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Neurology > Seizure Disorders > Flashcards

Seizure Disorders Flashcards

1
Q

define epilepsy

A

recurrent tendency to spontaneous abnormal electrical activity in the brain causing convulsions and abnormal behaviour

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2
Q

what are the underlying causes of epilepsy

A

idiopathic
structural abnormalities
childhood febrile convulsions

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3
Q

what structural abnormalities can predispose to epilepsy

A

SOL
developmental abnormalities
head injury

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4
Q

what is a prodrome

A

the period before a seizure occurs where specific symptoms occur

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5
Q

what features occur during a prodrome

A

deja vu
flashing lights
funny taste/smell
strange feeling in gut

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6
Q

describe the period of a seizure

A

period in which the patient loses awareness/becomes unresponsive
generally lasts less than 5 minutes
associated with tongue biting and incontinence

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7
Q

what features occur during the post-ictal state following a seizure

A

confusion
headache
muscle ache and weakness
Todd’s palsy

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8
Q

what is Todd’s palsy

A

temporary weakness following a seizure

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9
Q

what are the two different types of seizures that occur

A

focal

generalised

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10
Q

what is the difference between focal and generalised seizures

A

focal - occurs in one area of the brain

generalised - abnormal activity in multiple area of the brain

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11
Q

who is most likely to have partial seizures

A

older people

those with an underlying structural abnormality

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12
Q

what is the difference between simple and complex partial seizures

A

simple - no loss of awareness or post octal symptoms

complex - loss of awareness, aura and post-ictal symptoms

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13
Q

list some features of a partial seizure in the temporal lobe

A 
dysphasia
emotional disturbance 
visual/auditory hallucinations 
lip smacking/grabbing
odd taste/smell
flashbacks
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14
Q

list some features of a partial seizures in the frontal lobe

A

dysphasia
posturing movements
behavioural symptoms
Jacksonian seizures

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15
Q

sensory disturbance is most likely a partial seizure in which lobe of the brain

A

parietal lobe

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16
Q

who is most likely to develop generalised seizures

A

young people

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17
Q

list some triggers for bringing on generalised seizures

A

flashing lights

sleep deprivation

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18
Q

describe the tonic phase of a tonic clonic seizure

A

patient falls to the ground, becomes rigid and cyanosed as they stop breathing
tongue biting and urinary incontinence
usually lasts 1 minute

19
Q

describe the clonic phase of a tonic clonic seizure

A

asymmetrical convulsive jerks
eyes roll to the back of the head and breathing starts again
can last several minutes

20
Q

describe an absence seizure

A

brief lapse in awareness in which the patient stops what they are doing and stares blankly
EEG spike and wave at 4Hz

21
Q

describe myoclonic seizures

A

seizures that manifest as clonic like jerks without the tonic contractions

22
Q

give an example of a myoclonic seizure

A

juvenile myoclonic epilepsy

23
Q

describe the presentation of myoclonic epilepsy

A

presents in puberty
associated with early morning seizures
brought on by lack of sleep, bright lights and alcohol

24
Q

describe an atonic seizure

A

seizure that manifests as sudden loss of muscle tone with the maintenance of consciousness

25
Q

when is imaging indicated in epilepsy

A

to identify a structural abnormality

26
Q

what are the indications for an EEG

A

to classify epilepsy
confirm non epileptic attacks
evaluate patients being considered for surgery
to confirm non-convulsive status epilepticus

27
Q

what is the first line management for generalised seizures

A

sodium valproate
lamotrigine
levetiracetram

28
Q

what is the first line management for focal seizures

A

carbamazepine

29
Q

which anti-convulsant is contraindicated in generalised seizures and why

A

carbamazepine makes generalised seizures worse

30
Q

when is sodium valproate not a first line drug for generalised seizures

A

for young women due to teratogenicity

31
Q

what are the side effects of sodium valproate

A 
nausea
tremor 
oedema
ataxia 
weight gain
liver failure/pancreatitis 
thrombocytopenia 
irreversible hair loss
32
Q

what are the side effects of lamotrigine

A 
maculo-papular rash
Steven-Johnson syndrome 
DIC 
tremor 
diplopia
33
Q

most epilepsy patients are on how many drugs

A

just one, usually increase dose to be suitable

34
Q

what is SUDEP

A

sudden unexplained death in epilepsy

increased risk if epilepsy is poorly controlled, patient smokes, drinks or takes drugs

35
Q

if a patient with epilepsy has a seizure, how long can they not drive for

A

car - 1 year

HGV - 10 years

36
Q

what are the issues that can occur with AEDs and contraception

A

most AEDs are liver enzyme inducers which reduce the efficacy of COCP and progesterone only contraceptives

37
Q

what must be discussed with pregnancy and epilepsy

A

pre-pregnancy counselling about risk of congenital anomalies with AEDs - take high dose folic acid
drugs can also be passed through breast milk

38
Q

define status epilepticus

A

seizure that lasts more than 5 minutes
multiple seizures within 30 minutes
second seizure that occurs before the first is completely done

39
Q

what are the triggers for status epilepticus

A 
stopping AEDs suddently
infection
head injury
metabolic upset
eclampsia
40
Q

how is status epilepticus managed

A

IV lorazepam, if no improvement after 10 minutes try another dose
phenytoin second line

41
Q

if IV access cannot be established, how can status epilepticus be managed

A

rectal diazepam

buccal midazolam

42
Q

what is non-epileptic attack disorder

A

functional seizures at subconscious level

associated with past trauma

43
Q

describe the features of non-epileptic attack disorder

A

long seizures lasting 10-20 minutes
symmetrical florid convulsions with large movements
no improvement with anticonvulsants

Neurology (19 decks)

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