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3 - Nervous System > Physiology Epilepsy > Flashcards

Physiology Epilepsy Flashcards

1
Q

What is a seizure?

A

A convulsion or transient abnormal event resulting from a paroxysmal discharge of cerebral neurons

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2
Q

What is epilepsy?

A

The continuing tendency to have a seizure

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3
Q

List the criteria needed to diagnose a seizure.

A

1 - at least two unprovoked seizures occurring more than 24 hours apart
2 - one unprovoked seizure and a probability of further seizures similar to the general recurrence risk after two unprovoked seizures (approx. 75% or more)
3 - at least two seizures in a setting of reflex epilepsy

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4
Q

List the criteria to think about when looking at seizure types.

A

Focal/Generalized/Unknown Onset (area affected)
Level of consciousness
Motor or not

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5
Q

Clonic

A

Shaking/jerking movements

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6
Q

Tonic

A

Being stiff

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7
Q

*Automatisms

A

Automatic behaviours

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8
Q

*Emotions

A

Emotions or appearance of emotions

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9
Q
  • Tonic
A

Extension or flexion postures

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10
Q

*Autonomic

A

Flushing/sweating/piloerection

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11
Q

*Myoclonous

A

Jerking arrhythmically

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12
Q

*Clonus

A

Jerking rhythmically

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13
Q

*Cognitive

A

Language or thinking problems, deja vu

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14
Q

*Eyelid myoclonia

A

Lid jerks

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15
Q

*Atonic

A

Limp

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16
Q

*Sensations

A

Numb/tingling, sounds, smell, tastes, visions, vertigo

17
Q

*Behaviour arrest

A

Pausing, freezing, activity arrest

18
Q

*Hyperkinetic

A

Thrasing/pedaling

19
Q

*Spasm

A

Trunk flexion

20
Q

Why is the level of consciousness a key role in seizures?

A

Importance for driving, safety during seizures, employability, interference with schooling and learning

21
Q

Name some evidence helpful in classifying seizures.

A

Videos brought in by family
EEG patterns
Lesions detected by neuroimaging
Lab results e.g. detection of anti-neuronal antibodies
Gene mutations
Diagnosis of an epilepsy syndrome diagnosis

22
Q

Describe the EEG of a generalized seizure.

A

Sudden onset

All leads/cords have same start and pattern

23
Q

Describe the EEG of a partial/focal seizure.

A

Only some of the leads show disruption

Starts in one place and spreads to become more general

24
Q

List some differential diagnoses of seizures.

A 
Syncope
Migraine
TIA 
Hypoglycaemia 
Panic attacks
Breath holding attacks
Psychogenic non-epileptic seizures
25
Q

Describe some characteristics of non-epileptic seizures.

A 
Gradual onset 
Eye closure
Asymmetrical thrashing movements 
Side to side head movements
Pelvic thrusting 
Lack of stereotypic pattern 
Talking or screaming 
Long duration 
Sudden return to consciousness
Waxing and waning
26
Q

What causes seizures?

A

Genetic predisposition
Developmental e.g. neuronal migration abnormalities
Trauma and surgery
Pyrexia (fever)
Intracranial mass lesions: tumour
Vascular: cerebral infarction, arteriovenous malformation
Drugs and drug withdrawal
Encephalitis and inflammatory conditions
Metabolic abnormalities e.g. hypocalcaemia
Neural degenerative disorders
Provoked seizures: photosensitivity and sleep deprivation

27
Q

What investigations do you need to perform for seizures?

A

Blood tests: FBC, urea and electrolytes, calcium, glucose, CRP, toxin screen
Xray chest (mass in chest metastasized to head)
ECG
EEG
Neuroimaging: CT or MRI
Lumbar puncture if CNS infection a possibility

28
Q

When do you start treatment for seizures?

A

2 or more seizures
Single seizure if risk factors (structural lesion, EEG abnormality, partial seizure, family history of seizures)
Immediate treatment increases time to a second seizure and reduces the time to 2 year remission

29
Q

When do you stop treatment?

A

Consider after 2 years

Do gradually

30
Q

What is status epilepticus?

A

If seizures recur without recovery or a single seizure continues >5min, treat as status elipticus

31
Q

List examples of epilepsy surgery.

A 
Focal resections 
Hemispherectomy 
Large multilobar resections 
Corpus callostomy 
Vagal nerve stimulation
32
Q

Name the drugs for Step 1 (5-20min) of status epilepticus.

A

Lorazepam: 0.1mg/kg up to 4mg IV bolus
or
Diazepam: 0.15 - 0.2mg/kg up to 10mg at 2mg/min
(the above two drugs need to be repeated once every 5-10min if necessary)
or
Midazolam 10mg IV, intramuscular, intranasal or buccal = best option if no immediate IV access

33
Q

Name the drugs used for status epilepticus (step 2: 20-40min)

A

Sodium valproate
Phenytoin
Levetiracetam

34
Q

Name the drugs involved in step 3 (40-60min) of status epilepticus.

A

Induce a drug-induced coma in ICU:
Midazolam
or
Propofol

Monitor EEG to maintain burst suppression pattern

3 - Nervous System (29 decks)

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