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Revision Cards > Week 232 - Epilepsy > Flashcards

Week 232 - Epilepsy Flashcards

1
Q

Week 232 - Epilepsy: What is epilepsy?

A
  • The continuing tendency to have epileptic seizures.

* Epileptic seizures are a transient event experienced due to excessive and synchronous discharge of cerebral neurones.

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2
Q

Week 232 - Epilepsy: What are the two major categories of epileptic seizures?

A
  • Generalized

* Partial (Focal)

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3
Q

Week 232 - Epilepsy: What are the two types of partial seizure?

A
  • Complex - Loss of awareness.

* Simples - No loss of awareness.

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4
Q

Week 232 - Epilepsy: What are the three types of generalized seizure?

A
  • Tonic-clonic
  • Absence
  • Myoclonic
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5
Q

Week 232 - Epilepsy: What is a cryptogenic seizure?

A

• A seizure whose characteristics would suggest underlying cause, but which has not yet been identified.

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6
Q

Week 232 - Epilepsy: What are the differentials for epilepsy?

A

1) Syncope
2) Non-epileptic attacks
3) Panic attacks
4) Sleep disorders
5) Migraine
6) Transient ischaemic attacks
7) Hypoglycaemia

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7
Q

Week 232 - Epilepsy: What is the typical prodrome of syncope?

A

Nausea, clammy, blurring or loss of vision, deafness, tinnitus.

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8
Q

Week 232 - Epilepsy: What are the red flags for cardiogenic syncope?

A
  • Occurence on exercise
  • Family history of sudden death
  • Past history of IHD
  • No warning
  • Rapid recovery
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9
Q

Week 232 - Epilepsy: What is NEAD?

A

• Non-epileptic attack disorder.

- Psychologically mediated episodes of altered awareness.

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10
Q

Week 232 - Epilepsy: If, during a seizure, someone developed irregular and asynchronous jerks what would the likely diagnosis be?

A

• Non-epileptic attack

-NEAD

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11
Q

Week 232 - Epilepsy: Tongue biting and incontinence is common in which of the following, seizure, syncope of NEAD?

A

Epileptic seizure.

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12
Q

Week 232 - Epilepsy: What is the gold standard for investigation of seizures? Why is it not commonly used?

A
  • Video EEG

* Expensive and time consuming.

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13
Q

Week 232 - Epilepsy: What are the causes of epilepsy in infants?

A

• Developmental malformations, perinatal injuries and infections.

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14
Q

Week 232 - Epilepsy: What are the causes of epilepsy in children/adolescents?

A

Idiopathic generalised epilepsy.

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15
Q

Week 232 - Epilepsy: What are the causes of epilepsy in Young adults?

A

IGEs (Idiopathic), Head injury, alcohol, vascular malformations, hippocampal sclerosis.

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16
Q

Week 232 - Epilepsy: What are the leading causes of epilepsy in 30-50 yr olds?

A

Brain tumours

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17
Q

Week 232 - Epilepsy: What are the leading causes of epilepsy in the over 50s?

A

Cerebrovascular disease.

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18
Q

Week 232 - Epilepsy: What are the characteristics of Juvenile Myoclonic Epilepsy?

A
  • Upper limb jerks, generalised tonic-clonic seizures, absences.
  • Onset 8-18
  • Seizures on waking, precipitated by alcohol and sleep deprivation.
  • Good response to sodium valproate.
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19
Q

Week 232 - Epilepsy: What is heterotopic grey matter?

A
  • This is a developmental malformation where islands of grey matter have failed to migrate to the gyrae leaving a rim around the ventricles.
  • This is very epileptogenic.
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20
Q

Week 232 - Epilepsy: What is neurocycticercosis?

A

• Probably the most common cause of epilepsy world wide.

- Eggs of the pork tape worm migrate to the brain where they form cysts.

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21
Q

Week 232 - Epilepsy: What is the first line treatment of idiopathic generalised epilepsy?

A

• Sodium valporate

- In females - Lamotrigine or levetiracetam (Since sodium valporate has a high risk of birth defects.)

22
Q

Week 232 - Epilepsy: What is the first line treatment for focal/partial epilepsy?

A

Carbamazepine/lamotrigine/levetiracetam

23
Q

Week 232 - Epilepsy: What are the common side-effects of all anti-epilepsy drugs?

A

Tiredness, fatigue, dizziness.

24
Q

Week 232 - Epilepsy: Which anti-epilepsy drug has side effects including rash, ataxia and double vision?

A

Carbamazepine

25
Q

Week 232 - Epilepsy: Which anti-epilepsy drug can cause weight gain, tremor and is teratogenic?

A

Sodium Valporate

26
Q

Week 232 - Epilepsy: Which anti-epileptic drug is associated with psychiatric problems?

A

Levetiracetam

27
Q

Week 232 - Epilepsy: What is status epilepticus?

A

A seizure or series of seizures lasting for 30 minutes without regaining consciousness in between.

28
Q

Week 232 - Epilepsy: What are the causes for status epilepticus?

A
  • New - 50% (Encephalitis, trauma, tumours)

* Established eplilepsy - 50% (missed doses, infections)

29
Q

Week 232 - Epilepsy: What are the general measures for the treatment of status epilepticus?

A
  • Secure airway and monitor pulse, Bp, respiration.
  • IV access
  • Oxygen
  • Check U+Es, Ca, Mg, ABGs, ECG
  • iv glucose and thiamine.
30
Q

Week 232 - Epilepsy: What medication should be given early on in the treatment of status epilepticus?

A

IV Lorazepam 4mg.

alternatives include diazepam or buccal midazolam

31
Q

Week 232 - Epilepsy: Once status epilepticus is established what medication should be given? What dosage?

A

IV phenytoin 15mg/kg at 50mg/minute.

32
Q

Week 232 - Epilepsy: What is SUDEP?

A

Sudden unexplained death in epilepsy.

- Non-traumatic death unwitnessed death in patient with epilepsy.

33
Q

Week 232 - Epilepsy: What are the proposed causes of SUDEP?

A
  • Cardiac arrhythmias
  • Perictal hypoxia
  • Postictal cerebral depression with hypoventialition and bradycardia.
34
Q

Week 232 - Epilepsy: What are the risk factors for developing SUDEP?

A
  • High seizure frequency
  • AED polytherapy
  • Young age at onset
  • Male
  • Poor compliance
  • Long history of epilepsy
  • Seizures from sleep
  • Living/sleeping alone
35
Q

Week 232 - Epilepsy: Give a definition of coma.

A

A state of unrousable unconsciousness.

36
Q

Week 232 - Epilepsy: What score on the Glasgow coma scale is classed as coma?

A

≤8

37
Q

Week 232 - Epilepsy: What are the two coma mimics?

A
  • Locked-in syndrome - Arousal and awareness retained.

* Psychogenic coma

38
Q

Week 232 - Epilepsy: What physiological brain dysfunctions can cause coma?

A
  • Hypothermia
  • Sudden hypertension
  • Prolonged status epilepticus
  • Drugs, toxins, poisonings.
39
Q

Week 232 - Epilepsy: What is the initial management of coma?

A
  • Improve oxygenation (Intubate if necessary)
  • Correct hypotension and extreme hypertension.
  • Correct body temperature.
  • Glucose and thiamine
  • Identify and treat the underlying cause.
40
Q

Week 232 - Epilepsy: What four things will prevent you from performing a reliable neurological assessment of a patient in coma?

A

1) They are metabolically deranged.
2) They are hypothermic.
3) They have sedative drugs in their circulation.
4) They have an endocrine disturbance.

41
Q

Week 232 - Epilepsy: Why do you check for papilloedema in a coma patient?

A

This can help to identify if there is raised intracranial pressure / SAH

42
Q

Week 232 - Epilepsy: What is the relevance of checking whether the motor response is symmetrical?

A

To identify if there are unilateral signs indicating a hemisphere or brainstem lesion.

43
Q

Week 232 - Epilepsy: What is the purpose for checking meningism in coma patients?

A

To identify a possible cause of SAH or meningitis.

44
Q

Week 232 - Epilepsy: How do you test for brain stem function in coma patients?

A
  • Pupils
  • Corneal response
  • Gag reflex
  • Response to hypercapnia
  • Vestibulo-ocular response
45
Q

Week 232 - Epilepsy: What is the difference between arousal and awareness?

A

Arousal - Level of consciousness/alertness

Awareness - Content of consciousness, awareness of self and environment.

46
Q

Week 232 - Epilepsy: What is persistent vegetative state?

A

Recovery of arousal but not awareness.

47
Q

Week 232 - Epilepsy: What is persistent vegetative state mainly due to?

A

Diffuse cortical or subcortical damage.

48
Q

Week 232 - Epilepsy: What is a minimally conscious state?

A

Patients may,

  • Make eye contact/turn head when spoken to
  • Grasp an object when asked
  • Mouth words
  • Track objects with eyes
  • Have some intelligent verbalisation
49
Q

Week 232 - Epilepsy: What is the vestibulo-ocular response?

A

When an ear is irrigated with cold water the eyes should deviate towards that ear.
- An abnormal response indicates pontine damage, drugs/metabolic, CN palsy.

50
Q

Week 232 - Epilepsy: Which anti-epileptic drug does not reduce the efficacy of the oral contraceptive pill?

A

Clobazam

Revision Cards (61 decks)

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