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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
What does a myoclonic seizure look like?
QUICK jerky contraction and relaxation of muscles
26
What does a clonic seizure look like?
Rhythmic twitching/jerking of one or several muscles
27
What does a tonic seizure look like?
Sudden stiffening and contraction of muscles
28
What does an atonic seizure look like?
(loss of muscle tone and strength suddenly)
29
What are the two main types of focal epilepsy?
SIMPLE: without impaired consciousness COMPLEX: With impaired consciousness
30
What are the features of juvenile myoclonic epilepsy?
Early morning jerks/clumsiness | Generalised seizure
31
What are the risk factors for juvenile myoclonic epilepsy?
Sleep deprivation | 'Flashing lights'
32
In generalised epilepsy there is no apparent cause. True/False?
True
33
In focal epilepsy there is no apparent cause. True/False?
False | Underlying structural abnormality
34
What is the mechanism of action for most anti-epileptic drugs - phenytoin, carbamazepine, lamotrigine?
Inhibit voltage-gated sodium channels (reduce excitability and APs)
35
What is the mechanism of action of sodium valproate?
GABA synthesis
36
What class of drug are the majority of anti-epileptics?
Anticonvulsants
37
What is the main side effect of levetiracetam?
Mood swings
38
What are the main side effects of topiramate?
Sedation Dysphasia Weight loss
39
Gabapentin/pregabilin are more commonly used for...
Neuropathic pain
40
Which medications must you be aware will have reduced efficacy in females when taken with anti-epileptic drugs?
CAN INDUCE HEPATIC ENZYMES Combined oral contraceptive pill Progesterone only pill Morning after pill
41
What are the main types of status epilepticus?
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
What is the main type of acute seizure?
Status epilepticus
43
How should status epilepticus be managed?
Stabilize patient - ABC Identify cause - emergency bloods +/- CT Quick administration of anticonvulsants
44
Which anticonvulsants are used in status epilepticus?
Phenytoin Keppra Valproate Benzodiazepines
45
What are the main complications of convulsive status epilepticus?
``` EXCESS CEREBRAL ENERGY DEMAND + POOR SUBSTRATE DELIVERY = LASTING DAMAGE Respiratory insufficiency and hypoxia Hypotension Hypothermia Rhabdomyolysis ```
46
What investigation results would you expect in non-epileptic attack disorder?
CNS exam, MRI and EEG normal
47
List some examples of triggers of non-epileptic attack disorders
Traumatic events Physical/ sexual abuse Stress Anxiety/ depression
48
Outline the management of non-epileptic attack disorders
Stop epileptic treatment e.g. anticonvulsants | Find cause and treat e.g. counselling, CBT
49
What other terms can be used to describe non-epileptic attack disorders?
Pseudoseizures Psychogenic non-epileptic seizures Dissociated seizures Functional attacks
50
List the main side effects of lamotrigine
Rash | Steven Johnson Syndrome
51
Which drug is used as the 1st line treatment of absence seizures?
Ethosuxamide
52
List the main side effects of carbamazepine
Blurred vision Vertigo Hyponatraemia

Y3 NEUROLOGY (22 decks)

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