infection
Developmental abnormalities
Cerebrovascular disease
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6
Q

What are the two main categories of epilepsy?

A

Generalised

Focal

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7
Q

Which part of the brain does generalised epilepsy affect?

A

All of it

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8
Q

Name some forms of generalised seizures

A 
Grand mal/generalised tonic-clonic
Petit mal/absence
Myoclonic
Tonic
Atonic
Akinetic
Infantile spasms/febrile convulsions
Functional
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9
Q

What is a differential for generalised seizures?

A

Vasovagal

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10
Q

What is vasovagal reaction?

A

Loss of consciousness due to reacting to trigger (blood etc).
Quick recovery

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11
Q

Describe grand mal/generalised tonic-clonic

A

Tonic rigidity followed by a tremor.

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12
Q

What is the tonic phase?

A

Body rigidity

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13
Q

What can happen in the tonic phase?

A

Incontinence

Tongue biting

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14
Q

How long does a tonic episode tend to last?

A

Seconds to a minute

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15
Q

What is a clonic phase?

A

Convulsions

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16
Q

What can happen in a clonic phase?

A

Mouth frothing

Jerking

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17
Q

How long can a clonic phase last?

A

Minutes

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18
Q

What follows a generalised tonic-clonic seizure?

A

Drowsiness, confusion or coma

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19
Q

IS it possible to be conscious during a seizure?

A

No- if conscious then cannot be epilepsy!!!

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20
Q

How do you treat a generalised tonic-clonic seizure?

A

Leave generally and will resolve

Diazepam or phenytoin

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21
Q

How do you prevent generalised tonic-clonic seizures?

A

Sodium valproate
Lamotrigine in women of childbearing age
Carbamazepine

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22
Q

What causes an absence seizure?

A

Developmental abnormalities of neuronal control.

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23
Q

What are the symptoms of an absence seizure?

A

10-45 s (maybe 100/day) with consciousness altered- blank out.
3 Hz spike-and-wave EEG activity
Mild clonic spasms may occur

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24
Q

Who develops absence seizures?

A

Children

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25
Q

How do you prevent absence seizures?

A

Ethosxumide

Valproate

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26
Q

What must you NOT give to those with absence seizures?

A

Carbamazepine

Phenytoin

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27
Q

What is myoclonic seizure?

A

Isolated clonic jerks

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28
Q

How does myoclonic seizure present on EEG?

A

3Hz spike and wave

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29
Q

WHat are the symptoms of a myoclonic seizure?

A

Rhythmic series of clonic seizures

Isolated clonic jerks

30
Q

How do you prevent a myoclonic seizure?

A

Sodium valproate
Clonazepam
Lamotrigine

31
Q

What should you not give to someone with myoclonic seizures?

A

Carbamazepine

32
Q

What is a tonic seizure?

A

Intense stiffening of body without jerks

33
Q

What is an atonic seizure?

A

Sudden loss of posture leading to collapse

34
Q

What is an akinetic seizure?

A

Cessation of movement, falling and loss of consciousness

35
Q

What is an Infantile spasms/febrile convulsions?

A

A syndrome with bilateral attacks of brief recurrent myoclonic jerks.

36
Q

What causes Infantile spasms/febrile convulsions?

A

Fever

37
Q

How do you treat an Infantile spasms/febrile convulsions?

A

Leave if under 15m

Diazepam >15m

38
Q

What is a functional seizure?

A

Trigger will cause the person to trash when they see or hear something

39
Q

What is a functional seizure often a sign of?

A

Abuse

40
Q

What are partial seizures?

A

Seizure affecting only one part of the brain

41
Q

Give some examples of partial seizures

A

Simple partial
Complex partial
Temporal lobe
Partial seizures secondarily generalized

42
Q

What is a Partial seizures secondarily generalized?

A

Partial seizure immediately preceding a GTC seizure

43
Q

What is a simple partial seizure?

A

Just motor clonic restricted to one or a few muscles

44
Q

Where does a simple partial seizure originate?

A

Motor cortex

45
Q

What is The March of the Seizures?

A

In simple partial the clonic movement starts at the edge of the mouth and moves elsewhere

46
Q

How is consciousness impaired in a simple partial seizure?

A

No concious loss

47
Q

What is complex partial seizure?

A

SImilar to simple but with consciousness impairment/confusion/falling and Automatisms

48
Q

What are Automatisms?

A

Unconscious movement that may resemble simple repetitive tics

49
Q

What are some symptoms of a temporal lobe seizure?

A

Feeling of unreality or undue familiarity with the surroundings
Blank episodes of staring, vertigo, visual hallucinations
Auditory and balance affected
“Reality is unreal”

50
Q

What is the buzzword for a temporal lobe seizure?

A

Lipsmacking

51
Q

How do you treat partial seizures?

A

Carbamazepine or lamotrigine

52
Q

What is status epilepticus?

A

A life-threatening neurological condition defined as 5 or more minutes of either continuous seizure activity or repetitive seizures without regaining consciousness.
Used to be 30 minutes

53
Q

How serious is status epilepticus?

A

Medical emergency!

54
Q

What is the pathophysiology of epilepsy?

A

High frequency AP bursts
Hypersynchronization
Failure of synaptic inhibition

55
Q

What is the seizure threshold?

A

The minimum threshold at which seizures will occur

56
Q

How do you diagnose epilepsy?

A

EEG
History
Rule out syncope- BP and ECG

57
Q

How do you rule out syncope?

A

BP and ECG

58
Q

How does a seizure appear on EEG?

A

High voltage spike-and-wave activity

Normal between attacks

59
Q

When should you CT in epilepsy?

A 
Clinical or radiological skull fracture
 Deteriorating GCS
 Focal signs 
 Head injury with seizure 
 Failure to be GCS 15/15 4 hours after arrival 
Suggestion of other pathology (e.g. SAH)
60
Q

How do you actually treat epilepsy?

A 
Leave
Diazepam
Midazolam
Phenytoin
Treat underlying cause (hypoglycemia etc)
61
Q

What are some side effects of phenytoin?

A

Gum hypertrophy

Hirtuism

62
Q

How often should phenytoin be given?

A

Once a day MAX!

63
Q

How should epilepsy prophylaxis be given?

A

Start low and go slow

64
Q

Name four main antiepileptic drugs for prophylaxis

A

Clonazepam
Sodium valproate
Carbamazepine
Lamotrigine

65
Q

What are the side effects of Lamotrigine?

A

Rash

Headache

66
Q

What is clonazepam mainly used for?

A

Myotonic seizures

67
Q

What are some side effects of clonazepam?

A

Sleep

68
Q

What group should sodium valproate not be given to?

A

WOmen of child bearing age

69
Q

What are some side effects of sodium valproate?

A 
Weight gain/appetite stim
Teratogenic
Hair loss
Thrombocytopenia
Fatigue
Tremor
70
Q

What are some side effects of Carbamazepine?

A 
Presyncope
Nausea
Headache
Hyponatremia
Rash
71
Q

What can Carbamazepine interfere with?

A

Morning after pill

Neurology (30 decks)

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