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CP3 @ UoN - Medicine & Surgery > Epilepsy & LoC > Flashcards

Epilepsy & LoC Flashcards

1
Q

What are the classical features of a generalised (tonic-clonic) seizure?

A

Aura
LoC
Tonic phase (body rigid for 1min, tongue biting, incontinence)
Clonic phase (gen convulsion, frothing of mouth, rhythmic jerking, sev mins)
Post ictal phase (drowsiness/confusion/coma for sev hrs)

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2
Q

What are the three main types of syncope?

A

Vasovagal/cardiogenic syncope
Post hypotension
Post-prandial hypotension

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3
Q

What causes vasovagal syncope?

A

Due to sudden reflex bradycardia/peripheral vasodilation

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4
Q

What are the features of vasovagal syncope?

A

Occurs in response to standing/fear/venesection/pain
Pt unconscious <2mins
Recovery rapid, no treatment required

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5
Q

What is postural hypotension?

A

Drop in systolic BP of 20mmHg on standing from sitting/lying

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6
Q

What causes postural hypotension?

A

Pooling of blood in legs due to gravity

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7
Q

What factors increase the risk of postural hypotension?

A

Fluid depletion
Age-related autonomic dysfunction
Polypharmacy

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8
Q

What is post-prandial hypotension?

A

Drop in systolic BP of 20mmHg (or diastolic of 10mmHg) after eating

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9
Q

What causes post-prandial hypotension?

A

Pooling of blood in splanchnic vasculature

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10
Q

What are the less common causes of syncope?

A

Carotid sinus syncope (excessive vagal response)
Anaemic syncope
Micturition syncope
Coughing/exertion syncope

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11
Q

What features distinguish seizures from syncope?

A

Witness account of jerking movements, incontinence, post-episode confusion & amnesia = SEIZURE
Cardiac evaluation can detect risk factors for syncope

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12
Q

What investigations are appropriate in a pt w/ recurrent syncope?

A 
Bloods - FBC, U&amp;Es, glucose
Lying/standing BP, tilt-tabel tests
ECG/24hr tape (heart block, arrhythmias, long QT)
EEG
Echo/CT head
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13
Q

What advice must be given to all pts w/ recurrent syncope?

A

Do not drive until cause found

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14
Q

What is a seizure?

A

Convulsion/transient abnormal event resulting from paroxysmal discharge of cerebral neurones

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15
Q

What is epilepsy?

A

Continuing tendency to have seizures even if a long time separates the attacks
Affects 1% of population

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16
Q

What is a partial seizure?

A

Single focus of electrical activity

  • simple partial
  • complex partial
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17
Q

What are the features of a simple partial seizure?

A

No impairment of consciousness, single limb jerking w/ sensory aura (pattern depends on lobe involved)

  • Temporal (lip smacking, chewing)
  • Frontal (motor movements, speech arrest, Jacksonian march)
  • Parietal (sensory disturbances, tingling/numbness
  • Occipital (visual disturbances)
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18
Q

What are the features of a complex partial seizure?

A

Consciousness impaired at some stage

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19
Q

What is Todd’s paralysis?

A

Temporary paresis of originally affected limb after a partial seizure

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20
Q

What are the features of Temporal Lobe epilepsy?

A

Classical aura w/ sense of fear/deja-vu/hallucinations
Confusion/anxiety
Automatisms (lip smacking/chewing)

21
Q

What are generalised seizures?

A

Widespread focus of electrical activity across both hemipsheres

  • absence
  • tonic-clonic
  • tonic
  • clonic
  • myoclonic
  • atonic
22
Q

What are the features of absence seizures?

A

<10secs of LoC in 4-10yrs, more common in girls
Stimulated by hyperventilation/flashing lights
Remit by puberty, predispose to adult epilepsy

23
Q

What are the features of tonic seizures?

A

Extended/flexed trunk

24
Q

What are the features of clonic seizures?

A

Jerking

25
Q

What are the features of myoclonic seizures?

A

Brief, shock like movements

26
Q

What are the features of atonic seizures?

A

Sudden drop to the floor

27
Q

What are the 2o causes of epilepsy?

A

Structural (trauma, SoL, stroke, SLE, AVMs)
Developmental (CP)
Metabolic
-hypo/hyper (glycaemia, calcaemia, natraemia)
-liver disease
Drugs (withdrawal, cocaine, TCAs, SSRIs, ciprofloxacin)
Infection (encephalitis, HIV, syphilis)

28
Q

What is the immediate first aid treatment of a patient having a generalised seizure?

A

Place pt in recovery position
Remove harmful objects in location
Rectal dizepam

29
Q

What should be done if the seizure lasts >3mins (status epilepticus)?

A 
ABCDE
IV Lorazepam (4mg bolus)
Finger prick glucose (IV glucose 50ml of 50%)
IV Pabrinex (if alcoholism)
Preg test
IV Phenytoin (if seizures persist, 15mg/kg)
Continue intubation (anaesthetic review)
CT/LPs/cultures
30
Q

What are the possible causes of status epilepticus?

A 
Epilepsy
Hypoxia
Stroke
Brain injury
Metabolic derangements
Infections
Eclampsia
Drug withdrawal/toxicity
31
Q

What is the prognosis of status epilepticus?

A

Mortality 10%

32
Q

What investigations are appropriate in suspected epilepsy?

A

Bloods - FBC, U&Es, LFTs, Ca, Mg, glucose
Head CT/MRI
EEG

33
Q

When is treatment for epilepsy started?

A

After two seizures, if organic causes ruled out

34
Q

What is the goal of epilepsy treatment?

A

Control seizures w/ lowest possible dose w/ fewest side effects
-achieved in 70%

35
Q

What are the most common triggers for epileptic seizures?

A 
Lack of sleep
Alcohol/drugs
Hypoglycaemia
Caffeine
Stress
Flashing lights
36
Q

What medications are used to treat generalised seizures?

A

1st line - Valproate, Lamotrigine (if female of childbearing age)
Adjuncts - Clozabam, Carbamazepine, Levetiracetam
Ethosuxamide if absence seizure

37
Q

What medications are used to treat partial seizures?

A

1st line - Carbamazepine, Lamotrigine (if female of childbearing age)
Multiple adjuncts used

38
Q

How does Valproate work?

A

Potentiates GABA

Causes Na channel blockade

39
Q

What are the common side effects of Valproate?

A 
Rash/hair loss
Sedation/wt gain
Tremor
Birth defects
Thrombocytopenia
Liver damage
40
Q

How does Lamotrigine work?

A

Blocks Na channel

Reduces glutamate release

41
Q

What are the common side effects of Lamotrigine?

A

Mild sedation

Bone marrow toxicity

42
Q

How does Carbamazepine work?

A

Na channel blocker

43
Q

What are the common side effects of Carbamazepine?

A 
Rashes
Dizziness
Double vision
Agranulocytosis
Birth defects
Liver damage
Induces metabolism of itself/other drugs
44
Q

How does Phenytoin work?

A

Voltage dependent blockage of Na channels

45
Q

What are the common side effects of Phenytoin?

A

Gum growth
Nystagmus
Enzyme induction

46
Q

Why does Phenytoin require therapeutic monitoring?

A

Zero order kinetics

Disproportionate increases in plasma concentration

47
Q

What are the serious side effects common to all anti-epileptic drugs?

A

Leucopenia
Rashes
Steven-Johnson Syndrome
Toxic Epidermal Necrolysis

48
Q

When can drug withdrawal be considered?

A

Seizure free for 2-4 years

  • drug reduced in dose every 4wks
  • pt stopping driving during withdrawal
49
Q

What are the current laws regarding epilepsy and driving?

A

Pts must tell DVLA immediately/stop driving if had a seizure
-if pt was awake & LoC, license is revoked
Pts can apply for a new license if no seizures for 6mo after 1 seizure
-1yr after repeat attacks
If sleep-related epilepsy can drive if only had seizures while sleeping for 3yrs

CP3 @ UoN - Medicine & Surgery (135 decks)

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