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Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

in a falls history, what aspects should be asked about in the “before” segment

A 
pallor
light headedness
triggers - flashing lights 
posturing of limbs 
head turning
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2
Q

in a falls history what aspects should be asked about in the “during” segment

A

tonic
clonic
rigidity
responsiveness and awareness

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3
Q

in a falls history what aspects should be asked about in the “after” segment

A

speed of recovery

disorientation

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4
Q

risk factors for epilepsy

A 
complicated birth 
delayed development 
previous seizures including febrile 
head injury
family history 
drugs 
alcohol
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5
Q

list drugs precipitating epileptic seizures

A 
theophylline 
tramadol 
opioids
penicillins 
cephalosporins 
quinolones 
lithium 
lidocaine 
antidepressants 
anticholinergics 
prochlorperazine
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6
Q

which single investigation should all people who have had a fall/collapse get?

A

ECG

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7
Q

which cardiac condition is it vital not to miss in terms of falls

A

LQTS

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8
Q

who gets a CT scan acutely

A

skull fracture
deteriorating GCS
focal neurological deficit head injury with seizure failure of GCS 15/15 after 4 hours
suggestion of other pathology

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9
Q

what is an EEG and is it a good test to diagnose epilepsy after a collapse

A

electroencephalogram

it is a dreadful test and should not be used to diagnose epilepsy after a collapse

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10
Q

what is an EEG used for

A

to classify epilepsy
confirm non-epileptic attack/non-convulsive status
surgical evaluation

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11
Q

differential diagnoses of collapse

A 
syncope
seizure 
hypoglycaemia 
pseudoseizure 
sleep phenomena 
parasomnias
migraine 
cataplexy 
tonic spasms of MS
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12
Q

how long until you are able to drive a car after your first seizure

A

6 months

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13
Q

how long until you are able to drive a HGV/PCV after your first seizure

A

5 years

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14
Q

1 seizure = epilepsy, true or false

A

false

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15
Q

when can you drive a car if you have epilepsy

A

1 year being seizure free

or 3 years during sleep

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16
Q

when can you drive a HGV/PCV if you have epilepsy

A

after being medication free for 10 years

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17
Q

define epilepsy

A

a tendency to recurrent spontaneous epileptic seizures

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18
Q

define seizure

A

abnormal synchronisation of electrical activity

  • excitatory
  • inhibitory
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19
Q

what is SUDEP

A

sudden unexplained death in epilepsy

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20
Q

how are seizures classified

A

focal/partial

generalised

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21
Q

describe focal seizures

A

irritation occurs in a certain area of the brain eg stroke, haemorrhage, demyelination, tumour

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22
Q

focal seizures can have secondary generalisation, true or false

A

true

23
Q

describe generalised seizures

A

abnormal electrical activity all over the brain

24
Q

how can epilepsy be classified

A

focal

generalised

25
Q

how can focal epilepsy be classified

A

simple

complex

26
Q

describe simple focal epilepsy

A

consciousness NOT impaired

27
Q

describe complex focal epilepsy

A

consciousness IS impaired

28
Q

define focal epilepsy

A

recurrent focal seizures +- 2ndary generalisation

29
Q

how can generalised epilepsy be classified

A 
absence
atonic 
tonic 
tonic clonic / primary generalised
myoclonic
30
Q

define generalised epilepsy

A

recurrent generalised seizures

31
Q

what group of epilepsy is Juvenile Myoclonic Epilepsy and what is the best treatment

A

primary generalised

Na valproate but lamotrigine is used as an alternative

32
Q

what group of epilepsy is Complex partial epilepsy with hippocampal sclerosis and what is the best treatment

A

focal epilepsy
carbamazepine or lamotrigine
occurs in <30 yo

33
Q

what is the benefit of anti epileptic drugs AEDs

A

to reduce likelihood of having more seizures in the first place

34
Q

AEDs are prescribed after 1 seizure, true or false

A

FALSE

not prescribed after a one off seizure

35
Q

carbamazepine is used for focal/generalised epilepsy only

A

focal

makes generalised epilepsies worse

36
Q

what is phenytoin and what is it used for

side effects?

A

anti-convulsant
acute management only
enzyme inducer

37
Q

what is Na valproate and what is it used for

A

Na channel inhibitor anti convulsant

all types of epilepsy

38
Q

side effects of Na valproate

A

TERATOGENIC
weight gain
hair loss
fatigue

39
Q

what is carbamazpine and what is it used for

A

Na channel blocker anti convulsant

focal epilepsy only

40
Q

what is lamotrigine and what is it used for

A

Na channel blocker anti convulsant

focal and generalised epilepsies

41
Q

what is a side effect of lamotrigine and what is done as a result

A

Steven Johnson Syndrome

dose is slowly titrated up

42
Q

what is levetiracetam

side effects?

A

anti convulsant

well tolerated but can cause mood swings

43
Q

what is a side effect of topiramate

A 
weight loss 
parasthesia 
poor cognition 
sedation 
dysphasia
enzyme inducer
44
Q

which anti convulsants induce hepatic enzymes and why is this a problem

A 
carbamazepine 
oxcarbazine 
phenobarbitol 
phenytoin 
primodone 
topiramate
They alter the efficacy of the OCP
45
Q

Progestogen only pills and implants can be used with antoconvulsants, true or false

A

FALSE, they should not be used

46
Q

how should contraception be managed in ladies on anti-convulsants

A

need higher dose of contraceptive pill and morning after pill

47
Q

management of women wanting to get pregnant on AEDs

A

preconceptual counselling
risk benefit balance with drugs
high dose folic acid + vit K

48
Q

what is status epilepticus SE

A

recurrent epileptic seizure without full recovery of consciousness
continuous seizure lasting >30 min

49
Q

what types of status epilepticus are there

A

generalised convulsive
non-convulsive
continuous focal seizures

50
Q

list precipitants of SE

A 
severe metabolic disorders 
abrupt withdrawal of AEDs
infection 
trauma 
SAH 
treating absence seizures with carbamazepine
51
Q

why is SE so dangerous

A

multi organ failure

excitotoxicity results in neuronal death

52
Q

investigations in SE

A

ABCDE
bloods - FBC, LFT, U+E
+- CT scan

53
Q

pharmacological management of SE

A 
benzodiazepines: buccal/IM midazolam twice maximum with 5 minute intervals
phenytoin 
Na valproate 
keppra 
thiopentone, propofol - ICU!

Neurology (25 decks)

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