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Neurology HK > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

what is epilepsy

A

response to spontaneous, intermittent abnormal excitatory signals in the brain

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2
Q

inhibitory neurotransmitter in brain

A

GABA

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3
Q

what increases with GABA

A

Chloride

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4
Q

excitatory neurotransmitter in the brain

A

glutamate

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5
Q

what receptors does glutamate bind to

A

NMDA receptors

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6
Q

what increases with glutamate

A

Calcium

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7
Q

what are the 2 broad groups of seizures

A

generalized

focal (partial)

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8
Q

what are the 3 types of partial seizure

A

simple
complex
partial with secondary generalization

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9
Q

features of partial simple seizure

A

awareness intact
focal motor/autonomic/psychic or sensory (e.g. visual, olfactory) symptoms
no post-ictal symptoms

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10
Q

clinical features of partial complex seizures

A

awareness impaired
deja vu
lip smacking/jaw clenching/vertigo (automatism)
post ictal symptoms common

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11
Q

what lobe does complex partial seizures usually arise in

A

temporal

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12
Q

describe a partial seizure with secondary generalisation

A

electrical disturbance starts focally then spreads widely causing a typically convulsive seizure (pseudoseizure)

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13
Q

what are post ictal symptoms

A

headache
confusion
myalgia
sore tongue

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14
Q

seizures in frontal lobe

A

motor features - posturing, head/eye movements, peddling of legs dysphagia/speech arrest

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15
Q

seizures of parietal lobe

A

sensory disturbances - tingling, numbness

motor symptoms are rare - only if spread to pre-central gyrus)

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16
Q

seizures of occipital lobe

A

visual phenomena - spots, lines, flashes

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17
Q

1st line treatment for partial seizures

A

carbamazepine

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18
Q

2nd line treatment for partial seizures

A

sodium valproate

lamotrigine if woman of child bearing age

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19
Q

lamotrigine will diffuse into breast milk. True/false?

A

true - no harm to baby

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20
Q

what are the types of generalized seizures

A 
absent (petit mal) 
tonic-clonic seizure (grand mal)
myoclonic
tonic atonic 
infantile spasms
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21
Q

brief (<10s) pauses e.g. suddenly stops talking mid sentence then carries on

A

absent seizures

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22
Q

typical EEG finding for absent seizures

A

3 hertz notch

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23
Q

when do absent seizures typically present

A

childhood

24
Q

limbs stiffen then jerk with loss of consciousness

A

tonic-clonic

25
Q

do you commonly get post-ictal symptoms in tonic-clonic seizures

A

yes

26
Q

sudden jerk of a limb, face of trunk

may throw suddenly to ground

A

myoclonic

27
Q

what drug should be avoided in myoclonic seizures

A

carbamazepine

28
Q

sudden loss of muscle tone causing fall with no loss of consciousness (floppy)

A

atonic seizure

29
Q

what condition is associated with infantile spasms

A

tuberous sclerosis

30
Q

most common cause of seizures

A

idiopathic (often familial)

31
Q

structural causes of seizures

A 
cortical scarring (previous head injury)
developmental 
space occupying lesion
stroke 
hippocampal sclerosis ((after febrile convulsion)
vascular malformations
32
Q

non-epileptic causes of seizure

A 
trauma 
stroke 
haemorrhage 
raised ICP
alcohol/benzodiazepine withdrawal 
metabolic disturbances infection
33
Q

what drugs can trigger seizures

A

cocaine
tricyclics
tramadol
theophylline

34
Q

triggers for seizures

A 
alcohol
stress
sounds/flashing lights
drugs
lack of sleep
35
Q

most common time for epilepsy to present

A

childhood-adolescence

36
Q

investigations of suspected seizure

A

ECG
MRI/CT - if suspected skull fracture, deteriorating GCS, focal signs, suggestion of other pathology
EEG - doesn’t always prove patient doesn’t have epilepsy

37
Q

treatment of generalised tonic-clonic

A

1st - sodium valproate or lamotrigine

2nd line - carbamazepine or topiramate

38
Q

treatment of absence seizures

A

sodium valproate
lamotrigine
ethosuximide

39
Q

myoclonic seizures treatment

A

sodium valproate or lamotrigine 1st line

avoid carbamazepine

40
Q

process of switching drugs

A

introduce new drug when still on old drug

only withdraw old drug when established on new drug

41
Q

carbamazepine
action
SE

A

action - blocks voltage gated Na channels in pre-synaptic neuron which decreases excitable action potentials
SE: leucopenia, visual changes, impaired balance/drowsiness, rash

42
Q

lamotrigine
action
SE

A

action - blocks voltage gated Na channels in pre-synaptic neuron which decreases excitable action potentials
SE: rash (toxic epidermal necrolyis,)hypersensitivity, visual changes, tremor, agitation, vomiting, aplastic anaemia

43
Q

phenytoin
action
SE

A

action - blocks voltage gated Na channels in pre-synaptic neuron which decreases excitable action potentials
SE: visual changes, tremor, ataxia

44
Q

Na valproate
action
SE

A 
action: enhances GABA synthesis (increasing inhibitory signals)
SE: VALPROATE
Appetite (weight gain)
Liver failure 
Pancreatitis
Reversible hair loss
Oedema
Ataxia 
Teratogenic, tremor, thrombocytopenia
Encephalopathy
45
Q

levetiracetam SE

A

mood swings

46
Q

topiramate SE

A

sedation
dysphagia
weight loss

47
Q

advice for women with epilepsy planning a pregnancy

A

folic acid supplements 5mg/day
no valproate
most drugs present in breast milk (lamotrigine not thought to be harmful to infants)

48
Q

what drugs are liver enzyme-inducing AEDs

A

carbamazepine
phenytoin
barbiturates

49
Q

what is affected in enzyme inducing AEDs

A

morning after pill not adequate

affect contraceptive pill and Depo-Provera

50
Q

rules for ordinary driving licenses with diagnosed epilepsy

A

can drive if had not had a seizure (on or off medication) for one year
only have seizures when asleep
have previously had awake seizures but have only had seizures when asleep for the last 3 years

51
Q

rules for ordinary driving license with one -off seizure

A

can drive 6 months after seizure if:
only ever one seizure
clear EEG
don’t need to take AEDs

52
Q

rules for HGV/PCV license in one-off seizure

A

can get license back after 5 years if :only ever one seizure
clear EEG
no AEDs
low risk of further seizures

53
Q

rules for HGV/PCV with diagnosis of epilepsy

A

can get license if:
seizure free for 10 years
no treatment for 10 years
low risk of seizure in the future

54
Q

seizure for >5 minutes

A

status elipticus

55
Q

acute management of status elipticus

A

airway management and O2
benzodiazepine - IV lorazepam (if IV access)
if not - IM midazolam

56
Q

what is non-epileptic attack disorder

A

happens for psychological reasons rather than physical ones

e.g. thoughts, feelings, past experiences

57
Q

clinical findings on non-epileptic distress disorder

A

normal EEG

seizure like episodes

Neurology HK (26 decks)

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