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Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What are RFs for epilepsy?

A 
Birth
Development
Past seizures
Head injury (inc. LOC)
FHx
Drugs 
Alcohol
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2
Q

In 1st seizure clinic is examination important?

A

No- has little/no benefit

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3
Q

What should be examined if a diagnosis of syncope is suspected?

A

CVS examination

L+S BP important

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4
Q

What Ix should be considered in fallen patient?

A

ECG- mandatory
Imaging- MRIb vs CTb
Possible EEG- 0.5-4% of interictal EEGs are abnormal

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5
Q

What fallen patients will get a CT acutely?

A 
Clinical or radiological skull fracture
Deteriorating GCS
Focal signs
Head injury with seizure
Failure to be GCS 15/15 4 hours after arrival
Suggestion of another pathology- eg SAH
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6
Q

What conditions are commonly confused with epilepsy?

A

Syncope
Non-epileptic attack disorder (pseudoseizures, psychogenic non-epileptic attacks)
Panic attacks / Hyperventilation attacks
Sleep phenomena

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7
Q

What should be explain regarding seizures/epilepsy and driving?

A

1st seizure car- 6 months, 5y for HGV/PCV
Epilepsy car- 1y or 3y during sleep, 10y off medication for HGV/PCV
Discuss SUDEP

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8
Q

What is epilepsy?

A

A tendency to recurrent, usually spontaneous, epileptic seizures

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9
Q

Why do epileptic seizures occur?

A

Abnormal synchronisation of neuronal activity- usually excitatory with high frequency action potentials, sometimes predominantly inhibitory
Interruption of normal brain activity- focally, generalised

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10
Q

How long do epileptic seizures usually last?

A

Brief- seconds to minutes

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11
Q

What neurological changes occur in epilepsy?

A

Cell numbers/types
Connectivity
Synaptic function
Voltage gated ion channel function

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12
Q

What are the contributing factors to epilepsy?

A 
Genetic
Acquired Brain
Metabolic
Toxic
Environmental
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13
Q

How common is epilepsy?

A

50-80/100000

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14
Q

At what age does epilepsy occur?

A

Any age, but most commonly infancy and old age

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15
Q

How many people die of epilepsy each year?

A

1 in 400, young adults with severe epilepsy being 1 in 100

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16
Q

Can a generalised seizure start from a focal point?

A

Yes

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17
Q

How is epilepsy classified?

A 
Epileptic Seizures (Semiology, EEG)- generalised, partial-focal site of origin
Epilepsy syndrome (seizure type, age, aetiology)
Aetiology
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18
Q

What is the classification of partial epileptic seizures?

A

Simple: without impaired consciousness
Complex: with impaired consciousness

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19
Q

What is the classification of general epileptic seizures?

A 
Absence
Myoclonic
Atonic
Tonic
Tonic clonic
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20
Q

How are epileptic seizures classified?

A

Partial
Generalised
Unclassified

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21
Q

What is the motor semiology of partial seizures?

A 
Rhythmic jerking
Posturing
Head and eye deviation
Other movements (e.g. cycling)
Automatisms (eg plucking)
Vocalisation
22
Q

What is the sensory semiology of partial seizures?

A 
Somatosensory
Olfactory
Gustatory
Visual 
Auditory
23
Q

What is the psychic semiology of partial seizures?

A 
Memories
Deja vu
Jamais vu
Depersonalisation
Aphasia
Complex visual hallucinations etc
24
Q

What predisposition to do most generalised epilepsies have?

A

Genetic

25
Q

What findings are usually seen on EEG in generalised epilepsy?

A

Spike-wave abnormalities

26
Q

When does generalised epilepsy usually present?

A

Childhood and adolescence

27
Q

What is the 1st line treatment of primary generalised epilepsy?

A 
Sodium valproate (teratogen)
Lamotrigine as alternative/if pregnant
28
Q

What occurs in juvenile myoclonic epilepsy?

A

Early morning jerks

Generalised seizures

29
Q

What are RFs for juvenile myoclonic epilepsy?

A

Sleep deprivation

Flashing lights

30
Q

What is the cause of focal onset epilepsy?

A

Underlying structural cause

31
Q

When does focal onset epilepsy present?

A

Any age

32
Q

What occurs in focal onset epilepsy?

A

Frequent complex partial seizures with hippocampal sclerosis

33
Q

What is the treatment of focal onset epilepsy?

A

Carbamazepine or lamotrigine (sodium valproate works well, but avoided due to S/Es)

34
Q

What percentage of epilepsies are ‘drug resistant’?

A

35%

35
Q

What system is targeted by antiepileptic drugs (AEDs)?

A

GABA

36
Q

What is the initial treatment for partial seizures?

A 
Carbamazepine and lamotrigine first line
Oxycarbazepine
Levetiracetam
Topiramate
Sodium valproate
37
Q

What are ‘add on’ drugs for partial seizures?

A 
Gabapentin
Tiagabine
Pregabalin
Zonisamide
Vigabatrin
Clonazepam
Clobazam
38
Q

What is the first line treatment for absence generalised seizures?

A

Sodium valproate

Ethosuximide

39
Q

What is the second line treatment for absence generalised seizures?

A

Topiramate

Levetiracetam

40
Q

What is the first line treatment for myoclonic generalised seizures?

A

Sodium valproate
Levetiracetam
Clonazepam

41
Q

What is the second line treatment for myoclonic generalised seizures?

A

Lamotrigine

Topiramate

42
Q

What is the first line treatment for atonic, tonic and generalised tonic clonic seizures?

A

Sodium valproate

43
Q

What is the second line treatment for atonic, tonic and generalised tonic clonic seizures?

A

Levetiracetam
Topiramate
Lamotrigine

44
Q

When is phenytoin used in seizure management?

A

Acutely- rapid loading possible

45
Q

What are some S/Es of sodium valproate?

A

Wt gain
Teratogenic
Hair loss
Fatigue

46
Q

What can carbamazepine do to primary generalised seizures?

A

Make them worse

47
Q

Does lamotrigine take a long time to titrate up?

A

Yes

48
Q

Describe levetiracetam use

A

Few interactions with other medications

Well tolerated, though can cause mood swings

49
Q

What are some S/Es of topiramate?

A

Sedation
Dysphasia
Wt loss
(Not particularly well tolerated)

50
Q

When are drugs given in seizure management?

A

If diagnosed as epilepsy
If single seizure but high risk of recurrence
Only if patient wants drug

51
Q

What anticonvulsants induce hepatic enzymes?

A 
Carbamazepine
Oxcarbazepine
Phenobarbitol
Phenytoin
Primidone
Topiramate
52
Q

What can the enzyme induction properties of some anticonvulsants effect, and what does this mean?

A

Can alter efficacy of combined oral contraceptive pill
Shouldn’t use POP
Depot progesterone needs more frequent dosing, progesterone implants not effective
Morning after pill not adequate- increase dose

Neurology (27 decks)

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