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Flashcards in Epilepsy Deck (67)
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1

What is the approach to the fallen?

History
Patient; before, during and after
Eye witness; before, during and after

2

What are the important features to an epilepsy history?

Onset; what were they doing, light headedness or other syncopal symptoms, what did they look like (pallor, breathing, posturing of limbs, head turning)
Event itself;
Type of movements; tonic phase, clonic movements, corpopedal spasm, rigor, responsiveness and awareness throughout
Afterwards; speed of recovery, sleepiness/disorientation, deficits

3

What is common of a frontal lobe tonic clonic seizure?

Right hand moves upwards
Head turns to the right
Stiff movements
Clonus

4

What is important to do if you suspect syncope over epilepsy?

CV exam
L+S BP

5

What are common drugs which can precipitate epilepsy?

Theophylinne
Amphetamines
Tramadol
Antibiotics; penicillins, cephalosporins, quinolones
Antidepressants
Anticholinergics
Antiemetics; prochlorperazine
Cocaine
Opioids; diamorphine, pethidine

6

What investigation is the MOST important when working someone up for a seizure?

ECG; prolonged QT syndrome can trigger a generalised tonic clonic seizure and is LIFE THREATNING

7

Who gets a CT scan acutely?

Clinical or radiological skull#
Deteriorating GCS
Focal signs; stroke or bleed
Head injury with seizure
Failure to be GCS 14/15 4 hours after arrival
Suggestion of other pathology eg. SAH or stroke

8

When are EEGs helpful?

Classification of epilepsy
Confirmation of non-epileptic attacks
Surgical eval for epilepsy surgery
Confirmation of non-convulsive status

9

Can you diagnose epilepsy with an EEG?

NO

10

What are conditions that can "mimic" epilepsy?

Syncope
Non-epileptic attack disorder (pseudoseizures, psychogenic non-epileptic attacks)
Panic attacks/ hyperventilation attacks
Sleep phenomena
Hypoglycamia; ALWAYS DO A BG

11

What are the laws around driving and epilepsy?

1st seizure; 6 months or if HGV/PCV 5 years
Epilepsy; 1 year seizure free or 3 years seizure free if nocturnal epilepsy. If HGV/PCV; 10 years seizure free

12

What is a good description of myoclonus?

Clumsy and jerky in the morning

13

What is epilepsy?

A tendency to recurrent, usually spontaneous, epileptic seizures

14

What is an epileptic seizure?

Abnormal synchronisation of neuronal activity; usually excitatory with high frequency action potentials
Can be focal or generalised

15

Why do epileptic seizures happen?

Too little inhibition/ too much excitation
Changes in:
Cell number/type
Connectivity
Synaptic function
Voltage gated ion channel function
Genetic, acquired brain, metabolic (hypoglycaemia), toxic

16

What is SUDEP?

Sudden Unexplained Death in Epilepsy; seizure with subsequent cardiac arrest

17

What is a focal seizure?

Brain abnormal; stroke, haemorrhage, demyelination, tumour which will irritate the surrounding area resulting in abnormal discharge of electricity
If it hits a pathway; it will become generalised SO you can get a focal seizure with secondary generalisation

18

What is a generalised seizure?

A seizure that begins on a pathway such as the corticothalamic circuit and therefore every time a person has a seizure it will be generalised
This differs from focal seizures where you can have purely focal seizures which secondarily generalise

19

What is the difference between simple and complex partial/focal seizures?

Simple; without impaired consciousness
Complex; with impaired consciousness

20

What are the different types of generalised seizures?

Absence
Myoclonic
Atonic
Tonic
Tonic clonic

21

Which seizures can cause a loss of consciousness?

Complex partial seizure Generalised absence seizure

22

What motor symptoms can be involved in partial seizures?

Rhythmic jerking
Posturing
Head and eye deviation
Cycling
Automatisms (plucking)
Vocalisation

23

What sensory symptoms an be involved in partial seizures?

Somatosensory
Olfactory
Gustatory
Visual
Auditory

24

What psychic symptoms can be involved in partial seizures?

Memories
Deja vu
Jamais Vu
Depersonalisation
Aphasia
Complex visual hallucinations

25

Who is likely to get generalised seizures?

Genetic predisposition
Present in childhood and adolescence

26

What EEG pattern will generalised seizures show?

Spike wave pattern

27

What is the treatment of choice for primary generalized epilepsy?

Sodium valproate

28

What is the alternative treatment for primary generalized seizures for women of child bearing age?

Lamotrigine

29

Describe juvenile myoclonic epilepsy

Early morning jerks
Generalised seizures
Risk factors; sleep deprivation, flashing lights

30

What are some common side effects of sodium valproate?

HIGHLY TERATOGENIC
Weight gain
Hair loss