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Neurology > Epilepsy > Flashcards

Flashcards in Epilepsy Deck (36)
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1
Q

Risk factors for epilepsy (7)

A
Birth
Development
Seizures in past inc. febrile 
Head injury
Family history
Drugs
Alcohol
2
Q

When do we do an ECG and why

A

Single seizure or first fit ALWAYS

Long QT syndrome can present with seizure

3
Q

Imaging in seizure

A

MRIb and CTb

MRIb subtle structural abnormalities in brain could be seizure focus

4
Q

Who gets a CT scan acutely (6)

A
  • Clinical or radiological skull fracture
    • Deteriorating GCS
    • Focal signs
    • Head injury with seizure
    • Failure to be GCS 15/15 4 hours after arrival
    • Suggestion of other pathology – eg SAH
5
Q

When do we use EEG

A

Classify epilepsy, surgical evaluation, confirmation of non convulsive status, confirmation of non epileptic attack

Do not use to figure out cause of attack. USE HISTORY

6
Q

Driving and epilepsy - if you have 1 seizure

A

6months no car

5 years lorry

7
Q

Driving and epilepsy - Epilepsy diagnosed

A

1yr no car
3yrs no car if seizure in sleep
10 years off medication for lorry

8
Q

When do we counsel about SUDEP

A

At first diagnosis

9
Q

What is a seizure?

A

seizure is abnormal synchronisation of neuronal activity - usually excitatory with high frequency action potentials
Interruption of normal brain activity - focal or generalised
Usually brief - secs to mins

10
Q

If seizure area in brain affects right frontal lobe

A

Motor cortex

Left motor symptoms - left arm stiff

11
Q

If seizure in occipital lobe

A

Visual changes

12
Q

If seizure in temporal lobe

A

Abnormal memories, epileptic deja vu

13
Q

If seizure in limbic system

A

Fear and emotion

14
Q

Broad classifications of epilepsy (2)

A

Generalised

Partial/focal epilepsy

15
Q

Tx of choice for primary generalised epilepsy

A

Sodium Valproate

16
Q

Tx of choice for focal onset epilepsy and why

A

Carbemazepine
or lamotrigine
sodium valproate works but not 1st choice as side effects

17
Q

When do we use phenytoin

A

Anticonvulsant only used acutely - long term effects include gum hypertrophy

18
Q

When do we NOT use carbemazepine

A

Primary generalised epilepsies

Can make them worse

19
Q

What is sodium valproate

A

Domestos of anticonvulsants however with lots of side effects

20
Q

Side effects of sodium valproate (4)

A

Weight gain
Teratogenic
Hair loss
Fatigue

21
Q

Use of Lamotrigine

A

Well tolerated in generalized and focal epilepsies

22
Q

Anti convulsants that induce hepatic enzymes

A

Carbamazepine, oxcarbazepine, phenobarbitol, phenytoin, primidone, topiramate

23
Q

Why should we be aware of anti convulsants that induce hepatic enzymes

A

Can alter efficacy of COCP

Morning after pill dose must be increased

24
Q

What is status epilepticus?

A
  • Recurrent epileptic seizures without full recovery of
    consciousness
  • Continuous seizure activity lasting more than ?30
    minutes
25
Q

Types of status epilepticus (3)

A

– Generalized convulsive status epilepticus
– non convulsive status
• conscious but in “altered state”
– Epilepsia partialis continua
• continual focal seizures, consciousness preserved

26
Q

Precipitants of status (6)

A
• Severe metabolic disorders
– hyponatraemia, pyridoxine deficiency
• Infection
• Head trauma
• Sub-arachnoid haemorrhage
• Abrupt withdrawl of anti-convulsants
• Treating absence seizures with CBZ
27
Q

Complications of convulsive status

A
• Excess cerebral energy demand and poor substrate
delivery causes lasting damage
• Can cause
– respiratory insufficiency and hypoxia
– hypotension
– hyperthermia
– rhabdomyolysis
28
Q

Managing status

A
• Stabilize patient
– ABC
• Must identify cause!!
– Emergency blood tests +/- CT
• Anti-convulsants
– Phenytoin (check levels)
– Keppra
– valproate
– Benzodiazepines
• A quick way to admit to ITU
29
Q

Simple focal seizures

A

Small part of brain affected, person conscious, doesnt spread. A SFS are sometimes called auras as it can be a warning of another seizure -> secondary generalised

30
Q

Complex focal seizures

A

Affects a larger part of one hemisphere, consciousness may be affected

31
Q

Secondary generalised seizures

A

Focal start then generalises and moves across network in brain
Unconscious
Tonic colonic

32
Q

Absences (petit mal)

A

Unreactive to stimulus, unaware of what doing, may be confused with day dreaming

33
Q

Tonic seizures

A

Muscles suddenly become stiff

34
Q

Atonic seizures

A

Muscles relax suddenly

35
Q

Myoclonic seizures

A

Muscle jerks

36
Q

Tonic colonic (grand mal)

A

At the start of the seizure:

the person becomes unconscious
their body goes stiff and if they are standing up they usually fall backwards
they may cry out
they may bite their tongue or cheek.
During the seizure:

they jerk and shake (convulse) as their muscles relax and tighten rhythmically
their breathing might be affected and become difficult or sound noisy
their skin may change colour and become very pale or bluish
they may wet themselves.
After the seizure (once the jerking stops):

their breathing and colour return to normal
they may feel tired, confused, have a headache or want to sleep.