Epilepsy Flashcards Preview

Neurology > Epilepsy > Flashcards

Flashcards in Epilepsy Deck (26)
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1
Q

What are the differential diagnoses of blackouts?

A
  • syncope
  • first seizure
  • hypoxic seizure
  • concussive seizure
  • cardiac arrhythmia
  • non-epileptic attack (narcolepsy, movement disorder, migraine)
2
Q

What information would you want to find out following an attack?

A

History from patient: warning signs, what they were doing at the time/night before, what happened after, any incontinence or tongue biting. Any trauma including head injury, birth trauma or febrile convulsions? Psych, drug, alcohol and FH.

History from witness: level of responsiveness, breathing, colour, pulse, behavior

3
Q

What is vasovagal syncope?

A

Fainting due to body overreacting to a certain trigger eg blood. This triggers a drop in BP and HR –> reduced blood flow to brain –> faint.

4
Q

What are the prodromes of vasovagal syncope?

A

Lightheadedness, nausea, hot, sweating, tinnitus and tunnel vision.

5
Q

What can trigger vasovagal syncope?

A

Prolonged standing, venepuncture, watching medical procedures, trauma, micturition, coughing, standing up quickly.

6
Q

How common is epilepsy?

A

Aside from stroke, it is the most common neurological condition.

7
Q

What are the main differences between syncope and seizure?

A

Syncope:

  • upright posture, pallor common, due to a precipitating factor (eg standing for too long), injury and incontinence rare, rapid recovery and gradual onset

Seizure:

  • any posture, pallor uncommon, sudden onset, injury and incontinence common, precipitating factors rare and slow recovery
8
Q

What is a hypoxic seziure and when would this occur?

A

Caused by reduced supply of O2 to the brain. Occurs when people are brought to their feet too quickly after a faint.

9
Q

When would a concussive seizure occur?

A

After any blow to the head.

10
Q

Give an example of a cardiac arrhythmia that can cause seizures.

A

Long QT-syndrome - look at FH.

11
Q

Describe the features of non-epileptic attacks.

A
  • more common in women
  • history of abuse
  • may look like a tonic-clonic seizure
12
Q

How is a possible first seizure investigated?

A
  • take blood sugar (could be a hypo)
  • ECG (looking for arrhythmias)
  • are they under the influence of alcohol or drugs?
  • CT head
13
Q

What are the driving regulations after a seizure?

A

Suspected:

  • may drive after 6 months if investigations are normal and no further seizures
  • if investigations abnormal or alcohol related they cannot drive for 1 year
  • HGV or PSV after 5 years if not on any meds, no further events and investigations are normal

Diagnosed:

  • can drive after 1 year if seizure free or only sleep attacks
  • HGV/PSV after 10 seizure free years and no anti-epileptics
14
Q

Describe some features suggestive of epilepsy.

A

History of myoclonic jerks in the morning (like when you’re leg twitches when you are falling asleep); absences; feeling strange when lights are flickering; fidgeting with clothes; deja vu etc.

15
Q

What is epilepsy?

A

An intermittent, stereotyped disturbance of consciousness, behaviour, emotion, motor function or sensation which is believed to result from abnormal neuronal discharges –> seizures recur spontaneously.

16
Q

How many people in the UK have active epilepsy?

A

Over 300000.

17
Q

What are the 2 main groups of seizures?

A

Generalised and focal/partial (ILEA classification)

18
Q

Name the different types of generalised seizures.

A
  • tonic-clonic
  • myoclonic
  • clonic - person loses consciousness and falls to the floor
  • tonic - arms and legs move rhythmically and in jerking movements
  • atonic - breif lapse in muscle tone
  • absence - blanking out
19
Q

What are focal seizures characterised by?

A

Aura, motor features, autonomic features and degree of awareness/responsiveness.

Can develop into generalised convulsive seizure.

20
Q

Define status epilepticus.

A

Prolonged or recurring tonic clonic seizures for more than 30 minutes with no recovery period in between seizures. 5-10% mortality.

21
Q

Describe the differences between primary generalised and focal epilepsy.

A

Primary generalised:

  • no warning
  • < 25
  • may have a history of absences/myoclonic jerks
  • generalised abnormality on ECG
  • may have FH

Focal/partial:

  • aura
  • any age
  • can become secondary generalised
  • focal abnormality on ECG
  • MRI may show cause
22
Q

What are the investigations for epilepsy?

A

EEG, photic stimulation and hyperventilation. MRI for patients under 50 with possible focal onset seizures.

23
Q

Which drugs are 1st line for primary generalised epilepsy?

A

Sodium valproate, lamotrigine and levetiracetam.

24
Q

Which drugs are 1st line for partial and secondary generalised?

A

Lamotrigene or carbamazepine.

25
Q

Which drug is 1st line for absence seizures?

A

Ethosuximide.

26
Q

Which drugs are 1st line for status epilepticus?

A

Midazolam, lorazepam or diazepam - enhance the effects of GABA.