seizure epilepsy Flashcards
differences between seizures & epilepsy?
seizure - one occurrence
epilepsy - chronic occurrences of seizures
what is a seizure?
period where a group of neurons in brains are synchronously firing, when they should not be.
cause of a seizure?
why does this happen basically?
sudden excitatory signals happening over and over again
↑excitatory neurotransmitter or ↓inhibitory neurotransmitters
what is the main excitatory neurotransmitter?
what receptor does it hit?
glutamate
hitting NMDA receptors
what is the main inhibitory neurotransmitter?
what receptor does it hit?
GABA
hitting on GABA receptors
what is the main excitatory neurotransmitter?
what receptor does it hit?
when this excitatory neurotransmitter hits this receptor, what happens?
glutamate
NMDA receptor
Ca2+ influx –> AP generated
what is the main inhibitory neurotransmitter?
what receptor does it hit?
when this inhibitory neurotransmitter hits this receptor, what happens?
GABA
GABA receptors
Cl- influx –> AP inhibited
how are seizures categorised/ defined?
-4 ways
is it local or general
which lobe effected
by level of consciousness
based on symptoms
1 hemisphere or 1 lobe having a seizure,
what is this called?
-2 name
if he is conscious, what is it called then?
-2 names
if he has impaired consciousness, what is it called then?
focal aka partial
aware or simple
focal impaired awareness
Both hemispheres having a seizure,
what is this called?
generalised seizures
define tonic seizures?
what might happen to pt, especially scary in older people?
muscle stiffen & flex
pt falls backwards
define atonic seizures?
muscles floppy
what might happen to pt, especially scary in older people?
pt falls forward
person has seizure with violent muscle contractions.
what kind of seizure is this?
Clonic
define tonic-clonic seizures?
= muscles tense & then rapidly relax & contract
define myoclonic seizures?
short muscle twitches
what is the most common type of seizure based on symptoms?
Tonic-clonic
person has seizure where they lost consciousness but then quickly regained consciousness, looks like they spaced out.
what seizure was this?
Absence seizures
pt has focal to bilateral hemisphere seizure.
what is this seizure called?
secondary generalised seizures
define status epilepticus ?
what type of seizure is this normally based on symptoms?
Seizures ≥ 5 minutes
tonic-clonic
status epilepticus is not an emergency.
true or false?
false
drug class to treat status epilepticus?
benzodiazepines
Epilepsy Prevalence in the UK? %
0.8%
RF for epilepsy?
-3
Cerebral palsy – 30% have epilepsy
Tuberous sclerosis
Mitochondrial disease
mostly epilepsy just happens, whether there are RF or not.
true or false?
true
pt has 1 lobe or hemisphere having a seizure.
if he is conscious, what is this type of seizure called?
-2 names
if he has impaired consciousness, what is it called then?
-2 names
focal aware or simple partial
focal impaired or complex partial
age group and gender that has most absence seizure?
3-10year olds
girls
prognosis for absence seizures?
90-95% grow out of it in adolescence
1st line Mx for absence seizures?
-2 drugs
Sodium valproate & ethosuximide
how does syncope differ from epilepsy?
(i. e. what features does syncope have that epilepsy does not).
- 4
syncope:
nausea
darkened vision
muffled ears beforehand,
gradually lose consciousness
driving rules for someone who just had a seizure?
no driving 6 months
driving rules for someone who was just diagnosed an epileptic?
must be seizure-free 12 months to drive again
Antiepileptic meds inhibit what anticoagulant med?
warfarin
Antiepileptics are contraindicated in pregnancy.
why?
which antiepileptics is particularly problematic in pregnancy?
they are teratogenic
sodium valproate
drug group used to target epilepsy?
- has two names
Antiepileptic aka anticonvulsant
1st line long term Mx for focal seizures?
-name
drug group of this drug?
this drug can however actually exacerbate two types of seizures, which ones?
carbamazepine
Antiepileptic aka anticonvulsant
absence & myoclonic seizures.
1st line long term Mx for general seizures?
-name
drug group of this drug?
sodium valproate
Antiepileptic/anticonvulsant
define general seizures?
Both hemispheres having seizure
what is the postictal phase ?
feel drowsy for ~15 min post seizure
genera symptoms of seizures?
Altered levels of consciousness
Muscle tightening/floppiness/contraction etc.
Bite tongue
Incontinence of urine
Postictal phase
Symptoms of a focal seizure depend on locality.
what is the differentiating symptom if seizure is in
frontal lobe
parietal lobe
occipital lobe (3)
temporal lobe (2)
frontal lobe – head/leg movement, posture is weak
parietal lobe- paraesthesia
occipital lobe – floaters/flashes/colours (visual)
temporal lobe – hallucinations, lip smacking
which Ix is used to record brain activity?
Electroencephalogram
person is having a seizure,
it has only been a couple of minutes.
what is the 1st line acute Mx here?
1st: ABCDE + recovery position
person is having a seizure,
it has been 5 minutes.
what drug can you give to help stop seizure?
- class
- routes
Benzodiazepine
intranasally
under tongue
person is having a seizure,
it’s been over 10 minutes.
what is this seizure called now?
status epilepticus
child is having a seizure,
what medication is 1st line to stope seizure acutely here.
- name
- preferred route
diazepam
rectal
what are the two main drugs used to prevent seizures?
moa of each?
Sodium valproate - ↑GABA
Carbamazepine - blocks Na+ channels
moa of BZD?
-step by step
↑GABAA –> ↑Cl- influx –> causes rapid hyperpolarisation and ∴ neuronal inhibition
child has myoclonic seizure in morning after poor sleep.
what seizure is this?
juvenile myoclonic epilepsy
juvenile myoclonic epilepsy age of onset
12
sex most effected by juvenile myoclonic epilepsy?
females
best drug to stops symptoms of juvenile myoclonic epilepsy?
sodium valproate
juvenile myoclonic epilepsy is an umbrella term, what three seizures come under it which the pt will experience?
myoclonic
tonic-clonic
absence
why should you be careful of using sodium valproate in female teenage with juvenile myoclonic epilepsy?
malformations in pregnancy
pt has juvenile myoclonic epilepsy,
what do you see in EEG?
3-6Hz spikes
define epileptic seizure
define non-epileptic seizures
abnormal electrical discharge in the brain
no abnormal electrical discharge
non-epileptic seizures aka?
pseudoseizure
how can prolactin be used to differentiate between epileptic seizures and non-epileptic seizures?
Prolactin goes up in epileptic seizures but not pseudoseizures
how can tongue biting be used to differentiate between epileptic seizures and non-epileptic seizures?
epileptic = bite sides of tongue
pseudo epileptic = bite tip of tongue.
Non - Epileptic seizure causes
mental stress
diabetes
sleep
arrhtymia
features of non - epileptic seizures that make it differ from epileptic seizures?
- 4
- (in terms of symptoms)
Eyes closed
Alert through event
No post ictal phase
Will not respond to AED’s
CNS triggers of seizures?
-6
Strokes Haemorrhage in brain Cortex is malformed Hippocampus is sclerosed Trauma to brain Infection
what electrolyte imbalances can cause triggers seizure?
-3
hyponatraemia, hypocalcaemia, hypomagnesemia
PNS triggers of seizures?
-6
Electrolyte imbalance – hyponatraemia, hypocalcaemia, hypomagnesemia Drugs – cocaine Alcohol withdrawal – super common! Hypoglycaemia Arrhythmia
