YearClub 2026 Neurology session (Epilepsy) Flashcards
What is epilepsy?
Condition where there is a tendency to have seizures or transient episodes of abnormal brain activity.
What events are important to consider when looking at epilepsy?
Onset
Seizure itself
Post-seizure
Risk factors for epilepsy?
Prematurity, developmental issues, past seizures (e.g. febrile), head injuries, family history, alcohol.
Drug risk factors of epilepsy?
Benzo withdrawal, anti-emetics (clozapine), antibiotics (inc cyclosporin), bronchodilators (aminophyline).
Generalised tonic clonic seizure summary?
Generalized Tonic-Clonic seizures
Remember: TENSING AND JERKING, POST-ICTAL SX, associated tongue biting, incontinence
First Line: sodium valproate (except women of child bearing age)
Second Line: Lamotrigine/Carbamazepine
Carbamazepine also not suitable for women of child bearing age due to increased risk teratogenicity including hypospadias, neural tube defects and cardiac effects.
Focal seizure summary?
FOCAL seizures
Remember specific signs and areas of the brain;
FRONTAL = Jacksonian march (tonic contractions in one hand or on one side of the face or the muscles of one foot), post-ictal weakness
OCCIPITAL = Visual defects, floaters and flashes
TEMPORAL = Hallucinations, automatism, epigastric, de-javu, scents
PARIETAL = Paresthesia
First line: Lamotrigine/Carbamazepine
Second Line: sodium valproate
- Treatment is the reverse of TONIC CLONIC seizures.
Atonic seizures summary?
*ATonic seizures
Remember: drop attacks; brief lapses in muscle tone. Less than 3 mins, begins in childhood
First Line: sodium valproate (except women - since teratogenic properties).
Second Line: *LamoTrigine (First Line for women)
*Capital T’s can be used as a reminder.
Myoclonic seizures summary?
*MyoClonic seizures
Remember: Sudden lapses of muscle contraction. In children: juvenile myoclonic epilepsy.
First Line: sodium valproate
Second Line: *LevetiraCetam
*Capital C’s can be used as a reminder.
Absence seizures summary?
ABSENCE seizures
Remember: usually in children. Patient becomes blank and stares into space, then becomes normal again. (unaware of surroundings and won’t respond).
Tx: sodium valproate/ethosuxamide
NO CARBAMAZEPINE
Infantile Spasm’s summary?
INFANTILE SPASMS (West’s Syndrome)
Remember: starts around 6 m.o., Full body spasms, Poor prognosis; ⅓ dead by 25.
Tx: Prednisolone, Vigabatrin
What is Status epilepticus?
MEDICAL EMERGENCY!
SEIZURES LASTING >5 mins or >3 seizures in 1 hour.
Due to (amongst other causes): Severe metabolic imbalance, SA haemorrhage,
Carba with absence seizures, anticonvulsant withdrawal, head trauma, infection, etc.
Treatment for status epilepticus?
TX: ABCDE, high flow O2, IV lorazepam [repeat if seizures continue after 10 mins, but if AGAIN, then IV phenytoin]
In community: Buccal midazolam and Rectal diazepam
Sodium valproate risks?
SODIUM VALPROATE (inc GABA activity): TETRATOGENIC, LIVER DAMAGE, TREMORS
Carbamazepine risks?
CARBAMAZEPINE: AGRANULOCYTOSIS, APLASTIC ANAEMIA, CARDIAC PROBLEMS
Phenytoin risks?
PHENYTOIN: VIT D AND FOLATE DEFICIENCY
Phenytoin is contraindicated in pregnancy due to:
potential adverse effects of phenytoin on the foetus include facial clefting, vitamin K and D deficiencies, heart malformations, limb deformities, and neurologic defects.
