Epilepsy Flashcards

1
Q

What is the definition of epilepsy?

A

A tendency to recurrent, usually spontaneous, epileptic seizures.

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2
Q

Who does epilepsy most commonly affect?

A

Any age but most common in infancy and old age
Generalised epilepsy presents in childhood and adolescence and most have genetic predisposition

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3
Q

What are some risk factors for epilepsy?

A

Genetic
Acquired brain injury
Metabolic
Toxic
Environmental

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4
Q

What is the pathophysiology of epilepsy?

A

Epileptic seizure is abnormal synchronisation of neuronal activity (usually excitatory with high frequency action potentials but sometimes predominantly inhibitory)
Interruption of normal brain activity
Usually brief (secs-mins)

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5
Q

What is primary generalised epilepsy?

A

Often presents in childhood/teens
Early morning jerks
Risk factors - sleep deprivation, flashing lights

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6
Q

What is focal onset epilepsy?

A

Underlying structural cause
Onset at any age
Hippocampal sclerosis can occur

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7
Q

What are the types of generalised seizures?

A

Tonic-clonic
Absence
Atonic (‘drop attacks’)
Myoclonic

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8
Q

What are the types of focal seizures?

A

Temporal lobe
Frontal lobe
Parietal lobe
Occipital lobe

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9
Q

What is a tonic-clonic seizure?

A

Loss of consciousness and tonic (muscle tensing) and clonic (muscle jerking) episodes
May have tongue biting, incontinence, groaning and irregular breathing
Prolonged post-ictal period where person is confused, drowsy, feels irritable/depressed

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10
Q

What is an absence seizure?

A

Typically in children and stop as get older
Patient becomes blank, stares into space and then abruptly returns to normal
Unaware of surrounding during episode and won’t respond
Lasts 10-20 seconds

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11
Q

What is an atonic ‘drop attack’ seizure?

A

Brief lapses in muscle tone, causing patient to fall
Don’t usually last more than 3 minutes
Consciousness retained

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12
Q

What is a myoclonic seizure?

A

Sudden brief muscle jerks of a limb, trunk, face

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13
Q

What is temporal lobe epilepsy?

A

Aura occurring in most patients:
- Rising epigastric sensation
- Psychic or experiential phenomena (eg deja vu)
- Hallucinations less common (eg auditory, gustatory, olfactory)

Seizures lasting around 1 min
- Automatisms (lip smacking, grabbing, plucking)

With or without impaired awareness/consciousness

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14
Q

What is frontal lobe epilepsy (motor)?

A

Head/leg movements
Posturing
Post-ictal weakness
Jacksonian march

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15
Q

What is parietal lobe epilepsy (sensory)?

A

Paraesthesia

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16
Q

What is occipital lobe epilepsy (visual)?

A

Floaters/flashes

17
Q

What are some investigations for epilepsy?

A

ECG (rule out prolonged QT syndrome)
Imaging (MRIb)
EEG (generalised epilepsy shows generalised spike-wave abnormalities)

18
Q

What are the principles for starting anti-epileptics?

A

Drug therapy only started after minimum two fits
Only use one drug at a time, begin with small dose and gradually increase until control is achieved, toxic affects occur, or max dose is reached

19
Q

What are the first and second line drugs for generalised seizures in men?

A

1) Sodium valproate
2) Lamotrigine/levetiracetam

20
Q

What are the first line drugs for generalised seizures in women of childbearing age?

A

Lamotrigine/levetiracetam

21
Q

What are the first and second line drugs for focal seizures?

A

1) Lamotrigine/levetiracetam
2) Carbamazepine

22
Q

What is the first and second line treatment for absence seizures?

A

1) Ethosuximide
2) Sodium valproate
3) Lamotrigine/levetiracetam

23
Q

What anti-seizure drugs can exacerbate absence and myoclonic seizures?

A

Carbamazepine
Gabapentin
Phenytoin
Pregabalin
Lamotrigine (for myoclonic only)

24
Q

What is the first and second line drugs for myoclonic seizures?

A

1) Sodium valproate
2) Levetiracetam

25
Q

What is the driving advice for epilepsy?

A

If driver has seizure of any type, must immediately stop driving and inform the DVLA
First unprovoked epileptic seizure/single isolates seizure = 6 months no driving
Established epilepsy must be seizure free for at least 1 year

26
Q

What is the definition of status epilepticus?

A

A seizure lasting >5 mins, or multiple seizures over 5 minutes with incomplete resolution

27
Q

What are some precipitants of status epilepticus?

A

Severe metabolic disorders
Infection
Heady trauma
Sub-arachnoid haemorrhage
Abrupt withdrawal of anti-convulsants
Treating absence seizures with CBZ

28
Q

What can status epilepticus cause?

A

Respiratory insufficiency and hypoxia
Hypotension
Hypothermia
Rhabdomyolysis

29
Q

What are some investigations for status epilepticus?

A

Identify cause after stabilising patient
- Emergency blood tests +/- CT

30
Q

How is status epilepticus treated?

A

1) 2x doses benzodiazepines
- Diazepam 10-20mg rectally
- Midazolam 10mg buccally
- Lorazepam 4mg IV

2) IV phenytoin/levitiracetam/sodium valproate

3) General anaesthesia with propofol/midazolam/thiopental sodium
- Continued for 12-24 hours after last seizure then dose tapered

Generally:
Give high concentration oxygen
Give glucose if hypoglycaemic
Give IV thiamine is suggestion of alcoholism/impaired nutritional status
Assess cardiac and respiratory function