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neuro > epilepsy > Flashcards

epilepsy Flashcards

1
Q

management of generalised tonic-clonic seizures

A

males - sodium valporate

females - lamotrigine or levetiracetam

(girls under 10 + unlikely to need treatment when they are older may be offered sod val)

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2
Q

management of focal seizures

A

1st - lamotrigine or levetiracetam

2nd - cabamazepine, oxcarbazepine

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3
Q

absence seizure management

A

1st = ethosuximide

2nd
male - sodium valporate
female - lamotrigine or levtiracetam

(carbamazepine may exacerbate)

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4
Q

myoclonic seizures management

A

male - sodium valporate

female - levetiracetam

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5
Q

management of tonic or atonic seizures

A

male - sodium valporate

females - lamotrigine

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6
Q

generalised tonic-clonic seizure

A

loss of consciousness
tonic (muscle tensing) - comes first
clonic (muscle jerking)

may be assoc tongue biting, incontinence, groaning

after seizure - post ictal period, confused, drowsy

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7
Q

focal seizures

A

start in temporal lobes
affect hearing, speech, memory + emotions
- halluconations, memory flashbacks
- deja vu, doing strange things on autopilot

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8
Q

atonic seizures

A

drop attacks - brief lapses in muscle tone
dont usually last more than 3min
typically begin in childhood

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9
Q

myoclonic seizure

A

sudden brief muscle contractions - jump
patient usually awake
typically in kids as part of juvenile myoclonic epilepsy

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10
Q

general MoA of antiepileptic drugs (AEDs)

A

raising threshold + reducing liklihood of patient having a seizure

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11
Q

sodium valporate

A

increases activity of GABA, relaxing effect

SE -
- teratogenic
- liver damage, hepatitis
- hair loss, weight gain
- tremor
- enzyme inhibitor

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12
Q

carbamazepine SE

A

agranulocytosis
aplastic anaemia
indices P450 system so there are many drug interactions

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13
Q

phenytoin SE

A

acute management ONLY

folate + vit D deficiency
megoblastic anaemia - folate deficiency
osteomalacia - vit D deficiency

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14
Q

ethosuximide SE

A

night terrors
rashes

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15
Q

lamotrigine SE

A

stevens-johns syndrome
leukopenia

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16
Q

status epilepticus

A

seizure lasting more than 5 min or 2 or more seizures without regaining consciousness

17
Q

status epilepticus management

A

secure airway, high conc O2, assess cardiac/resp function, check blood glucose

IV lorazepam

10mg after 10mins, wait 5 mins then another 10mg, no more than 2 doses

if continuing after 20mins with reatment -> phenytoin
if persists induce general anaesthesia (propofol, thiopentone)

18
Q

status epilepticus management community

A

buccal midazolam
rectal diazepam

10mg after 10mins, wait 5 mins then another 10mg, no more than 2 doses

if continuing after 20mins with reatment -> phenytoin

19
Q

anticonvulsants

A

phenytoin - acute only
sodium valporate
lamotrigine
levetiracetam
topiramate

gabapentin, pregabalin

20
Q

levetiracetam

A

very popular
few interactions with other meds
causes mood swings - avoid in depression

21
Q

topiramate

A

SE = weight loss, sedation, dyphasia, psychosis

very affective in those with learning difficulties

22
Q

ladies and anticonvulsants

A

some anticonvulsants can induce hepatic enzymes
- carbamazepine, oxcarbazepine, phenobarbitol, phenytoin, primidone, topiramate

can alter efficacy of COCP
shouldnt use POP - depot progesterone needs more frequent dosing, progesterone implants not effective

23
Q

morning after pill in epilepsy

A

not adequate if taking enzyme inducing AEDs - dose should be increased

24
Q

women + sodium valporate

A

If women of childbearing age – shouldn’t take sodium valproate even if on contraception

  • Balance risk of uncontrolled seizures vs teratogenicity
    o Sodium val taken later in pregnancy can cause autism
  • Folic acid + vit K
25
Q

primary generalised epilepsy

A

Abnormal discharge across cortical network

  • Most have genetic predisposition
  • Often present childhood or teens
  • Present in childhood + adolescence, generalized spike-wave abnormalities on EEG

tonic clonic, myoclonic, atonic, absence

26
Q

management of primary generalised epilepsy

A

men - sodium valporate
women - lamotrigine

27
Q

generalised tonic-clonic seizures

A

loss of consciousness + tonic (muslce tensing) + clonic (muscle jerking episodes

28
Q

juvenile myoclonic epilepsy

A

typical onset in teenage years, commoner in girls

infrequent generalised seizures, often in morning/following sleep deprivation
daytime absences

risk factors - sleep deprivation, flashing lights

MX = sodium valporate

29
Q

how can antiepileptics medications interfere with other medications?

A

can induce/inhibit the P450 system resulting in varied metabolism of other medications - eg warfarin

30
Q

how can a focal seizure become generalised?

A

if focal seizure hits cortical pathways -> spread in brain + secondary generalised seizure

31
Q

tonic vs clonic

A

Tonic = lose consciousness, body stiff, may fall.

Clonic = limb jerk, bladder/bowel control loss, tongue bite.

32
Q

epilepsy and driving

A

1st seizure
- car = 6months
- HGV = 5yrs

epilepsy
- car = seizure free for 1yr (3if during sleep) with/without meds
- HGV = 10yrs off medication

33
Q

focal seizure in temporal lobe presentation

A

motor -> Autonomic movements: chewing, repetitive body movement (jerking, posturing etc).

sensory -> Olfactory sensation, rising feeling in stomach, auditory

psychic -> Memories, déjà vu, jamais vue (staring blankly)

34
Q

focal seizure in frontal lobe presentation

A

Head/eye deviation, urinary incontinence, vocalisation, bizzare behaviour

Head/leg movements, posturing, post-ictal weakness, Jacksonian march

35
Q

focal seizure in parietal lobe presentation

A

altered somatoensation, Paraesthesia -> sensory modalities that are associated with touch, proprioception, and interoception. These modalities include pressure, vibration, light touch, tickle, itch, temperature, pain, proprioception, and kinesthesia.

35
Q

focal seizure in occipital lobe presentation

A

visual symptoms - flashers/floaters

36
Q

risks of status epilepticus

A

hypoxia
rhabdomyolysis
hyperthermia (->hypotension->hypoperfusion to heart)
aspiration, brain damage

long term cerebral effects -> break down of blood brain barrier causes fluid shift -> cerebral oedema

37
Q

types of status epilepticus

A

Generalized convulsive status epilepticus

Non convulsive status
 Conscious but altered state

epilepsia partialis continua
 Continual focal seizures, conscious preserved

38
Q

precipitants of status epilepticus

A
  • Abrupt withdrawal of anti-convulsant
  • Treating absence seizures with CBZ
  • Severe metabolic disorders – hyponatremia, pyridoxine deficiency
  • Infection
  • Head trauma
  • Sub arachnoid haemorrhage

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