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Year 3 Neuroscience > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is epilepsy?

A

More than 2 seizures

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2
Q

What is a seizure?

A

AKA Ictus. Paroxysmal synchronised cortical electrical discharges

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3
Q

What is pathophysiology of seizure?

A

Result from imbalance in the inhibitory and excitatory currents (sodium and potassium channels), or neurotransmission (glutamate or GABA NEUROTRANSMITTERS) in the brain.

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4
Q

What are the two categories of epilepsy?

A

GENERALISED: abnormal neurotransmission in the whole brain which all results in loss of consciousness; PARTIAL/FOCAL: abnormal neurotransmission occurs in small part of the brain.

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5
Q

What are the types of generalised epilepsy? (x5)

A
  • Tonic-clonic – unconscious, tonic phase followed by clonic phase
  • Absence – Short-lived. Characterised by zoning out (still considered loss of consciousness) OR jerking (with loss of consciousness).
  • Myoclonic – exaggerated twitch of area of the body.
  • Atonic – short-lived loss of muscle tone which results in individual falling over flat suddenly.
  • Tonic seizures – sudden stiffness for around 20 seconds, followed by confusion and tiredness
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6
Q

What are the types of partial epilepsy? (x3)

A
  • Simple – uncontrolled twitched of one part of the body – no loss of consciousness.
  • Complex – affects the temporal lobe and most difficult to treat. Results in loss of awareness, confusion, and unusual behaviours and gestures.
  • Secondary generalised – generalised seizures develop from a partial one.
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7
Q

What is the aetiology of epilepsy?

A
  • Idiopathic in most cases
  • PRIMARY: idiopathic generalised epilepsy, temporal lobe epilepsy, juvenile myoclonic epilepsy
  • SECONDARY (known as symptomatic epilepsy): tumour, infection (meningitis, encephalitis, abscess), inflammation (vasculitis), toxic/metabolic (ion imbalances, liver failure, low blood sugar), drugs (including withdrawal), vascular (stroke), neurodegenerative (such as Alzheimer’s), malignant HTN, trauma, flashing lights, sleep deprivation
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8
Q

What is the common aetiology of focal seizure?

A

Brain lesions

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9
Q

What is the epidemiology of epilepsy? (x2)

A

Peak age of onset is early childhood or elderly

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10
Q

How should an epilepsy history be taken? (x7)

A
  • Rapidity of onset?
  • Duration of episode?
  • Alteration of consciousness?
  • Any tongue-biting or incontinence?
  • Any rhythmic synchronous limb jerking?
  • Any post-ictal period?
  • Drug history
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11
Q

What are the signs and symptoms of focal seizures: Frontal lobe focal motor? Temporal lobe? Frontal lobe complex partial?

A
  • FLFM: motor convulsions that may demonstrate Jacksonian march (spasm spreading from mouth or digit). There may be post-ictal flaccid weakness (called Todd’s paralysis)
  • TL: aura (visceral and psychic symptoms such as fear or deja-vu sensation), and hallucinations (olfactory, gustatory (taste))
  • FLCP: loss of consciousness with associated automatisms (performance of actions without thought) and rapid recovery
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12
Q

What is a convulsion?

A

Sudden, violent, involuntary movements

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13
Q

What are the signs and symptoms of each generalised seizure: Tonic-clonic? Absence? Myoclonic? Atonic? Tonic?

A
  • Tonic-clonic: vague symptoms before such as irritability, followed by tonic phase (generalised muscle spasm), followed by clonic phase (repetitive synchronous jerks) and associated faecal/urinary incontinence, tongue biting and unconsciousness. After, there is impaired consciousness, lethargy, confusion, headache, back pain and stiffness
  • Absence: loss of consciousness but maintained posture (patient stops talking and stares blank), blinking or rolling up of eyes with other repetitive motor actions such as chewing. No post-ictal phase
  • Myoclonic: exaggerated twitch of an area of the body
  • Atonic: short-lived loss of muscle tone which results in individual falling over flat suddenly
  • Tonic: sudden stiffness for around 20 seconds, followed by confusion and tiredness
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14
Q

What is status epilepticus?

A

A life-threatening neurological condition defined as 5 or more minutes of either continuous seizure activity or repetitive seizures without regaining consciousness.

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15
Q

What is non-convulsive status epilepticus?

A

Generalised epilepsy characterised by acute confused state, often fluctuating, and difficult to distinguish from dementia.

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16
Q

What are the investigations for epilepsy? (x4)

A
  • BLOOD: establish aetiology – electrolytes, glucose, ABG, toxicology. PROLACTIN is a serum marker of seizure
  • EEG: helps to confirm diagnosis and assists in classification
  • CT/MRI: for structural, space-occupying and vascular lesions
  • LP: for aetiology
17
Q

How is status epilepticus managed? (x5)

A
  1. Protect airway
  2. Check glucose and give if hypoglycaemic
  3. IV lorazepam or diazepam (repeat once after 15 minutes if needed)
  4. Recurrence or failure to respond: IV phenytoin under ECG monitoring, or IV phenobarbitone, levetiracetam or sodium valproate
  5. Failure to respond: general anaesthesia with intubation
18
Q

What must happen after anticonvulsant administration?

A

Should check plasma levels

19
Q

What is the indication for pharmacological management of seizures?

A

More than 2 unprovoked episodes

20
Q

How are epileptic seizures treated?

A
  • FOCAL: lamotrigine and carbamazepine
  • GENERAL: sodium valproate treats all. Can also use carbamazepine and lamotrigine (tonic-clonic), ethosuximide (absence), levetiracetam and topiramate (myoclonic), diazepam (status epilepticus) phenytoin, clobazam (BDZ), gabapentin, vigabatrin and more
21
Q

What patient education is there for epilepsy? (x5)

A

Avoid triggers like alcohol, encourage seizure diaries, recommend supervision in swimming/climbing, driving permitted if seizure free for 6 months, women of child-bearing age should be counselled on teratogenic effects of AEDs (anti-epileptic drugs) and should take folate to limit risk.

22
Q

Drug interactions of AEDs?

A

Enzyme-inducing AEDs can limit the effectiveness of OCP

23
Q

What surgical management is there for epilepsy? Indication?

A

Removal of definable epileptogenic focus (determined from detailed EEG, intracortical recordings, ictal SPECT (compares blood flow during and in-between seizures on MRI)). Indicated for refractory epilepsy.

24
Q

What are the complications of epilepsy? (x3)

A

Fractures, behavioural problems, and sudden death in epilepsy (SUDEP)

25
Q

What is the prognosis of epilepsy?

A

50% remission at 1 year.

Year 3 Neuroscience (14 decks)

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