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Neurology > Epilepsy > Flashcards

Flashcards in Epilepsy Deck (47):
1

what are the important parts of a seizures history

-Onset
-What were they doing?
-Environment, etc
-Light-head or other syncopal symptoms
-What did they look like
-Pallor, breathing (presyncope)
-Posturing of limbs, head turning (seizure)
Event itself
-Type of movements
-Tonic phase, clonic movements
-Corpopedal spasms, rigor
-Responsiveness and awareness throughout
Afterwards
-Speed of recovery (recover fast after faint), sleepiness/disorientation, deficits

2

if there is bilateral movement and retained consciousness is it a seizure

no

3

what type of seizure causes right hand to go up and the head to turn

frontal lobe seizures

4

is biting your tongue and incontinence specific to seizures

no

5

what are the risk factors for epilepsy

birth
developmental delay
previous seizures (inc 2+ more febrile seizures)
head injury
family Hx
drugs
alcohol

6

when can epilepsy be a problem for a patients occupation

if HGV driver or if they carry a firearm

7

what medications can lower seizure threshold

antibiotics (penicillin, cephalosporins, quinolones)
analgesics (tramadol)
anti-emetics (prochlorperazine)
opioids (diamorphine, pethidine)
aminophyline/ theophyline

8

what exams for seizures in clinic

don't usually examine in first clinic
if diagnosis of syncope do cardio exam, lying and standing BP

can do neuro exam if see them shortly after event

9

what investigations should you do for a collapse/ seizure

ALWAYS DO ECG

prolonged QT can provoke seizure


can do imaging- MRIb/ CTb if indicated

10

what is an EEG useful for

classification of epilepsy
confirmation of non epileptic attacks
surgical evaluation
confirmation of non convulsive attacks= actually only time its used

never used in acute attack to diagnose

11

when are CT scans done acutely

Clinical or radiological skull fracture Deteriorating GCS
Focal signs- might suggest stroke/ bleed
Head injury with seizure
Failure to be GCS 15/15 4 hours after arrival Suggestion of other pathology – eg SAH

12

should you do an EEG

not really
positive/ negative test means nothing in diagnosis of epilepsy

13

when after a seizures can you drive

1st seizure – car = 6 months, 5 years for HGV/PCV

Epilepsy – car = 1 year or 3years during sleep (nocturnal seizures), 10 years off medication for HGV/PCV

14

what is epilepsy

a tendency to recurrent, usually spontaneous seizures

15

what are the features of global (primary generalised) epilepsy
(who gets it, when, what are seizures like)

genetic predisposition
present in childhood and adolescence
can have tonic clonic, abscence, myoclonic, clonic and tonic seizures

16

what is seen on EEG in global epilepsy

generalised spike wave abnormalities

17

what is an epileptic seizures

abnormal synchronisation of neuronal activity (usually excitatory) which interrupts normal brain activity (can be focally or generalised) and is usually brief

18

why do you get epileptic seizures

too much excitation
too little inhibition
changes:
-cell number/ type
-connectivity
-synaptic function
-voltage gates channel function

genetic, acquired brain, metabolic, toxic and environmental factors

19

what is juvenile myclonic epilepsy

form of primary generalised epilepsy
get early morning jerks
generalised seizures
risk factors- sleep deprivation, flashing lights

20

what is the treatment for primary generalised epilepsy

sodium valproate (is teratogenic and cosmetic effects)
lamotrigine alternative

21

what is focal epilepsy

seizures that occur around an abnormal area of brain (stroke/ tumour) which irritates the brain and causes abnormal electrical activity

22

what is generalised epilepsy

when abnormal electrical activity hits a pathway and spreads to other part of brain (corticothalamic circuitry)
seizure can start from a focal point, and then secondary generalisation

23

what are the types of partial/ focal epileptic seizures

simple- without impaired consciousness
complex- with impaired consciousness

or

-motor (rhythmic jerking, posturing, head and eye deviation, automatisms, volacisation)
-sensory (somatosensory, olfactory, gustatory, visual, auditory)
-pyschic (memories, deja vu, jamais vu, depersonalisation, aphasia, complex visual hallucinations)

24

what are the types of generalised epileptic seizures

absence (go blank, stare into distance)
myoclonic (jerking of limbs)
atonic (loose muscle tone)
tonic
tonic clonic

25

what is the age of onset of focal onset epilepsy

can be any age- due to underlying structural cause

26

what is the treatment for focal onset epilepsy

initially:
lamotrigine (1st line)/ carbamazepine

(sodium valproate works well but not given because of SEs)

can then add on:
Gabapentin
Tiagabine
Pregabalin
Zonisamide
Vigabatrin
Clonazepam
Clobazam

27

how do antiepileptic drugs work

inhibit v activates Na+ channels (reduces pre synaptic excitability and the ability of APs to spread) (carbamazepine, oxcarbazepine, phenytoin, lamotrigine)
enhances activity of v gated K+ channels (stabilises neurone, reduces its excitability) (retigabine)
inhibition of V activates Ca+ channels that trigger neurotransmitter release (gabapentin and prehabalin)

28

what is the treatment for generalised absence seizures

sodium valproate
ethosuximide

29

what is the treamtment for generalised myoclonic seizures

sodium valproate
levetiracetam
clonazepam

30

what is the treamtment for generalised Atonic, Tonic, Generalised tonic clonic
seizures

sodium valproate

31

when is phenytoin used

acute management only

32

when do you give carbamazepine

Focal onset seizures
Can make primary generalized epilepsies worse
Dont give in generalized epileosy

33

when do you medicate epilepsy

when patient wants drug- balance benefits and side effects
if high risk of recurrence

34

which anti convulsants induce hepatic enzymes
IMPORTANT KNOW THIS IN EXAM

carbamazepine
oxcarbazepine
phenobarbitol
phenytoin
primidone
topiramate

35

how do anticonvulsants affect women in particular
IMPORTANT KNOW IN EXAM

Can alter efficacy of combined oral contraceptive pill
Shouldn't use progesterone only
pill
Morning after pill not adequate if taking enzyme inducing AEDs – dose should be increased
Balance risk of uncontrolled seizures vs teratogenicity
Folic acid and vitamin K- high dose folic acid 3 months before conception
Side effects may not be as acceptable in ladies (sodium valporate- fat and bald)

36

what does hippocampal sclerosis give

focal epilepsy

37

what is status epilepticus

recurrent epileptic seizures without full recovery of consciousness
continuous seizure activity lasting more than 30 mins

38

what are the types of status epilepticus

generalised convulsive status epilepticus
non convulsive (conscious but in altered state)
epilepsia partialis continua (continual focal seizures, consciousness preserved)

39

when do you start treatment for status epilepticus

at 10 mins

40

what can precipitate status epilepticus

severe metabolic disorders (hyponatraemia, pyridoxine deficiency)
infection
head trauma
sub arachnoid haemorrhage
abrupt withdrawal of anti convulsants
treating abscence seizures with carbamazepine

41

what is convulsive status

generalised convulsions without cessation

42

what can convulsive status cause

Excess cerebral energy demand and poor substrate delivery causes lasting damage:
-respiratory insufficiency and hypoxia
-hypotension
-hyperthermia
-rhabdomyolysis

death due to metabolic hyperpyrexia (50-69mins) or after this due to organ failure

43

what happens pathologically in uncontrolled status epilepticus

Glutamate release
Excitotoxicity
Neuronal death

44

what is the treatment for status epilepticus
IMPORTANT WILL BE IN EXAM

ABC- stabilise patient, always check glucose
IDENTIFY CAUSE- bloods, CT

for immediate control: (anticonvulsants)
1st line- benzodiazepines (lorazepam, diazepam, midazolam)
2nd- phenytoin
3rd- valproate
4th- keppra

for sustained control
-if established epileptic re establish AED Tx via Ng tube/ orally/ IV for phenytoin
- in other patients/ if ongiong seizures
--fosphenytoin with ECG monitoring
--phenytoin with ECG monitoring
--phenobarbital
maintain levels with NG/IV/orally

give 50mls 50% glucose if any suggestion of hypo
give thiamine if alcoholism/ impaired nutritional status

if status persists transfer to ICU within 1 hour. monitor with full EEGs or cerebral function monitor

control status with anaesthesia (thiopentone or propofol)

45

why should you be careful of benzodiazpeines

never give more than 2 doses - admit to ICU

46

what is parital status epilpeticus

should be considered in acute confusion
confirm with EEG
tx same as status epilepticius (minus anaesthesia and ICU)

47

when do you treat a seizure

at 10 mins
most get better
only after 10 mins think about benzodiazepams