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Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

(47 cards)

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1
Q

what are the important parts of a seizures history

A

-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

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2
Q

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

A

no

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3
Q

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

A

frontal lobe seizures

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4
Q

is biting your tongue and incontinence specific to seizures

A

no

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5
Q

what are the risk factors for epilepsy

A 
birth 
developmental delay 
previous seizures (inc 2+ more febrile seizures) 
head injury 
family Hx
drugs 
alcohol
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6
Q

when can epilepsy be a problem for a patients occupation

A

if HGV driver or if they carry a firearm

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7
Q

what medications can lower seizure threshold

A 
antibiotics (penicillin, cephalosporins, quinolones)
analgesics (tramadol)
anti-emetics (prochlorperazine)
opioids (diamorphine, pethidine)
aminophyline/ theophyline
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8
Q

what exams for seizures in clinic

A

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

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9
Q

what investigations should you do for a collapse/ seizure

A

ALWAYS DO ECG

prolonged QT can provoke seizure

can do imaging- MRIb/ CTb if indicated

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10
Q

what is an EEG useful for

A

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

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11
Q

when are CT scans done acutely

A

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

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12
Q

should you do an EEG

A

not really

positive/ negative test means nothing in diagnosis of epilepsy

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13
Q

when after a seizures can you drive

A

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

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14
Q

what is epilepsy

A

a tendency to recurrent, usually spontaneous seizures

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15
Q

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

A

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

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16
Q

what is seen on EEG in global epilepsy

A

generalised spike wave abnormalities

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17
Q

what is an epileptic seizures

A

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

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18
Q

why do you get epileptic seizures

A 
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

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19
Q

what is juvenile myclonic epilepsy

Study These Flashcards
A

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

20
Q

what is the treatment for primary generalised epilepsy

Study These Flashcards
A 
sodium valproate (is teratogenic and cosmetic effects)
lamotrigine alternative
21
Q

what is focal epilepsy

Study These Flashcards
A

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

22
Q

what is generalised epilepsy

Study These Flashcards
A

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
Q

what are the types of partial/ focal epileptic seizures

Study These Flashcards
A

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
Q

what are the types of generalised epileptic seizures

Study These Flashcards
A 
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

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