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Flashcards in epilepsy Deck (42)
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1
Q

what questions should you ask a witness of a suspected epileptic seizure with regards to the patient?

A
level of responsiveness
motor phenomena
pulse
colour
breathing
vocalisation
2
Q

what are some potentially relevant pieces of information you should ask a patient suspected of having epilepsy?

A
age
sex
PMH including head injury
psychiatric history
alcohol and drug use
family history
3
Q

what is the most common cause of fainting?

A

vasovagal syncope

4
Q

what are some precursor symptoms of vasovagal syncope?

A
light headed
nausea
hot and sweaty
tinnitus
tunnel vision
5
Q

what are some triggers for vasovagal syncope?

A
prolonged standing
standing up quickly
trauma
venepuncture
micturition
coughing
6
Q

how quickly do seizures come on when compared to syncope?

A

seizures have sudden onset, syncope has gradual onset

7
Q

what kind of posture do seizures occur in vs syncope?

A

seizures can occur in any posture whereas syncope occurs when the patient is upright

8
Q

when do hypoxic seizures occur?

A

when individuals are kept upright in a faint

9
Q

what do conussive seizures occur?

A

after any blow to the head

10
Q

when should you consider particularly the possibility of a cardiac arrythmia?

A

family history of sudden death
cardiac history
when collapse occurs with exercise

11
Q

can seizures cause cardiac arrythmias?

A

yes

12
Q

what investigations are essential when investigating a first seizure?

A

blood sugar
ECG
consideration of alcohol and drugs
CT head

13
Q

what advice would you give to a patient that has had a seizure?

A

give copies of safety information sheets
enquire about employment - may have to inform employer
explain driving regulations

14
Q

how long does it take after a first seizure for a patient to be able to drive?

A

6 months if investigations and circumstances are normal

5 years for HGV

15
Q

when is epilepsy normally diagnosed?

A

after a second unprovoked seizure

16
Q

what are some features that are suggestive of epilepsy?

A

history of myoclonic jerks
seeing “flickering lights” whilst feeling strange
history of deja vu
rising sensation from abdomen
episodes where the patient looks blank with lip smacking or fiddling with clothes

17
Q

what are epileptic seizures believed to result from?

A

abnormal neuronal discharges

18
Q

what is specific about the seizures in epilepsy?

A

they recur and are usually spontaneous

19
Q

what are the different ILAE general classifications of epilepsy?

A
tonic clonic seizures
myoclonic seizures
clonic seizures
tonic seizures
atonic seizures
absence seizures
20
Q

how are focal seizures characterised?

A

accoring to aura, motor features

autonomic features and degree of awareness of responsiveness

21
Q

what can focal seizures evolve into?

A

general convulsive seizures

22
Q

what is different about the EEG in focal epilepsy compared to primary generalised epilepsy?

A

the EEG has a generalised abnormaility in primary generalised
it has a focal abnormality on the EEG in focal seizures

23
Q

what investigations are important in diagnosing epilepsy?

A

EEG for primary generalised epilepsies
MRI for patients under age 50 with possible focal onset seizures
CT usually adequate in over 50s for diagnosing focal onset seizures
video telemetry if uncertainty about diagnosis

24
Q

what is first line treatment for primary generalised epilepsy?

A

sodium valproate
lamotrigine
levetiracetam

25
Q

what is the first line treatment for partial and secondary generalised seizures?

A

lamotrigine

carbamazepine

26
Q

what is first line treatment for absence seizures?

A

ethosuximide

27
Q

what is first line treatment for status epilepticus?

A

lorazepam

midazolam (diazepam)

28
Q

what are some side effects of sodium valrproate?

A
tremor
weight gain
ataxia
nausea
drowsiness
transient hair loss
pancreatitis
hepatitis
29
Q

what are some side effects of carbamazepine?

A
ataxia
drowsiness
nystagmus
blurred vision
low serum sodium levels
skin rash
30
Q

what are some side effects of lamotrigine?

A

skin rash

sleeping difficulties

31
Q

what are some side effects of levetiracetam?

A

irritability

depression

32
Q

what are some side effects of topiramate?

A

weight loss
difficulty finding words
tingling hands and feet

33
Q

what are some side effects of zonisamide?

A

bowel upset

cognitive problems

34
Q

what are some side effects of lacosamide?

A

dizziness

35
Q

what are some side effects of pregabilin?

A

weight gain

36
Q

what are some side effects of vigabatrin?

A

behavioural problems

visual field defects

37
Q

when can epilepsy patients hold a driving license?

A

when they have been seizure free for a year or have an established pattern of only sleep related attacks for a year

38
Q

what is status epilepticus?

A

prolonged or recurrent tonic-clonic seizures persisting for more than 30 minutes with no recovery period in between seizures

39
Q

what is first line treatment of TCSE?

A

midazolam -10mg
lorazepam - 0.07mg/kg
diazepam - 10-20mg IV, can repeat after 15 minutes of necessary

40
Q

what is second line treatment of TCSE?

A

phenytoin

valproate

41
Q

what is third line treatment of TCSE?

A

anaethesia usually with propofol or thiopentone

42
Q

what percentage of cases in TCSE in children show a neurological problem following an episode?

A

24%