Week 232 - Epilepsy Flashcards
Week 232 - Epilepsy: What is epilepsy?
- The continuing tendency to have epileptic seizures.
* Epileptic seizures are a transient event experienced due to excessive and synchronous discharge of cerebral neurones.
Week 232 - Epilepsy: What are the two major categories of epileptic seizures?
- Generalized
* Partial (Focal)
Week 232 - Epilepsy: What are the two types of partial seizure?
- Complex - Loss of awareness.
* Simples - No loss of awareness.
Week 232 - Epilepsy: What are the three types of generalized seizure?
- Tonic-clonic
- Absence
- Myoclonic
Week 232 - Epilepsy: What is a cryptogenic seizure?
• A seizure whose characteristics would suggest underlying cause, but which has not yet been identified.
Week 232 - Epilepsy: What are the differentials for epilepsy?
1) Syncope
2) Non-epileptic attacks
3) Panic attacks
4) Sleep disorders
5) Migraine
6) Transient ischaemic attacks
7) Hypoglycaemia
Week 232 - Epilepsy: What is the typical prodrome of syncope?
Nausea, clammy, blurring or loss of vision, deafness, tinnitus.
Week 232 - Epilepsy: What are the red flags for cardiogenic syncope?
- Occurence on exercise
- Family history of sudden death
- Past history of IHD
- No warning
- Rapid recovery
Week 232 - Epilepsy: What is NEAD?
• Non-epileptic attack disorder.
- Psychologically mediated episodes of altered awareness.
Week 232 - Epilepsy: If, during a seizure, someone developed irregular and asynchronous jerks what would the likely diagnosis be?
• Non-epileptic attack
-NEAD
Week 232 - Epilepsy: Tongue biting and incontinence is common in which of the following, seizure, syncope of NEAD?
Epileptic seizure.
Week 232 - Epilepsy: What is the gold standard for investigation of seizures? Why is it not commonly used?
- Video EEG
* Expensive and time consuming.
Week 232 - Epilepsy: What are the causes of epilepsy in infants?
• Developmental malformations, perinatal injuries and infections.
Week 232 - Epilepsy: What are the causes of epilepsy in children/adolescents?
Idiopathic generalised epilepsy.
Week 232 - Epilepsy: What are the causes of epilepsy in Young adults?
IGEs (Idiopathic), Head injury, alcohol, vascular malformations, hippocampal sclerosis.
Week 232 - Epilepsy: What are the leading causes of epilepsy in 30-50 yr olds?
Brain tumours
Week 232 - Epilepsy: What are the leading causes of epilepsy in the over 50s?
Cerebrovascular disease.
Week 232 - Epilepsy: What are the characteristics of Juvenile Myoclonic Epilepsy?
- Upper limb jerks, generalised tonic-clonic seizures, absences.
- Onset 8-18
- Seizures on waking, precipitated by alcohol and sleep deprivation.
- Good response to sodium valproate.
Week 232 - Epilepsy: What is heterotopic grey matter?
- This is a developmental malformation where islands of grey matter have failed to migrate to the gyrae leaving a rim around the ventricles.
- This is very epileptogenic.
Week 232 - Epilepsy: What is neurocycticercosis?
• Probably the most common cause of epilepsy world wide.
- Eggs of the pork tape worm migrate to the brain where they form cysts.
Week 232 - Epilepsy: What is the first line treatment of idiopathic generalised epilepsy?
• Sodium valporate
- In females - Lamotrigine or levetiracetam (Since sodium valporate has a high risk of birth defects.)
Week 232 - Epilepsy: What is the first line treatment for focal/partial epilepsy?
Carbamazepine/lamotrigine/levetiracetam
Week 232 - Epilepsy: What are the common side-effects of all anti-epilepsy drugs?
Tiredness, fatigue, dizziness.
Week 232 - Epilepsy: Which anti-epilepsy drug has side effects including rash, ataxia and double vision?
Carbamazepine
Week 232 - Epilepsy: Which anti-epilepsy drug can cause weight gain, tremor and is teratogenic?
Sodium Valporate
Week 232 - Epilepsy: Which anti-epileptic drug is associated with psychiatric problems?
Levetiracetam
Week 232 - Epilepsy: What is status epilepticus?
A seizure or series of seizures lasting for 30 minutes without regaining consciousness in between.
Week 232 - Epilepsy: What are the causes for status epilepticus?
- New - 50% (Encephalitis, trauma, tumours)
* Established eplilepsy - 50% (missed doses, infections)
Week 232 - Epilepsy: What are the general measures for the treatment of status epilepticus?
- Secure airway and monitor pulse, Bp, respiration.
- IV access
- Oxygen
- Check U+Es, Ca, Mg, ABGs, ECG
- iv glucose and thiamine.
Week 232 - Epilepsy: What medication should be given early on in the treatment of status epilepticus?
IV Lorazepam 4mg.
alternatives include diazepam or buccal midazolam
Week 232 - Epilepsy: Once status epilepticus is established what medication should be given? What dosage?
IV phenytoin 15mg/kg at 50mg/minute.
Week 232 - Epilepsy: What is SUDEP?
Sudden unexplained death in epilepsy.
- Non-traumatic death unwitnessed death in patient with epilepsy.
Week 232 - Epilepsy: What are the proposed causes of SUDEP?
- Cardiac arrhythmias
- Perictal hypoxia
- Postictal cerebral depression with hypoventialition and bradycardia.
Week 232 - Epilepsy: What are the risk factors for developing SUDEP?
- High seizure frequency
- AED polytherapy
- Young age at onset
- Male
- Poor compliance
- Long history of epilepsy
- Seizures from sleep
- Living/sleeping alone
Week 232 - Epilepsy: Give a definition of coma.
A state of unrousable unconsciousness.
Week 232 - Epilepsy: What score on the Glasgow coma scale is classed as coma?
≤8
Week 232 - Epilepsy: What are the two coma mimics?
- Locked-in syndrome - Arousal and awareness retained.
* Psychogenic coma
Week 232 - Epilepsy: What physiological brain dysfunctions can cause coma?
- Hypothermia
- Sudden hypertension
- Prolonged status epilepticus
- Drugs, toxins, poisonings.
Week 232 - Epilepsy: What is the initial management of coma?
- Improve oxygenation (Intubate if necessary)
- Correct hypotension and extreme hypertension.
- Correct body temperature.
- Glucose and thiamine
- Identify and treat the underlying cause.
Week 232 - Epilepsy: What four things will prevent you from performing a reliable neurological assessment of a patient in coma?
1) They are metabolically deranged.
2) They are hypothermic.
3) They have sedative drugs in their circulation.
4) They have an endocrine disturbance.
Week 232 - Epilepsy: Why do you check for papilloedema in a coma patient?
This can help to identify if there is raised intracranial pressure / SAH
Week 232 - Epilepsy: What is the relevance of checking whether the motor response is symmetrical?
To identify if there are unilateral signs indicating a hemisphere or brainstem lesion.
Week 232 - Epilepsy: What is the purpose for checking meningism in coma patients?
To identify a possible cause of SAH or meningitis.
Week 232 - Epilepsy: How do you test for brain stem function in coma patients?
- Pupils
- Corneal response
- Gag reflex
- Response to hypercapnia
- Vestibulo-ocular response
Week 232 - Epilepsy: What is the difference between arousal and awareness?
Arousal - Level of consciousness/alertness
Awareness - Content of consciousness, awareness of self and environment.
Week 232 - Epilepsy: What is persistent vegetative state?
Recovery of arousal but not awareness.
Week 232 - Epilepsy: What is persistent vegetative state mainly due to?
Diffuse cortical or subcortical damage.
Week 232 - Epilepsy: What is a minimally conscious state?
Patients may,
- Make eye contact/turn head when spoken to
- Grasp an object when asked
- Mouth words
- Track objects with eyes
- Have some intelligent verbalisation
Week 232 - Epilepsy: What is the vestibulo-ocular response?
When an ear is irrigated with cold water the eyes should deviate towards that ear.
- An abnormal response indicates pontine damage, drugs/metabolic, CN palsy.
Week 232 - Epilepsy: Which anti-epileptic drug does not reduce the efficacy of the oral contraceptive pill?
Clobazam
