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NEUROLOGY > Seizures > Flashcards

Seizures Flashcards

1
Q

What kind of questions would be important to ask someone who has had a seizure/ someone who witnessed it?

A

What were they doing before?

Did they feel dizzy, faint or unwell?

What did it look like?

Were they aware throughout?

How did they come around, were they sleepy?

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2
Q

How does a faint typically present?

A

Preceded by light headedness, sweating and pale complexion

Collapse and loss of consciousness, not confused after

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3
Q

Give some examples of drugs which are known to precipitate seizures

A

Antibiotics

Tramadol

Anti-emetics

Opioids

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4
Q

What are the definitions of seizures Vs epilepsy?

A

A seizure describes abnormal discharge of electrical activity in the brain

Epilepsy is the tendency to recurrent epileptic seizures

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5
Q

What does SUDEP stand for?

A

Sudden unexplained death in epilepsy

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6
Q

What are some of the risk factors for death in epilepsy?

A

Nocturnal seizures

Aspiration

Alcohol and drug use

Poor compliance with medication

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7
Q

What are focal seizures?

A

A seizure which occurs due to a part of the brain being structurally abnormal

E.g motor, sensory, olfactory seizures e.t.c

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8
Q

Who gets focal seizures?

A

Older patients - they are more likely to have an abnormality in the brain

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9
Q

What defines a seizure as being simple or complex?

A

Simple focal seizures are without impaired consciousness

Complex focal seizures are with impaired consciousness

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10
Q

What is a generalised seizure?

A

A seizure which occurs due to more than one part of the brain being affected

It is not due to a structural abnormality but due to a problem with the pathways

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11
Q

What are secondary generalised seizures?

A

When a focal seizure connects to a cortical pathway and spread across the brain to cause a generalised seizure

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12
Q

What abnormalities are classically seen on EEG with generalised seizures?

A

Spike-wave abnormalities on ECG

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13
Q

Who has generalised seizures?

A

Younger patients

*It is hardly ever diagnosed in patients aged 30+

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14
Q

What are the typical clinical features of juvenile myoclonic epilepsy?

A

Early morning jerks

Generalised seizures

Risk factors; sleep deprivation and flashing lights

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15
Q

What are the 5 main types of generalised seizures?

A

Absence

Myoclonic

Atonic

Tonic

Tonic-clonic

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16
Q

Describe absence seizures and the 1st line managemend

A

Brief pauses

Occurs in children

Ethusuxamide is 1st line (blocks calcium channels)

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17
Q

Describe a myoclonic seizure

A

Sudden jerks of the limb, face or trunk

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18
Q

Describe an atonic seizure

A

Sudden loss of muscle tone causes collapse

no loss of consciousness

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19
Q

Describe a tonic-clonic seizure

A

Patient goes rigid first (tonic) and then jerks (clonic)

Post-ictal confusion and drowsiness

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20
Q

In tonic clonic seizures, why do patients flex their arms into their chest?

A

Because flexor muscles are stronger than extensor muscles

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21
Q

What are the ways in which a focal seizure affecting the temporal lobe of the brain might present?

A

Motor features

Olfactory hallucinations (uncle involvement)

Auditory hallucinations (auditory cortex involved)

Emotional disturbance e.g sudden terror (hippocampal involvement)

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22
Q

What are the ways in which a focal seizure affecting the frontal lobe of the brain might present?

A

Motor features

Dysphagia and speech arrest

Post ictal Todd’s palsy

23
Q

What are the ways in which a focal seizure affecting the parietal lobe of the brain might present?

A

Motor disturbances

Sensory disturbances (e.g tingling numbness and pain)

24
Q

What are they ways in which a focal seizure affecting the occipital lobe of the brain might present?

A

Visual phenomena (e.g spots, lines and flashes)

25
Q

What investigations should be done for a patient presenting with seizures?

A

CVS exam and lying and standing BP (syncope)

ECG

CT

EEG

26
Q

What is the typical ECG sign which might be present in a patient presenting with seizures?

A

Prolonged QT syndrome

27
Q

Imaging, such as CT is not routine for first seizures. In what situations would it be considered?

A

Skull fractures

Deteriorating GCS

Head injury

Suspected SAH

28
Q

EEG is not the best test to do and is only really done to confirm non-convulsive attacks. T/F?

A

True

E.g spike wave abnormality in absence seizures

29
Q

When do you treat seizures?

A

If a patient has epilepsy and is at high risk of seizure recurrence

When the patient wants to be treated

30
Q

What is the first-line medication for focal epilepsy?

A

Carbamazepine

2nd line = lamotrigine

31
Q

What is the first-line medication for generalised epilepsy?

A

Sodium valproate

2nd line = lamotrigine or clonazepam

32
Q

Which two anticonvulsants should not be given together?

A

Sodium valproate and lamotrigine

33
Q

Which drug should never be given in generalised epilepsy?

A

Carbamazepine

34
Q

What are the side effects of sodium valproate?

A

WEIGHT GAIN

Hair loss

TERATOGENIC

35
Q

What are the side effects of carbamazepine?

A

Ataxia

Blurred vision

Vertigo

Hyponatraemia

36
Q

What are the side effects of lamotrigine?

A

Steven Johnson Syndrome

37
Q

Which drugs used in the treatment of epilepsy are liver enzyme inducing?

A

Carbamazepine, phenytoin and barbiturates

38
Q

Which side effects of sodium valproate (not including the fact it is teratogenic) are often considered less acceptable in women?

A

Weight gain and hair loss

most men get fat and bald anyway

39
Q

Which form of contraception is particularly badly affected by anticonvulsants and therefore should not be used in these patients?

A

The progesterone only pill

40
Q

A higher dose of the morning after pill is required in patients who are taking anticonvulsants. Can this be given out by a pharmacist?

A

No - it needs to be given by a doctor

41
Q

Women of child-bearing age should be taking which supplement?

A

Folic acid

42
Q

Lamotrigine is NOT harmful to infants and is therefore appropriate for breastfeeding mothers. T/F?

A

TRUE

43
Q

What is status epilepticus?

A

Recurrent epileptic seizures without full recovery of consciousness

Seizure activity is continuous for 30 minutes +

44
Q

What are the 3 types of status epilepticus?

A

Generalised convulsive status epilepticus

Non convulsive status

Epilepsia partialis continua

45
Q

What happens in generalised convulsive status epilepticus?

A

Generalised convulsions without cessation

46
Q

What happens in non-convulsive status?

A

Conscious but in an altered state

*more common in older patients

47
Q

What happens in epilepsia partialis continua?

A

Continual focal seizures with consciousness preserved

48
Q

What consequences can generalised convulsive status epilepticus have?

A

Respiratory insufficiency

Rhabdomyolysis

49
Q

What are some of the possible precipitants of status epilepticus.?

A

Severe metabolic disorders

Infection

Head trauma

Abrupt withdrawal of anticonvulsants

Treating absence seizures with carbamazapine

50
Q

What are functional attacks?

Aka Non epileptic attack disorder (NEAD), pseudo seizures and psychogenic seizures.

A

Seizures which relate to traumatic events, abuse or stress

51
Q

How can functional attacks be managed?

A

Explain the nature of the attacks to the patient

Treat underlying mental health problems

*patient needs to be psychologically ready to talk about/ be re-exposed to trauma

NOT treated with anticonvulsants

52
Q

What characteristic movements does non epileptic attack disorder (NEAD) present with?

A

Pelvic thrusting

Head turning

53
Q

How long must a person wait before they can drive an HGV after their first seizure assuming they have no more?

A

5 years

54
Q

How long must a person wait before they can drive a car after their first seizure assuming they have no more?

A

6 months

NEUROLOGY (18 decks)

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