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Neurology Clinical > Seizures > Flashcards

Seizures Flashcards

1
Q

What are the 3 categories of causes of syncope?

A

Reflex - bloods being taken, cough
Orthostatic - hypotension, dehydration, medication related (anti hypertensive), endocrine, ANS
Cardiogenic - arrhythmia, aortic stenosis

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2
Q

What are the typical things a patient will tell you of an account of syncope?

A 
They will have a very brief episode and will recover quickly - usually whilst still on the floor
Felt light headed, clammy, blacking out
Fully orientated quickly 
Urinary incontinence
Aborted by sitting
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3
Q

What is epilepsy?

A

Tendency to have recurrent unprovoked seizures

Neurones have a background activity and if this is disrupted then we can have a seizure

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4
Q

When is epilepsy diagnosed after 1 seizure?

A

A scan which shows high risk of recurrence i.e. stroke or tumour in part of the brain
Or an EEG which shows a tendency to seizures

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5
Q

What are the 2 main groupings of epilepsy and what are the differences between the 2?

A

Generalised seizures - electrical activity occurs across the whole brain
Focal seizures - electrical disturbance just happens in one part of the brain

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6
Q

In what age of patients is primary generalised mostly found in?

A

<20

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7
Q

What can put someone at risk of having generalised tonic clinic seizures early on in life?

A

Meningitis
Birth complications
Brain injuries
Trauma

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8
Q

What are the symptoms signs of juvenile myoclonus epilepsy?

A

Can have Absence and generalised tonic clonic seizures

Will have early morning myoclonus (brief jerks in limbs, drop things in the morning)

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9
Q

What investigations will the neurology clinic carry out to investigate referrals?

A

EEG
MRI
CT
Video telemetry

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10
Q

What is the first line treatment for primary generalised epileptics?

A

Sodium valproate
Lamotrigine
Levetiracetam

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11
Q

What is the acute treatment for a seizure?

A

Lorazepam / diazepam

Phenytoin / valporate

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12
Q

What anti epileptic drug shouldn’t be used in pregnancy?

A

Sodium valproate

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13
Q

What is the first line treatment for focal and secondary generalised seizures?

A

Lamotrigine
Carbamezapine
Levetiracetam

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14
Q

If someone has a single seizure when can they drive agin?

A

After 6 months if they have no further seizures and investigations are normal

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15
Q

What is status epilepticus?

A

Prolonged or recurrent tonic clonic seizures persisting for more than 30 mins with no recovery period between seizures

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16
Q

What is the first line treatment for status epilepticus?

A

Midazolam
Lorazepam
Diazepam

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17
Q

What is non-convulsive status epilepticus?

A

Prolonged unresponsiveness following a seizure

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18
Q

What is the typical history of a cardiogenic syncopal episode?

A 
Syncope on exertion
May have chest pain, palpitations, SOB
Comes round fairly quickly
May be sweaty/clammy
Unable to feel pulse 
May have few brief jerks
Rapid recovery
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19
Q

What things provoke seizures?

A 
Alcohol withdrawal 
Drug withdrawal
Few days after head injury
Within 24hrs stroke
Within 24hrs brain surgery
Severe electrolyte disturbance 
Eclampsia
20
Q

Describe an absence seizure?

A

Often in children and are unaware of them
May be provoked by hypoventillation / photic stimulation
Sudden arrest of activity for a few seconds - staring, may have eye fluttering

21
Q

What are the types of generalised seizures?

A

Generalised tonic clonic seizure
Absence seizure
Myoclonic seizures
Atonic seizures

22
Q

What are juvenile myoclonic seizures provoked by?

A

Alcohol

Sleep deprivation

23
Q

What type of seizures does a patient with juvenile myoclonic epilepsy have?

A

Absence seizures

Generalised tonic clonic seizures

24
Q

What is a typical feature of juvenile myoclonic epilepsy?

A

Early morning myoclonus

25
Q

What are the types of focal seizures?

A

Secondary generalised
Simple partial
Complex partial

26
Q

What might a patient feel before a complex partial seizure?

A

Rising feeling in their stomach
Funny smell/taste
De ja vu

27
Q

What is the presentation of a complex partial seizure?

A

Sudden arrest in activity
Staring into space
Automatisms i.e. limp smacking, repetitive picking at clothes

28
Q

What is the first line treatment for secondary generalised eizures?

A

Carbamezapine
Lamotrigine
Levetiracem

29
Q

What is the first line treatment for status epilepticus?

A

Midazolan
Lorazepam
Diazepam

30
Q

Mortality is highest in status epilepticus if it occurs after….

A

Stroke
Encephalitis
Mass lesion
Trauma

31
Q

What is the percentage of mortality in status epilepticus?

A

5-10%

32
Q

What is a pseudoseizure?

A

Non epileptic attack
Psychological attack
No abnormal brain activity

33
Q

What is a pseudoseizure like?

A

Psychological attack, may occur at times of stress or rest
Patients will give lots of details of what’s going on around them but little of themselves
May describe dissociation
Patient retains awareness - tracking eye movements
Movements not typical of a seizure i.e. pelvic thrusts, asynchronous movements, tremor

34
Q

How would you diagnose a seizure as a pseudoseizure?

A

Clinical features of the attack

Try and catch typical episode on EEG as it will show no abnormal brain activity

35
Q

What factors influence seizure risk?

A 
Alcohol / drug use
Drug interactions
Hormonal changes
Sleep disturbance, fatigue 
Photic stimulation (other rare triggers include noise &amp; patterns)
Stress/anxiety
36
Q

State 3 side effects of the drug phenytoin.

A

Arrhythmias
Hepatitis
Medication interactions (releases liver enzymes so make other drugs ineffective)

37
Q

State the side effects of sodium valproate.

A 
Tremor 
Weight gain 
Ataxia 
Nausea
Drowsiness 
Hepatitis 
Teratogenic
38
Q

State side effects of carbamezapine.

A 
Low serum Na
Nystagmus 
Blurred vision
Ataxia 
Drowsiness 
Skin rash
39
Q

State the side effects of lamotrigine.

A

Skin rash

Difficulty sleeping

40
Q

State the side effects of levetiracetam.

A

Irritability

Depression

41
Q

What anti-epileptic drugs can cause hepatitis?

A

Sodium valproate

Phenytoin

42
Q

What anti-epileptic drugs can cause drowsiness?

A

Carbamezapine

Sodium valproate

43
Q

What anti-epileptic drug can cause other drugs to become ineffective and why?

A

Phenytoin

Because it releases liver enzymes

44
Q

What anti-epileptic drugs cause ataxia?

A

Sodium valproate

Carbamezapine

45
Q

in the event of status epileptics, why may midazolam be the first line treatment of choice before diazepam?

A

because of the route of administration;
midazolam can be given buccal or nasal whereas diazepam has to be IV or rectal therefore more uncomfortable for the patient

Neurology Clinical (21 decks)

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