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Year 2 - Nervous > Seizures/epilepsy > Flashcards

Seizures/epilepsy Flashcards

1
Q

Define epilepsy

A

Tendency to recurring seizures

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2
Q

Differentials of a blackout/loss of consciousness (5)

A 
Epileptic seizure
Syncope
Non-epileptic seizure, e.g. psychogenic seizure
Arrhythmia
Head trauma/concussive seizure
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3
Q

Name 3 types of syncope

A

Reflex syncope, e.g. after taking blood, straining on toilet
Orthostatic syncope, e.g. dehydration, anti-hypertensives
Cardiogenic syncope, e.g. arrhythmias

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4
Q

Questions to ask when assessing a collapse/blackout

  • patient account (3)
  • witness account (6)
A

Patient account

  • history of events leading up to collapse
  • history of the episode itself (any warning symptoms, awareness of it happening)
  • any recollection of what happened afterwards
Witness account
-how was the patient prior
-describe the patient during the episode:
eyes open/closed
any jerking
pallor
breathing pattern
duration
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5
Q

Seizure markers/signs (4)

A

Prolonged disorientation/confusion
Tongue biting
Incontinence
Muscle pains

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6
Q

Symptoms (4) /signs (2) of cardiogenic syncope, e.g. from arrhythmia

A

Chest pain
Dyspnoea
Clammy/sweaty
Palpitations

Pallor - pale grey
Few brief jerks

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7
Q

Symptoms (2) /signs (3) of reflex syncope, e.g. after blood taken

A

Lightheaded
Sweaty

Vision blacking out
Pale
Few brief jerks

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8
Q

Define a seizure

A

Sudden burst of electrical activity in brain temporarily affecting function

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9
Q

Causes of provoked seizures (4)

A

Alcohol/drug withdrawal
Within few days after head injury
Within 24hrs of stroke
Severe electrolyte disturbance

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10
Q

2 classifications of seizures

A

Generalised

Focal

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11
Q

Define generalised seizures vs focal seizures

A

Involve both hemispheres and therefore involve the whole body

Involves just one hemisphere

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12
Q

Name 6 types of generalised seizures

A 
Absence seizures
Tonic seizures
Atonic seizures
Clonic seizures
Myoclonic seizures
Tonic-clonic seizures
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13
Q

Clinical features of absence seizures (2) + who are they found in most

A

Staring blankly for 5-10 secs
Automatisms - lip smacking, blinking

Children

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14
Q

Phases of a generalised tonic clonic seizure, formerly GRAND MAL seizure (2)

A

Tonic phase

  • body stiffens; goes rigid
  • cry or groan before clonic phase

Clonic phase

  • muscles rapidly rhythmically contract then relax
  • urinary incontinence
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15
Q

Clinical features of generalised tonic clonic seizures

  • tonic phase (4)
  • clonic phase (4)
  • post tonic-clonic state (1)
A 
Tonic phase:
Loss of consciousness (not always) - collapse
Groaning
Stiff/rigid muscles initially
Tongue biting
Clonic phase:
Limb jerking - quick and rhythmic
Eyes open - staring or rolled upwards
Dribbling
Urinary incontinence

POST-ICTAL STATE (confusion for hours etc) after tonic clonic seizure stops

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16
Q

What are myoclonic seizures

  • characteristic feature
  • duration
A

Brief, shock like jerks/twitch of a muscle or a group of muscles, usually lasting no more than a second or two

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17
Q

What are atonic seizures

A

Sudden loss or decrease of normal muscle tone and the person often falls to the ground

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18
Q

What are tonic seizures

A

stiffening of your muscles. These seizures usually affect muscles in your back, arms and legs and may cause you to fall to the ground

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19
Q

What are clonic seizures

A

Repeated or rhythmic, jerking muscle movements

20
Q

Juvenile myoclonic epilepsy is a type of what generalised seizure + what is triggered by (2)

A

Myoclonic

Alcohol
Sleep deprivation - BIG RF

21
Q

List the 2 types of focal (partial seizures)

A

Focal aware seizure (used to be called simple partial seizure) = fully aware of what’s happening

Focal impaired awareness seizure (used to be called complex partial seizure) = change or loss of consciousness

22
Q

Are focal or generalised seizures more common in people with epilepsy

A

Focal

23
Q

Focal seizures most commonly arise from pathology in what lobe

A

Temporal

24
Q

Symptoms/signs of focal seizures

  • motor (5)
  • sensory (4)

*mostly seen in focal AWARE seizures rather than focal impaired seizure

A

Motor:
Muscle jerking of one side of body/specific part of body
Automatisms - lip smacking, chewing, picking at clothes
Staring into space
Post-ictal weakness of one side

Sensory:
Feeling fear/anxiety
Feeling de ja vu
Aphasia
Changes to vision, hearing, smell, taste
25
Q

List some automatisms (4)

A

Lip smacking
Picking at clothes
Chewing
Eyelid fluttering

26
Q

What are secondary generalised seizures

A

Focal seizures that have evolved into generalised seizures, i.e. once limited to one hemisphere but now affects brain bilaterally

27
Q

Investigation of seizures (6)

A 
EEG
ECG - to rule out long QT syndrome
FBC
Blood glucose
U+Es - maybe hypo/hypernatraemia, uraemia
Toxicology screen - for illicit drugs
CT
28
Q

First line treatment drug options of ongoing *primary generalised epilepsies (4) + what class of drugs are they

*e.g. tonic/atonic/clonic/tonic-clonic/myoclonic/absence seizures

A

Anticonvulsants:

  • sodium valproate - contraindicated in women of child bearing age OR
  • lamotrigine OR
  • topiramate OR
  • levetiracetam
29
Q

First line treatment drug options of *focal seizures (4) + what drug class they are

*e.g. focal aware or focal impaired seizure

A

Anticonvulsants:

  • Carbamazepine OR
  • Lamotrigine OR
  • Oxcarbazepine OR
  • Levetiracetam
30
Q

First line treatment of absence seizures (1)

A

Ethosuximide

31
Q

Treatment of an ACUTE generalised or focal seizure (2)

  • 1st line
  • 2nd line - if above doesn’t work
A

IV benzodiazepine - lorazepam

IV phenytoin (an anti-epileptic) - if above doesn’t work

32
Q

Side effects of the following anti-epileptics:

  • phenytoin (3)
  • sodium valproate (5)
  • carbamazepine (4)
  • lamotrigine (2)
  • levetiracetam (2)
A

Phenytoin - arrhythmia, hepatitis, drug-drug interactions

Sodium valproate - tremor, ataxia, nausea, drowsy, hepatitis

Carbamazepine - ataxia, drowsy, nystagmus, blurry vision

Lamotrigine (best tolerated, least side effects) - skin rash, sleep disturbance

Levetiracetam - irritable, depression

33
Q

What is the best tolerated + least side effects anti-epileptic

A

Lamotrigine

34
Q

What is status epilepticus + it is usually persistence/recurrence of which type of seizure

A

> 5 mins of either continuous seizure activity
OR
repetitive seizures without regaining consciousness between them for >5 mins

Tonic-clonic seizure

35
Q

Treatment of status epilepticus

-1st line (2)

A

First line

  • 100% oxygen
  • IV benzodiazepine - lorazepam
36
Q

Risk factors of status epileptics (2)

A

Not taking anticonvulsants properly

Chronic alcohol

37
Q

Why is it important to treat an acute or prolonged seizure ASAP

A

During long convulsive seizures, body struggles to circulate oxygen so brain doesn’t get enough oxygen and can lead to brain damage so important to give oxygen ASAP

38
Q

After a SINGLE SEIZURE, someone can drive a car/HGV after how long if investigations are normal and no further seizures

A

Car - 6 months

HGV - 5 years

39
Q

Patients DIAGNOSED WITH EPILEPSY can drive a car once they have been seizure free or have only had seizures arising from sleep after how long

A

1 year

40
Q

If patients with epilepsy have daytime seizures but then becomes nocturnal, how long does this have to be established before they can drive a car

A

3 years

41
Q

Epileptics can only drive a HGV/PSC if they have been seizure free for how long + if they’re not on anti-epileptics

A

10 years

42
Q

What is the post-ictal state

A

Altered state of consciousness after an epileptic seizure

-confusion, drowsy, amnesia for hours after seizure

43
Q

Absence seizure can be reliably tested by doing what

A

Inducing it by HYPERVENTILATION

44
Q

Focal seizures are often preceded by what weird sign

A

Smelling a weird burnt smell or hallucinating

45
Q

Focal seizures often secondary generalise into what type of seizure

A

Tonic clonic

Year 2 - Nervous (39 decks)

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