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Y3 NEUROLOGY > Seizure Disorders > Flashcards

Seizure Disorders Flashcards

1
Q

List risk factors for epilepsy

A 
Birth and abnormal development
Past seizures (inc. febrile fits)
Head injury (LOC)
Family history
Drugs
Alcohol
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2
Q

List drugs that are common precipitants of epilepsy

A 
Antibiotics
Tramadol
Anti-emetics
Opioids
Aminophylline
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3
Q

What is the mandatory first investigation in all patients presenting with a seizure?

A

ECG

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4
Q

Which seizure patients usually qualify for MRI/CT?

A

Intracranial pathology
Trauma
Focal signs
Low GCS

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5
Q

What is the rule regarding driving after your first seizure?

A

Can’t drive until seizure-free for:car: 6 months

hgv: 5 years

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6
Q

What is the rule regarding driving with epilepsy?

A

Can’t drive until seizure-free for:car: 1 year

hgv: 10 years

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7
Q

Define “seizure”

A

Abnormal discharge of electrical activity in the brain

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8
Q

Define “epilepsy”

A

A tendency for repeat epileptic seizures

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9
Q

Define “epileptic seizure”

A

Abnormal synchronisation of neural activity, usually excitatory, causing interruption of brain activity

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10
Q

What are the 2 classifications of epileptic seizure?

A

Focal

Generalised

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11
Q

What is the difference between focal and generalised epileptic seizure?

A

Focal: part of brain structurally abnormal causing focal symptoms e.g. stroke
Generalised: neural cortical pathways conduct seizure to different brain areas

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12
Q

Which is more common in children and young people - focal or generalised epileptic seizures?

A 
Generalised seizures (typically genetic predisposition)
Focal seizure can have onset at any age, more common in adults
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13
Q

What is the treatment of choice for focal seizures?

A

Carbamazepine or Lamotrigine

Sodium valproate is an alternative

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14
Q

What is the treatment of choice for primary generalised epilepsy?

A

Sodium valproate

Lamotrigine as an alternatives

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15
Q

Which patient group in particular should not be given sodium valproate and why? What are the other side effects?

A

Young girls
Teratogenic
Weight gain, hair loss, fatigue

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16
Q

Which epileptic drug can make generalised seizures worse?

A

Carbamazepine

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17
Q

List clinical features of functional non-epileptic attack

A

Prominent motor activity
Collapse
Fear, gasping, hyperventilation
Prolonged duration (up to 20mins)

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18
Q

What is status epilepticus?

A

Recurrent epileptic seizures without full recovery of consciousness, lasting more than 30 minutes

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19
Q

List some precipitants of status epilepticus

A 
Infection
Trauma
Metabolic disorders
Withdrawal of anti-convulsants
Sub-arachnoid haemorrhage
Treating abscence seizures with carbamazepine
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20
Q

Which drug is preferred over diazepam for immediate control of acute seizure?

A

Phenytoin

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21
Q

What are some common differential diagnoses for epilepsy?

A 
Syncope
Non-epileptic attack disorder (pseudoseizures)
Panic attacks
Hyperventilation
Sleep phenomenon
TIA/Migraine/ Hypoglycaemia
22
Q

Which investigation should be performed if primary generalised epilepsy is suspected? What would be the results?

A

EEG

Spike-wave abnormality

23
Q

List the six types of generalised epilepsy. Which is the most common?

A 
Tonic-clonic (most common)
Abscence 
Myoclonic 
Clonic
Tonic 
Atonic
24
Q

What does an abscence seizure look like?

A

Blank out or stare into space for few seconds ‘drop attacks’

25
Q

What does a myoclonic seizure look like?

A

QUICK jerky contraction and relaxation of muscles

26
Q

What does a clonic seizure look like?

A

Rhythmic twitching/jerking of one or several muscles

27
Q

What does a tonic seizure look like?

A

Sudden stiffening and contraction of muscles

28
Q

What does an atonic seizure look like?

A

(loss of muscle tone and strength suddenly)

29
Q

What are the two main types of focal epilepsy?

A

SIMPLE: without impaired consciousness
COMPLEX: With impaired consciousness

30
Q

What are the features of juvenile myoclonic epilepsy?

A

Early morning jerks/clumsiness

Generalised seizure

31
Q

What are the risk factors for juvenile myoclonic epilepsy?

A

Sleep deprivation

‘Flashing lights’

32
Q

In generalised epilepsy there is no apparent cause. True/False?

A

True

33
Q

In focal epilepsy there is no apparent cause. True/False?

A

False

Underlying structural abnormality

34
Q

What is the mechanism of action for most anti-epileptic drugs - phenytoin, carbamazepine, lamotrigine?

A

Inhibit voltage-gated sodium channels (reduce excitability and APs)

35
Q

What is the mechanism of action of sodium valproate?

A

GABA synthesis

36
Q

What class of drug are the majority of anti-epileptics?

A

Anticonvulsants

37
Q

What is the main side effect of levetiracetam?

A

Mood swings

38
Q

What are the main side effects of topiramate?

A

Sedation
Dysphasia
Weight loss

39
Q

Gabapentin/pregabilin are more commonly used for…

A

Neuropathic pain

40
Q

Which medications must you be aware will have reduced efficacy in females when taken with anti-epileptic drugs?

A

CAN INDUCE HEPATIC ENZYMES
Combined oral contraceptive pill
Progesterone only pill
Morning after pill

41
Q

What are the main types of status epilepticus?

A

Generalised convulsive status epilepticus (generlasised convulsions without cessation)
Non-convulsive status (conscious but in altered state)
Epilepsia partialis continua (continual focal seizures, consciousness preserved)

42
Q

What is the main type of acute seizure?

A

Status epilepticus

43
Q

How should status epilepticus be managed?

A

Stabilize patient - ABC
Identify cause - emergency bloods +/- CT
Quick administration of anticonvulsants

44
Q

Which anticonvulsants are used in status epilepticus?

A

Phenytoin
Keppra
Valproate
Benzodiazepines

45
Q

What are the main complications of convulsive status epilepticus?

A 
EXCESS CEREBRAL ENERGY DEMAND + POOR SUBSTRATE DELIVERY = LASTING DAMAGE
Respiratory insufficiency and hypoxia
Hypotension
Hypothermia
Rhabdomyolysis
46
Q

What investigation results would you expect in non-epileptic attack disorder?

A

CNS exam, MRI and EEG normal

47
Q

List some examples of triggers of non-epileptic attack disorders

A

Traumatic events
Physical/ sexual abuse
Stress
Anxiety/ depression

48
Q

Outline the management of non-epileptic attack disorders

A

Stop epileptic treatment e.g. anticonvulsants

Find cause and treat e.g. counselling, CBT

49
Q

What other terms can be used to describe non-epileptic attack disorders?

A

Pseudoseizures
Psychogenic non-epileptic seizures
Dissociated seizures
Functional attacks

50
Q

List the main side effects of lamotrigine

A

Rash

Steven Johnson Syndrome

51
Q

Which drug is used as the 1st line treatment of absence seizures?

A

Ethosuxamide

52
Q

List the main side effects of carbamazepine

A

Blurred vision
Vertigo
Hyponatraemia

Y3 NEUROLOGY (22 decks)

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