Revision - Epilepsy & Headache Flashcards by Esme Cosham

What age do febcons typically occur in?

6m - 5y

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What happens in a myoclonic seizure?

Sudden, brief muscle contractions

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What happens in a tonic vs atonic seizure?

Tonic - sudden increase in muscle tone

Atonic - sudden loss of muscle tone (drop attack)

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What may atonic seizures be indicative of?

Lennox-Gastaut syndrome

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When do infantile spasms typically start?

First 6m of life

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What 3 features are seen in infantile spasms?

1) Flexion of trunk, limbs –> extension of arms (Salaam attack)

2) Progressive mental handicap

3) EEG: hypsarrhythmia

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Mx of infantile spasms?

1) ACTH

2) Vigabatrin

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Driving following 1st seizure vs established epilepsy?

1st seizure - must not drive for 6 months

Established epilepsy - must be seizure free for a year

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Mechanism of sodium valproate?

Increases GABA

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Side effects of sodium valproate?

1) Teratogenic (harmful in pregnancy)
2) Liver damage and hepatitis
3) Hair loss (regrowth may be curly)
4) Tremor
5) Reduce fertility
6) Ataxia
7) Increased appetite and weight gain

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1st & 2nd line antiepileptics in partial/focal seizures?

1st –> lamotrigine or levetiracetam

2nd –> carbamazepine

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How does sodium valproate interact with the P450 system?

Inhibitor

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How does carbamazepine interact with the P450 system?

Inducer

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Side effects of carbamazepine?

1) dizziness and ataxia
2) drowsiness
3) leucopenia and agranulocytosis
4) SIADH
5) visual disturbances (especially diplopia)

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Which antiepileptic can cause SIADH?

Carbamazepine

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1st line antiepileptics in myoclonic seizures?

Men - sodium valproate

Women - levetiracetam

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1st line antiepileptics in tonic and atonic seizures?

Men - sodium valproate

Women - lamotrigine

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1st line antiepileptics in absence seizures?

Men & women –> ethosuximide

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What type of anaemia can phenytoin cause?

Megaloblastic

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Mx of status epilepticus? (if IV access)

ABCDE

1) IV lorazepam 4mg

wait 5 mins

2) IV lorazepam 4mg

wait 5 mins

3) IV levetiracetam (or phenytoin or valproate)

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What obs is always essential in a seizure?

Blood glucose

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1st line mx of status epilepticus if no IV access?

Buccal or IM midazolam 10mg

Or rectal diazepam 10mg

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1st line management of generalised tonic-clonic seizures in males and females?

Males - sodium valproate

Females - lamotrigine or levetiracetam

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Which antiepileptic may exacerbate absence seizures?

Carbamazepine

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What location seizure may there be paraesthesia?

Parietal lobe

What location seizure may there be flashes/floaters?

Occipital lobe

first-line for chronic or frequent tension headaches?

Amitriptyline

Management of prolonged (over 10 days) cases of sinusitis?

1) Steroid nasal spray 2) Abx (phenoxymethylpenicillin first-line) 3) 3) Leukotriene inhibitors e.g. montelukast

What are hormonal headaches related to?

Low oestrogen Tend to occur 2 before and the first 3 days of the menstrual period

When should a headache in pregnancy prompt investigations for pre-eclampsia?

In the 2nd half of pregnancy

Treatment options in hormonal headaches?

1) Triptans 2) NSAIDs

What is cervical spondylosis?

Degenerative changes in the cervical spine

Presentation of cervical spondylosis?

1) Neck pain worse on movement 2) Headache

What condition is trigeminal neuralgia associated with?

What 4 main types can migraine be categorised into?

1) Migraine without aura 2) Migraine with aura 3) Hemiplegic migraine 4) Silent migraine

What is a silent migraine?

Migraine with aura but WITHOUT a headache

What is the main feature of hemiplegic migraines?

Unilateral limb weakness

What is familial hemiplegic migraine?

An autosomal dominant genetic condition characterised by hemiplegic migraines that run in families.

Management of acute migraine?

1) NSAIDs (e.g., ibuprofen or naproxen) 2) Paracetamol 3) Triptans (e.g., sumatriptan) 4) Antiemetics if vomiting occurs (e.g., metoclopramide or prochlorperazine)

What class of drug are triptans?

5-HT3 agonists (stimulate serotonin receptors)

Can a 2nd dose of triptans be taken for a migraine attack?

If the attack resolves and then reoccurs, another dose can be taken If it does not work the first time, another second dose should NOT be taken for the same attack.

What are the main contraindications to triptans?

Related to risks of vasoconstriction associated with triptans: - HTN - Coronary artery disease - Previous stroke, TIA or MI

What prophylactic medications can be used to reduce the frequency and severity of migraine attacks?

1) Propanolol 2) Amitriptyline 3) Topiramate (teratogenic)

What is a medical prophylaxis management for menstrual migraines?

Prophylactic triptans

How long do clusters typically last?

4-12 weeks, up to 4 episodes a day

Investigation of choice in cluster headaches?

MRI with gadolinium contrast

Management of an acute attack of a cluster headache?

1) High flow 100% O2 2) Triptans

1st line drug for prophylaxis of cluster headaches?

Verapamil

What makes a febrile convulsion 'complex'?

- >15 mins - more focal features e.g. movement limited to only one side of the body - recur within 24 hours or within the same illness - prolonged post-ictal period

Incomplete immunisation against which 2 pathogens are a risk factor for CNS infection in children?

1) Strep. pneumoniae 2) H. influenzae

What is Todd’s paresis?

Transient hemiparesis following a seizure. This is a potential short-term complication of complex or focal seizures in particular, and usually subsides completely within 48 hours.

What lobe is affected in a Jacksonian march?

Frontal lobe

What lobe is affected in a seizure with postictal weakness?

Frontal

When are myoclonic jerks in JME most common?

Shortly after waking or following sleep deprivation

What is the typical age of onset of JME?

Teenage years, more common in girls

What is management of JME?

usually good response to sodium valproate

What 2 medications does management of infantile spasms involve?

1) Prednisolone 2) Vigabatrin

What is Lennox-Gastaut syndrome? Features? EEG finding?

Multiple seizure types. Features: - atypical absences, falls, jerks - 90% moderate-severe mental handicap EEG –> slow spike

What EEG feature is seen in Lennox-Gastaut?

Slow spike

What may be beneficial in the management of Lennox-Gastaut syndrome?

Ketogenic diet

What is benign rolandic epilepsy? Features?

Most common in childhood, more common in males. Features: paraesthesia (e.g. unilateral face), usually on waking up.

Notable side effects of carbamazepine?

1) Agranulocytosis 2) Aplastic anaemia 3) Induces the P450 system so there are many drug interactions

Notable side effects of phenytoin?

1) Folate and vitamin D deficiency 2) Megaloblastic anaemia (folate deficiency) 3) Osteomalacia (vitamin D deficiency)

Notable side effects of ethosuximide?

1) night terrors 2) rashes

Which antiepileptic can cause night terrors?

Ethosuximide

Which antiepileptic can cause hair loss?

Sodium valproate

Are antiepileptics safe in breastfeeding?

Yes - most are safe

Key side effect of doxycycline?

Photosensitivity

What is the most common cause of 1ary headache in children?

Migraine without aura

How long can an episode of cluster headache last?

15 mins to 2 hours

What lobe is affected in a seizure featuring post-ictal dysphasia?

Temporal lobe

Visual field defect caused by pituitary adenoma vs craniopharyngioma?

Pituitary adenoma - bitemporal superior quadrantanopia Craniopharyngioma - bitemporal inferior quadrantanopia

What is the most common complication of roseola infantum?

Febrile convulsion

Headache linked to valsalva manoeuvres?

Raised ICP until proven otherwise

What dose of lorazepam is given in status epilepticus?

4mg

What medication may specialists consider prescribing as rescue medication for recurrent febrile seizures?

Buccal midazolam or rectal diazepam

How can a posterior communicating artery aneurysm affect the eyes?

Can cause a painful CN III (oculomotor) nerve palsy: - ptosis - diplopia - lateral deviation of eye Compression of the oculomotor nerve at the junction of the posterior communicating artery and the internal carotid artery.

What blood test can be used to differentiate between a true seizure and a pseudoseizure?

Prolactin

EEG feature of benign rolandic epilepsy?

Centrotemporal spikes

What is benign rolandic epilepsy characterised by?

Partial seizures at night

When should parents be advised to call an ambulance in a febcon?

>5 mins

What is used for cluster headache prophylaxis?

Verapamil

Mx of medication overuse headaches?

simple analgesia + triptans: stop abruptly opioid analgesia: withdraw gradually

How are triptans given in the acute mx of a cluster headache?

Onset of pseudo vs true seizures?

Pseudo - gradual onset True - sudden onset

What triad of features is seen in PD?

1) Tremor 2) Bradykinesia 3) Rigidity

Are the symptoms of PD characteristically symmetrical or asymmetrical?

Asymmetrical

Is PD more common in men or women?

2x more common in men

What is the frequency of the tremor in PD?

3-5 Hz

When is the tremor in PD most marked?

At rest When the patient is distracted: e.g. Performing a task with the other hand (e.g., miming the act of painting a fence) exaggerates the tremor.

When does the tremor in PD improve?

With voluntary movement