Epilepsy Flashcards Preview

Neurology > Epilepsy > Flashcards

Flashcards in Epilepsy Deck (67):
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

31

What is the treatment for focal onset epilepsy?

Identify the underlying structural cause
1st line: carbamazepine or lamotrigine

32

What is the most common type of focal onset epilepsy?

Complex partial seizures with hippocampal sclerosis

33

What is the most common type of primary generalised epilepsy?

Juvenile myoclonic epilepsy

34

What is a very important side effect of carbamazepine?

Enzyme inducing in the liver; reduced the efficacy of the OCP and morning after pill

35

What channel will carbamazepine, lamotrigine and phenytoin inhibit?

Voltage gated sodium channel
Reduced pre-synaptic excitability

36

What channel will levetiracetam inhibit?

SV2A which is required for the release of neurotransmitter at the presynaptic terminal

37

What channel will pregabalin and gabapentin inhibit?

Voltage gated Ca 2+ channels in the presynaptic terminal

38

What will benzos and barbiturates target in the neurone?

GABA receptor which reduced neuronal activity

39

What will sodium valproate target?

Enhances GABA synthesis

40

Why do you need to be careful when co-prescribing sodium valproate and lamotrigine?

Sodium valproate inhibits the metabolism of lamotrigine so cana get a toxic dose BUT they work synergistically well together, just need to prescribe a lower dose of lamotrigine

41

Treatment for partial seziures

INITIAL:
Carbamazepine
Lamotrigine

42

What is the treatment for absence generalised seizures?

Sodium valproate
Ethosuximide

43

What is the treatment for myoclonic seizures?

Sodium valproate
Levetiracetam
Clonazepam

44

What is the treatment for atonic, tonic and tonic clonic seizures?

Sodium valproate
Levetiracetam
Topiramate
Lamotrigine

45

When is phenytoin used?

Acute management ONLY as rapid loading dose possible

46

Should you prescribe carbamazepine in primary generalised seizures?

NO; makes MUCH worse. This is why you NEED to determine the cause for the epilepsy

47

What condition is topiramate commonly used in?

Idiopathic Intracranial Hypertension; causes weight loss

48

Why does lamotrigine take a long time to titrate up?

Can cause SJS; start at a very low dose then build up
If there are ANY rashes, STOP immediately

49

When should you prescribe anticonvulsants?

If the patient has epilepsy
If there has been a single seizure but a high risk of recurrence

50

Which anticonvulsants induce hepatic enzymes?
EXAM QUESTION

Carbamazepine
Oxcarbazepine
Phenobarbital
Phenytoin
Primidone
Topiramate

51

Why is it important to know which anticonvulsants induce hepatic enzymes?
EXAM QUESTIONS

Can alter the efficacy of OCP and emergency contraception - you MUST get the higher dose
SHOULDN'T use POP; not effective

52

What should be given to women preconception who have epilepsy?

3 months preconception:
High dose folic acid
Vitamin K

53

What is status epilepticus?

Recurrent epileptic seizures without full recovery of consciousness
Continuous seizure activity lasting more than 10-30 mins

54

What are the different types of status epilepticus?

Generalised convulsive status epilepticus
Nonconvulsive status; conscious but in altered state (Use EEG for this)
Epilepsia partialis continus (continual focal seizures, consciousness preserved)

55

What are precipitants of status?

Severe metabolic disorders; hyponatraemia, pyridoxine deficiency
Infection
Head trauma
SAH
Abrupt withdrawal of anticonvulsants
Treating absence seizures with CBZ

56

What can status cause?

Respiratory insufficiency and hypoxia
Hypotension
Hyperthermia
Rhabdo
DEATH

57

What occurs after 30-60 mins of status?

Peripheral metabolic effects due to SUCH high demand

58

What occurs after 60 mins - 8 hours of status?

Multiorgan failure

59

What occurs after 8 hours of status?

Central effects

60

What is the order of drugs you would give in status?
EXAM QUESTION

10mg benzo then repeat after 5 mins. ONLY GIVE 2 DOSES OF BENZO
THEN
Phenytoin, sodium valproate and levetiracetam

61

What should you do if phenytoin/ sodium valproate/ levetiracetam doesn't work?

Phone ICU as they need to be sedated with propofol to flatten EEG for around 48 hours`

62

What should be given if there is ANY suggestion of a hypo in a patient in status?

50m 50% glucose

63

What should be given if there is ANY suggestion of alcoholism or nutritional deficiency in a patient in status?

IV thiamine

64

What are the different types of benzos?

Lorazepam 4mg IV (long duration
Diazepam 10-20mg IV

65

What should you do if you don't have IV access in a patient in status?

Diazepam or midazolam PR

66

What are the dosages of phenytoin and phenobarb given in status?

Phenytoin i18mg/kg IV <50mg/min with ECG monitoring
Phenobarb 15mg/kg IV 100mg/min

67

What is important to do surrounding a patients normal anticonvulsant medication when they are in status?

Give normal dosages down NG tube as abrupt withdrawal of anticonvulsant medication is a trigger of status epilepticus