Epilepsy: Seizures, Syndromes and Management Flashcards Preview

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Flashcards in Epilepsy: Seizures, Syndromes and Management Deck (53):
1

what kind of questions would you ask about onset of fall?

what were they doing?

light-head or other syncopal symptoms?

what did they look like? eg pallor, breathing, posturing of limbs, head turning

2

what kind of questions would you ask about the event itself?

types of movements - tonic phase, clonic movements, carpopedal spasms, rigor

responsiveness and awareness throughout

3

what kind of questions would you ask about after the fall?

speed of recovery
sleepiness / disorientation
deficits

4

what are the risk factors for epilepsy?

birth
development
seizures in past (inc febrile fits)
head injury (including LOC)
family history
drugs and alcohol

5

what drugs are most known to precipitate epileptic seizures?

aminophylline / theophylline

analgesics eg tramadol

antibiotics eg penicillins, cephalosporins, quinolones

anti-emetics eg prochlorperazine

opioids eg diamorphine, pethidine

6

you don't usually examine patients in 1st seizure clinic as it has little benefit but when would an examination be important?

syncope - cardio exam and L + SBP

7

who with a fall gets a CT scan acutely?

clinical or radiological skull fracture
deteriorating GCS
focal signs
head injury with seizure
failure to be GCS15/15 after 4 hours
suggestion of other pathology eg SAH

8

what investigations take place for the fallen?

ECG - mandatory

Imagine - MRIb vs CTb

9

what is EEG used for?

classification of epilepsy
confirmation of non-compulsive status
surgical evaluation
confirmation on non-epileptic attack

10

when should you never use EEG?

just because someone has collapsed and you are unsure about the cause

11

seizure does not always mean epilepsy - true or false?

true

12

how long should you wait until driving after 1st seizure?

6 months for car
5 years for HGV / PCV

13

how long should you wait until driving when you have epilepsy?

1 year seizure free
or 1 year with seizures that you still retain consciousness
or 3 years seizures only during sleep
10 years off medication for HGV/PCV

14

do most people have a genetic predisposition to generalised epilepsy?

yes

15

when does generalised epilepsy normally present?

in childhood and adolescence

16

what is the pattern on EEG in generalised epilepsy?

generalised spike wave abnormalities

17

what can be seen on ECG which is fatal and makes patients prone to seizures?

long QT

18

raising a limb and turning of the head indicates a seizure in what part of brain?

frontal lobe seizure phenomenon

19

tongue biting and loss of urinary continence are specific features of generalised seizures - true or false?

false

these symptoms are not seizure specific - patient can lose urinary continence during vaso-vagal episode

20

what are the differential diagnoses for epilepsy?

syncope
non-epileptic attack disorder
panic attacks
sleep phenomena

21

what is the treatment of choice for primary generalised epilepsy?

sodium valproate treatment of choice but is teratogenic

lamotrigine as alternative

22

describe the usual symptoms of juvenile myoclonic epilepsy?

early morning jerks
generalised seizures

23

what are the risk factors for juvenile myoclonic epilepsy?

sleep deprivation
flashing lights

24

describe the pathophysiology of focal onset epilepsy?

due to underlying structural cause (bran injury / haemorrhage)
area around this becomes irritated
causes abnormal discharges of energy - seizures

25

focal seizures can also become generalised - true or false?

true - if a focal seizure excited a neighbouring pathway which can spread activity around the brain, then seizures can become generalised

26

what treatment is first line for focal epilepsy?

carbamazepine (interacts with basically all drugs) or lamotrigine

sodium valproate works as well but not first line due to SE

27

what is the most common cause of focal / partial epilepsy in patients <30?

complex partial seizures due to hippocampal sclerosis

28

why should carbamazepine not be used for generalised seizures?

it can make them worse

29

what are the different types of generalised seizures?

myoclonic - jerks
atonic - loss of tone
tonic
tonic / clonic
absence - pt goes black

30

why is lamotrigine sometimes unsuitable at the beginning of generalised epilepsy treatment?

it can take around 2-3 months to reach peak action

31

what other treatment with less side effects than sodium valproate can be used in generalised epilepsy is lamotrigine is taking too long to work?

levetiracetam (keppra)

32

what age group is more likely to get focal seizures?

>50 as they are more likely to have structural damage

33

carbamazepine is a well tolerated - true or false?

false - not well tolerated, patients feel dizzy and unsteady

34

why should sodium valproate and lamotrigine be given together with caution?

sodium valproate makes the lamotrigine dose higher, therefore a lower dose of lamotrigine should be prescribed if dural therapy used

35

what anticonvulsant medications are considered old?

phenytoin
sodium valproate
carbamazepine

36

what anticonvulsants are considered new?

lamotrigine
levetiracetam
topiramate
gabapentin / pregabalin (not widely used anymore)

37

what side effects can occur from older anticonvulsants?

phenytoin - unwanted cosmetic change

sodium valproate - above but also teratogenic

carbamazepine - dizzy / unsteady

38

what side effects can occur from newer anti-convulsants?

lamotrigine - steven johnson syndrome (check for rash)

levetiracetam - mood swings

topiramate - sedation, dysphasia and weight loss

gabapentin / pregabalin - addictive

39

when should anti convulsants be prescribed?

if patient has epilepsy - not just seizures

unless extremely high risk of seizure recurrent in non epileptic seizures

40

what anticonvulsants affect hepatic enzymes and therefore causing problems for females?

carbamazepine
oxcarbazepine
phenobarbitol
phenytoin
primidone
topiramate

41

what contraceptives are affected by anticonvulsant drugs?

combined OCP

DONT use progesterone only pill

depot progesterone injection needs more frequent dosing

progesterone implants not effective

42

morning after pill dose should be increased or decreased in those on anticonvulsants?

increased

43

why should all females of child bearing age be given pre-conceptual counselling?

allows them to balance risk of uncontrolled seizures if not taking medication or teratogenicity if continue with medication

44

if females with epilepsy do wish to conceive, what medication must they start 3 months prior to conception?

folic acid and vitamin K

45

what is status epilepticus?

recurrent epileptic seizures without full recovery of consciousness between them
can last for over 30 mins

46

what are the different types of status epilepticus?

generalised convulsive

non convulsive status - conscious but in altered state

epilepsia partialis continua (continual conscious focal seizures)

47

what can precipitate a status epilepticus?

severe metabolic disorders - hyponatraemia, pyridoxine deficiency

infection

head trauma / sub arachnoid haemorrhage

abrupt withdrawal of anti-convulsants

48

generalised convulsive status epilepticus can cause what further effects on body?

respiratory insufficiency and hypoxia
hypotension
hyperthermia
rhabdomylosis

49

how should status epilepticus be investigated?

ABCDE

identify cause - emergency blood tests +/- CT

if suspicious of hypoglycaemia give 50mls 50% glucose

50

how is status epilepticus treated?

benzodiazepines x2 doses (10 mins, then 15 mins) - usually buccal midazolam

phenytoin if unresolving
+ sodium valproate
+ levetiracetam (keppra)

51

when should you consider transferring a patient in status epilepticus into ITU?

when requiring to give phenytoin as it has been unresolved for a prolonged period

52

how would you confirm a patient with acute confusion is in partial status epilepticus?

EEG

53

how do benzodiazepines work to reverse status epilepticus?

they suppress the area of the brain which is over-excited and impairing consciousness

consciousness returns when electrical activity is sedated