Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Neurology > Seizures + Epilepsy > Flashcards

Seizures + Epilepsy Flashcards

1
Q

What is epilepsy? What is the difference between epilepsy and seizures?

A

Tendency to have seizures, which are transient episodes of abnormal electrical activity
No clear/organic cause for seizures

Epilepsy and seizures both involve abnormal synchronous electrical activity BUT epilepsy = increased tendency w/o specific precipitating factor i.e. experience spontaneous recurrent seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

If someone was suspected to have epilepsy, how would they be investigated acutely?

A

Bloods
-can look for evidence that seizure was non-epileptic i.e. has organic cause:
Infection/electrolyte disturbance/lactate/creatinine kinase
-lactate= can differentiate between seizure + pseudoseizure i.e. muscle contractions will lead to rise in lactate (produced due to anaerobic respiration)

Brain imaging:

  • CT= SOL (tumour or haemorrhage)
  • MRI brain= looking for structural problems which might be causing seizures i.e. gliosis/fibrosis (temporal lobe epilepsy)

Blood glucose= exclude hypo

ECG= rule out problems with heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the main different types of seizure?

A

Generalised tonic-clonic

Focal seizures

Absence seizures

Atonic seizures

Myoclonic seizures

Infantile spasms/West syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the features of a generalised tonic-clonic seizure? How is this type of seizure managed?

A

LOC
Impaired awareness due to being generalised
Muscle tensing (tonic)
Muscle jerking (clonic)
Tongue biting + incontinence
Post-ictal period= confusion/drowsy/depressed

Sodium valproate
Lamotrigine or carbamazepine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What part of the brain is affected by focal seizures? What are the features of focal seizure? How are they managed?

A 
Temporal lobe 
Features:
-hallucinations 
-memory flashbacks 
-deja vu 
-strange actions on autopilot

Carbamazepine or lamotrigine
Sodium valproate
I.e. opposite to tonic-clonic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Who is mostly likely to suffer from absence seizures? What are the features of this kind of seizure?
What would you expect to see on an EEG?
How are they managed?

A

Children

Become blank + stare into space
= momentary lapse in awareness
Unaware of surroundings and won’t respond
Lasts 10-20 secs then abruptly stops
Patient might not be able to recollect the attacks and may appear as if daydreaming

3Hz spike and wave

Sodium valproate or ethosuximide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the features of an atonic seizure? What syndrome can they be associated with? How is this type of seizure managed?

A

Brief lapse in muscle tone which leads to patient collapse/drop
Lennox-Gastaut syndrome (epileptic encephalopathy)

TX:

  • sodium valproate
  • lamotrigine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the features of a myoclonic seizure and when does it normally occur? How is it managed?

A

Sudden muscle contraction which appears as a jump
Patient awake
Associated with juvenile myoclonic epilepsy

Sodium valproate
Lamotrigine
Levetiracetam
Topiramate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the first line anti-epileptic drug in most types of epilepsy? What is the MOA? What are the potential SE?

A 
Sodium valproate (except for focal= carbamazepine)
MOA= increases GABA acitivity which decreases the brains excitability

SE:

  • teratogenic
  • liver damage + hepatitis
  • hair loss
  • tremor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the SE for carbamazepine?

A

Agranulocytosis
Aplastic anaemia
Induces p450= possibility of drug interactions
Makes OCP ineffective
Induces enzymes involved in own destruction so can become inaffective
Hyponatraemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the SE of phenytoin?

A 
Folate + vitamin D deficiency 
Megaloblastic anaemia (due to folate deficiency) 
Osteomalacia (vitamin D def)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the SE of ethosuximide?

A

Night terrors

Rashes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the SE of lamotrigine?

A

Stevens-Johnson syndrome or DRESS syndrome

Leukopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What would you be worried about if a seizure lasted >5mins? How is this situation managed?

A

STATUS EPILEPTICUS Medical emergency where seizure has lasted longer than 5 mins or more than 3 seizures in an hour

ABCDE approach:

  • secure airway
  • high concentration 02
  • assess cardiac + resp function
  • check blood glucose
  • IV access
  • IV lorazepam 4mg (repeated after 10 mins if seizure persistent)
  • IV phenobarbital or phenytoin if seizure persists
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How can you differentiated between non-epileptic and epileptic seizure?

A

Non-epileptic seizure isn’t caused by the classical abnormal synchronous electrical activity activity so no EEG abnormalities

Tends to be associated with psychiatric presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How can you differentiate between an episode of syncope and a seizure?

A
  1. Post ictal confusion (seizure) is only definitive way to differentiate between syncope and seizure
    =presents as extreme confusion, lack of awareness of self or where they are when come out of episode

Post-syncope= relatively ok but can feel bit dazed

  1. Location of tongue bite
    - front/tip= syncope
    - back/sides= seizure
17
Q

How might someone describe a syncopal episode in terms of before, during and after?

A

Before:
-syncopal prodrome= sweating/pallor/light headed

During:
-bitten front of tongue when collapsed/fallen

After:
-feel relatively ok

18
Q

How might someone/witness describe an seizure episode in terms of before, during and after?

A

Before:

  • aura= visual spots/certain taste
  • sense of deja vu
  • abnormal movements

During:

  • biting back of tongue
  • urinary incontinence

After:

  • very fatigued= due to muscle contractions
  • post-ictal confusion
19
Q

How is syncope different from a seizure?

A

Caused by hypoperfusion of brain= induces LOC
-bradycardia and peripheral hypoperfusion
Shorter duration= 30s-2mins -»transient onset
Lack of tonic-clonic sequence BUT brief clonic jerking may occur

20
Q

What are the 2 main features used to classify seizures?

A

Onset= where in the brain the seizure originates from

  • generalised= both hemispheres affected
    • motor
    • non-motor= absence
  • focal= specific region of brain affected
    • non-motor onset vs motor onset
    • aware vs impaired awareness
  • unknown

Level of awareness
-impaired awareness= generalised seizure rather than focal

21
Q

What changes might you see on a CT scan that implied temporal lobe epilepsy?

A

Fibrosis in temporal lobe area

22
Q

How can you use blood tests to differentiate between epileptic and non-epileptic seizures?

A

Epileptic seizures:

  • raised lactate= due to vigorous contraction of muscles causing them to go into anaerobic respiration
  • raised creatinine kinase (CK)= due to contraction causing breakdown of muscle
23
Q

What are the most important SE to consider with anti-epileptic drugs? Give an example of drug for each.

A

Teratogenic= Sodium valproate
Electrolyte disturbance= Carbamazepine (induces hyponatraemia due to SIADH)
Enzyme-inducing (CYP metabolic enzymes)= phenytoin + carbamazepine

24
Q

When should epilepsy patients be refered for epilepsy surgery programme?

A

When they have failed 2 first line drugs

25
Q

What is chronic/drug resistant epilepsy?

A

Continous seizures depsite effective trial at least two appropriate selected anti-epileptic drugs

26
Q

What is the impact of chronic epilepsy for the patient?

A

Impaired quality of life

  • restrictions of lifestyles
  • stigma and descrimination
  • SE of medication

Increased risk of injury

Premature mortality

27
Q

What is the difference between a focal and generalised seizure?

A

Focal:

  • asynchronous activity starts in one part of the brain and can spread
  • can have aura/motor/autonomic/awareness changes
  • can evolve into generalised seizure

Generalised
-asynchronous activity spreads throughout the brain from the start

28
Q

What is a complex partial seizure?

A

Focal seizure with impaired consciousness

29
Q

What are the 7 different types of aura which can be experienced and which part of the brain does this indicate the focal seizure is most likely to originate from?

A

Somatosensory

  • tingling etc
  • Parietal lobe

Visual

  • colourful flashing lights with rapid onset
  • dream-like visions
  • Occipital lobe

Olfactory

  • familiar smell
  • temporal lobe

Auditory

  • hearing familiar song
  • Temporal

Autonomic

  • rising abdo sensation, moving into chest
  • Temporal/frontal/parietal

Emotional

  • fear/anger/sadness/sexual arousal
  • temporal lobe

Psychic

  • deja vu
  • Temporal
30
Q

What is an epileptic syndrome?

A

Grouping of patients which share similar:

  • seizure type
  • age of onset
  • natural history
  • EEG patterns
  • Genetics
  • response to treatment
31
Q

What are the different classifications of epilepsy syndromes?

A

Partial and generalised

Further divided into idiopathic or symptomatic
I.e. could have idiopathic partial or symptomatic partial

Idiopathic= pressumed genetic causes 
Symptomatic= secondary to known/presumed cerebral pathology
32
Q

What is hippocampal sclerosis?
What features might someone present with if they are experiencing seizures with this pathology?
What can be done to try and improve care?

A

Loss of pyramidal neurones, granule cell disperson and gliosis in hippocampus

Is a common cause of refractory temporal lobe epilepsy

Deja vu
Unpleasant smells
Autonomic response
Slower to recover from seizure

33
Q

What is the recruitments by the DVLA to drive again after seizure?

A

Single seizure:

  • imaging and EEG not supporting epilepsy
  • need to wait 6 months

Epilepsy

  • need to be 12 months seizure free
  • unable to drive HGV
34
Q

What drug is used to treat acute episode of epilepsy in ED?

A

Phenytoin infusion given after benzos

35
Q

What are the different anti-epileptics available? State their MOA and which type of epilepsy they can be used for?

A

Barbituates

  • increased GABA activity= increased inhibitory activity
  • partial/focal

Benzodiazepine

  • increased GABA activity
  • Status epilepticus

Carbamazepine i.e. tegrelol

  • inhibits Na+ channels
  • tonic clonic

Phenytoin

  • inhibits Na+ and Ca2+ channels
  • status

Valproate

  • increased GABA and inhibits Na+
  • partial/TC/Absence

Levetiracetam

  • inhibits synaptic conduction
  • no drug interactions but cleared by kidneys and has side effects
  • partial

Lamotrigine

  • inhibits Na+ channels
  • Partial or TC

Topiramate
-decreased glutamate

36
Q

What are the common side effects associated with AEDs which block Na+ channels? Which drugs would this include?

A

Dizziness + double vision

Carbamazepine
Phenytoin
Valproate
Lamotrigine

37
Q

Which AED have a high teratogenic risk?

A 
Valproate 
Phenytoin
Phenobarbitone 
Topiramate 
Mysoline
38
Q

How should somenone with epilepsy be managed pre-conceptually if they are trying to conceive?

A

5mg daily folic acid
Try to achieve monotherapy
Withdrawl teratogenic seizure medication and swap for subsitute
NOTE:
-switch to new medication will take time so should use contraception during this period

39
Q

What is status epilepticus?

What is the initial treatment?

A

Contiuous seizure lasting at least 5 mins OR can be 2(+) seizures where there is incomplete recovery of consciousness between them

Management (0-60mins)
Lorazepam (benzo)
-fast mechanism of action and has long half life i..e can have anti-seizure effects for 12hrs

Phenytoin

Neurology (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions