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Neurology > Seizure disorders & Epilepsy > Flashcards

Seizure disorders & Epilepsy Flashcards

1
Q

What is a seizure?

A

Spontaneous uncontrolled abnormal brain activity

A transient abnormal event, which is caused by a paroxysmal (sudden) discharge of cerebral neurons

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2
Q

What does ‘ictus’ mean?

A

Can refer to any acute event but in the case of epilepsy it refers to the seizure

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3
Q

What does ‘aura’ mean?

A

Sensory disturbances that precede a seizure by a few minutes

Can be visual, tactile, olfactory, anything

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4
Q

What is epilepsy?

A

A tendency to spontaneous, intermittent, abnormal, electrical activity in part of the brain manifesting as seizures

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5
Q

What is the differential diagnosis of a seizure?

A 
Epilepsy
Non-epileptic seizure
Postural syncope
Migraine
Cataplexy
Dystonia
T.I.A
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6
Q

What is cataplexy?

A

A sudden and transient episode of muscle weakness accompanied by full conscious awareness

Typically triggered by emotions such as laughing, crying, or terror

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7
Q

What is dystonia?

A

Sustained muscle contractions cause twisting and repetitive movements or abnormal postures.

The movements may resemble a tremor.

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8
Q

What causes a blackout?

A

Problem with blood circulation

  • heart problem
  • low BP

Disturbance of brain function
- epilepsy etc.

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9
Q

When does epilepsy usually present?

A

In childhood or adolescence

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10
Q

What causes epilepsy?

A

Genetics

Developmental abnormalities

After effects of trauma / surgery

Hypoxia

Drugs

CNS infection

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11
Q

What is the pathogenesis of an epileptic seizure?

A

Each person has a ‘seizure threshold’: the level of excitability at which the neuron cells will depolarise uncontrollably

In epilepsy this seizure threshold is lowered

When the threshold is reached you get

Abnormal synchronised depolarisation of neural cells and thus neurons

Normal inhibitory mechanisms fail

This causes symptoms that depend on where the action is

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12
Q

Which neurotransmitters are involved in epilepsy?

A

Glutamate: excitatory

GABA: inhibitory, this fails to inhibit activity

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13
Q

What is meant by a ‘seizure threshold’?

A

The level of excitability at which neural cells will discharge uncontrollably

This levels is lowered in epilepsy

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14
Q

What are some triggers that push an area of the brain past it’s seizure threshold?

A 
Flashing lights
Alcohol
Sleep deprivation
Physical / mental exhaustion
Infection
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15
Q

How are epileptic seizures classified?

A

Partial: focal, remain confined to one part of the brain

Generalised: originate from midbrain or brainstem and spread to both hemispheres of the brain

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16
Q

What is a secondary generalised seizures?

A

Partial seizures which spread to lower areas of the brain, which results in the initiation of a generalised seizure

17
Q

What types of partial seizures are there?

A

Simple: without impaired awareness

Complex: with impaired consciousness

18
Q

What are the usual features of a partial seizures?

A

Remains conscious

Depends on the area of the brain affected

In temporal lobe:

  • olfactory and visual
  • hallucinations
  • blank staring
  • jamais vu or deja vu

In motor cortex:

  • called Jacksonian seizures
  • movement that starts in one area and spreads
  • may be jerking or simply holding a certain position

In occipital lobe:
- visual phenomena

Todd’s paralysis post seizure

19
Q

What is Todd’s paralysis?

A

Sometimes occurs after a simple partial seizure

Paralysis of the involved limbs for a while after

20
Q

What is jamais vu?

A

Feelings of unfamiliarity or unreality

21
Q

How can you distinguish a simple partial seizure from a complex partial seizure?

A

Simple: they will have full awareness and remain conscious

Complex: impaired consciousness and memory
Automatism

22
Q

What is automatism?

A

When a person has impaired consciousness, but their motor function is still intact so they can move about

23
Q

What types of generalised seizures are there?

A

Absence seizures: petit mal

Tonic clonic seizures: grand mal

24
Q

What are the usual features of an absence seizure?

A

Childhood onset

Patient unresponsive to stimuli but still conscious

They stare blankly, may go pale
Usually only last a few seconds

25
Q

What are the usual features of tonic clonic seizures?

A

Aura before the attack

Tonic phase:

  • rigidity
  • tongue biting
  • incontinence
  • no breathing: hypoxia

Clonic phase:

  • convuslions / limb jerking
  • eye rolling
  • tachycardia
26
Q

What is a myoclonic seizure?

A

A generalised seizure which has a clonic phase only

27
Q

What is a tonic seizure?

A

A generalised seizure with a tonic phase only

28
Q

What is a non-epileptic seizure?

A

Paroxysmal (sudden) event featuring changes in behaviour, sensation and cognitive function

Often happens in the place of psychological processes, such as panic, shame, guilt

29
Q

What are the usual feeaures of non-epileptic seizures?

A

Situational: strong emotion

Duration 1 - 20 mins

Dramatic motor phenomena
Prolonged atonia

Eyes closed

Ictal crying + speaking

30
Q

How can you differentiate a non-epileptic seizure from an epileptic one?

A

Non-epileptic:
Tend to be longer, pre-syncopal symptoms, prolonged upright position

Epileptic:
Tongue biting, head turning, muscle pain, cyanosis

31
Q

Investigation of epilepsy?

A

Diagnose clinically:

Eye-witness description of seizure
Patient’s description of any aura, post-seizure experiences

EEG: look at electrical activity of brain

Neurological exam

Observational + EEG: watch the patient over a few days

Brain imaging

32
Q

How do you decide if treatment for epilepsy is indicated?

A

Is it definitely epilepsy

Do they need treatment? Are seizures frequent or rare

Are they trying to get pregnant? The drugs are not good for pregnancy

33
Q

Management of epilepsy?

A

Are there any triggers for the seizure? If so, advise how they can avoid them

Advise how, if they experience an aura, they can sometimes prevent the seizure occurring or get to a safe place

They are unable to drive, and advise on risky things like swimming, heights

Drugs
Surgery

34
Q

What drugs are used to treat epilepsy? Give examples of the drugs.

A

Sodium channel inhibitors: lamotrigine

Calcium channel inhibitors

Drugs that increase GABA (an inhibitory neurotransmitter)
- sodium valproate

Diazepam for seizure control

35
Q

What is status epilepticus?

A

A medical emergency

Where there are continuous seizures without recovery of conscious

Risk of death from cardiorespiratory failure

36
Q

Management of status epilepticus?

A

Administer oxygen

Anti-convulsants IV

37
Q

Sodium valproate is a safe drug in all patients.

True or false?

A

False

Don’t give it to pregnant women or those who might get pregnant in near future

Neurology (23 decks)

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