Epilepsy Flashcards

1
Q

Causes of epilepsy

A
  • Idiopathic
  • Congenital
  • Acquired
  • Non-epileptic/provoked: Withdrawal, metabolic, raised ICP, infection
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2
Q

Prodrome of a seizure

A

Change in mood or behaviour lasting hours/days

Not part of seizure

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3
Q

Aura of a seizure

A

Simple partial seizure (usually temporal) which may precede other manifestations
Epigastric rising, Deja/Jamais vu, Automatisms, Smells, Lights etc

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4
Q

Partial/Focal seizure

A

Only one hemisphere

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5
Q

Primary generalised seizure

A

No aura/warning

Affects whole cortex not one hemisphere

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6
Q

Simple seizure

A

Awareness unimpaired

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7
Q

Complex seizure

A

Awareness impaired

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8
Q

Secondary generalised seizure

A

Focal seizure –> generalised seizure

aura–>tonic-clonic

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9
Q

Epilepsy history

A
Aura
Specific trigger (lights)
Lateral tongue biting
Tonic clonic movements
Cyanosis
Post-ictal phase
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10
Q

Simple partial seizure features

A

Focal motor, sensory, autonomic or psychic symptoms

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11
Q

Complex partial seizure features

A

Aura
Autonomic: change in skin colour, temp, palpitations
Awareness lost
Automatisms: lip smacking, fumbling, swallowing
Amnesia

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12
Q

Absence seizure features

A
(Petit mal)
ABrupt onset/offset
Short <10s
Eyes glazed, blank stare
Normal intelligence, brain scan, examination
Clonus or automatisms
EEG 3Hz spike and wave
Stimulated by hyperventilation and photics
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13
Q

Tonic Clonic seizure features

A
(Grand Mal)
LOC
Tonic: limbs stiffen
Clonic: rhythmic jerking
\+/- cyanosis, incontinence, tongue biting
Post ictal confusion and drowsiness
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14
Q

Myoclonic seizure features

A

Sudden jerk of limbs, trunk or face

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15
Q

Atonic seizure features

A

Sudden loss of muscle tone –> fall

No LOC

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16
Q

West syndrome/infantile spasms

A

Head nodding and arm jerks

EEG hypsarrhythmia

17
Q

Temporal localising seizure features

A

Automatisms: lip smacking, chewing, fumbling
Deja/jamias vu
Delusional behaviour
Abdominal: rising, n/v
Emotional disturbance: terror, panic, anger, elation
Tastes, smells

18
Q

Frontal localising seizure features

A

Motor features

19
Q

Parietal localising seizure features

A

Sensory disturbance

20
Q

Occipital localising seizure features

A

Visual phenomena

21
Q

Diagnosis of epilepsy

A
Need more than 1 seizure
Bloods
Raised serum prolactin 10 min after fit
Urine toxicology
ECG
EEG
MRI
22
Q

Tonic Clonic seizure treatment

A

1) Valproate

2) Lamotrigine

23
Q

Absence seizure treatment

A

1) Valproate/ethosuximide

2) Lamotrigine

24
Q

Tonic, atonic, myoclonic seizure treatment

A

1) Valproate

2) Levetiracetam

25
Q

Focal +/- secondary generalised seizure treatment

A

1) Lamotrigine

2) Carbamazepine

26
Q

Lamotrigine side effect

A

Skin rash (stephen johnson syndrome)

27
Q

Valproate side effects

A
Appetite ↑ → ↑wt.
Liver failure: monitor LFTs over 1st 6mo
Pancreatitis
Reversible hair loss
Oedema
Ataxia
Teratogenicity, Tremor, Thrombocytopaenia
Encephalopathy: due to ↑ ammonia
28
Q

Carbamazepine side effects

A

Leukopenia
Skin reactions
Diplopia
Syndrome of inappropriate ADH (SIADH) –> hyponatraemia

29
Q

Phenytoin side effects

A
Gingival hypertrophy
Hirsutism
Cerebellar syndromes: Ataxia, Nystagmus, Dysarthria
Peripheral sensory neuropathy
Diplopia
Tremor
30
Q

Status epilepticus definition

A

Seizure > 30mins or repeated seizures without regain of conciousness

31
Q

Investigations for status epilepticus

A

BM
Bloods
ECG
EEG

32
Q

Treatment of status epilepticus

A

1) Lorazepam: 2-4mg bolus over 30s, 2nd dose if don’t respond in 2 mins
2) Phenytoin: 18mg/kg IV infusion
3) Diazepam infusion
4) Dexamethasone

33
Q

Pregnancy and epilepsy treatment

A

Don’t give valproate

Give lamotrigine and folic acid