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Core Conditions third year > epilepsy > Flashcards

epilepsy Flashcards

1
Q

what is a seizure

A

it is the abnormal electrical discharge in the brain causing symptomatic manifestations
one seizure is not epilepsy but is an indication for investigations

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2
Q

what is epilepsy

A

it is when there are recurrent seizures

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3
Q

what is the recurrence rate of seizures after one year

A

70%

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4
Q

Epidemiology

A

life time risk of seizures is 5%

prevelance of seizure is 0.5%

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5
Q

Types of seizures

A

Generalised - involves both hemispheres simultaneously

Focal (partial) - activity is limited to one part of the cortex

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6
Q

Epilepsy starting age 35 and over usually are?

A

focal cerebral event

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7
Q

what can one tell from the symptoms and signs of a seizure

A

one can predict the region of brain affected

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8
Q

causes seizures

A 
Idiopathic
Genetic - tuberous sclerosis
developmental
Neoplastic (brain tumour)
traumatic (head injury)
infective
inflammatory (vasculitis)
benzodiazepine withdrawl
metabolic - hypernatraemia, hypocalcaemia, ureamia, glucose fluctuations
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9
Q

What happens before a Tonic-Clonic seizure

A

Aura

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10
Q

What happens during a Tonic-Clonic seizure

A

Px goes rigid then stops breathing, cyanosed and LOC and may fall heavily
after few minutes rigidity relaxed and starts clonic jerks
Urinary incontinence or tongue biting may occur

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11
Q

What happens after a Tonic-Clonic seizure

A

Px regains consoiusness but is confused and drowsy

headaches are common

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12
Q

what happens in absence seizures

A

always start in childhood
child goes blank and stares for few seconds only and then continue as normal
maybe speaking a sentences then stops for few seconds <10s and then continue where left off
Px do not relies it is happening to them but may have many per day.

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13
Q

what absence seizure could be mistaken for

A

daydreaming

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14
Q

Myoclonic seizures Sx

A

Brief jerking movements usually in arms

occur in the morning or upon waking

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15
Q

what provokes myoclonic seizures

A

alcohol
fatigue
sleep deprivation

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16
Q

Atonic seizures Sx

A

Atonic (opposite tonic) Px briefly losses muscle tone and becomes flacid and floppy.

17
Q

what can atonic seizures result in

A

heavy falls with or without LOC

18
Q

Tonic seizures

A

Px has generalised increased muscle tone and is associated with LOC

19
Q

Clonic seizures

A

Aura
tonic clonic jerks
may urinary incontinence or tongue biting
afterwards drowsy and confused

20
Q

What is an aura

A 
strange feeling in gut
flashing lights
strange smells
deja vu
usually before neuro event
21
Q

What investigations should be carried after a seizures

A 
Head CT or MRI
Electroencephalography (EEG)
Full bloods
HIV
CXR
syphilis serology
CSF
22
Q

types of focal (partial) seizures

A

simple partial seizures - no LOC

complex partial seizure - with LOC –> suggests temporal lobe involvement

23
Q

causes of seizures by age groups

A

children and teenagers - genetic and congenital disorders

younger adults - trauma drugs and alcohol

elderly >60 cerebrovascular events and neoplasms

24
Q

Lifestyle management of seizures

A

Advice on work and risk prevention
Caution if work involves driving, heights, machinery, fires or water
legal restrictions on driving

25
Q

first line drug Rx for focal seizures or secondary generalised tonic-clonic seizures (GTCS)

A

Lamotrigine

26
Q

second line drug Rx for focal seizures or secondary GTCS

A 
Carbamazepine
Levetiracetam
Sodium valproate
Topiramate
Zonisamide
27
Q

1st line for GTCS

A

Sodium valproate

Levetiracetam

28
Q

2nd line for GTCS

A

Lamotrigine
Topiramate
Zonisamide

29
Q

1st line absence

A

Ethosuximide

30
Q

2nd line absence

A

Sodium valproate

31
Q

1st line myoclonic

A

Sodium valproate

32
Q

2nd line myoclonic

A

Levetiracetam

Clonazepam

33
Q

when is surgery indicated

A

when seizures are drug resistant

34
Q

when should sodium valproate be prevented

A

in F of reproductive age unless benefits outweigh risks

35
Q

What should you as a clinicion be aiming when giving drug Rx for seizures

A

use as few and simple doses as possible

ideally one drug

36
Q

When drug withdrawal can be considered?

A

after 2 seizure free years gradual withdrawal can be considered

37
Q

What is secondary GTCS

A

starts off as a simple seizures and evolves into a GTCS

starts with no LOC then becomes LOC and convulsions

Core Conditions third year (78 decks)

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