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Neurology finals > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is epilepsy

A

A recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain, manifesting as a seizure

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2
Q

What are convulsions the motor signs of?

A

Electrical discharges

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3
Q

What does an aura imply?

A

A focal seizure

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4
Q

What symptoms may be present post-ictally from a seizure in the motor cortex

A

Headache
Confusion
Myalgia
Temporary weakness

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5
Q

What is post ictal weakness often called?

A

Todd’s palsy

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6
Q

What symptom may be present post-ictal from a seizure in the temporal lobe

A

Dysphasia

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7
Q

What proportion of seizures are idiopathic

A

2/3

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8
Q

List some other causes of seizures

A

Cortical scarring - head injury years before onset
Developmental - dysembryoplastic neuroepithelial tumour or cortical dysgenesis
Space occupying lesion
Stroke
Hippocampal sclerosis
Vascular malformations
Tuberous sclerosis
Sarcoidosis
SLE
PAN
Antibodies to voltage gated potassium channels

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9
Q

How is epilepsy diagnosed?

A

Diagnosis is difficult due to the heterogenous nature of the disease
All patients with a seizure must be referred for specialist assessment and investigation within 2 weeks

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10
Q

What must be established in the history of a seizure?

A

Tongue biting
Collateral from witness
Slow recovery
Funny turns/odd behaviour
Deja vu and odd episodic feelings of fear may be relevant
Any triggers? Alcohol, stress, flickering lights, TV. Triggering attacks tend to recur

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11
Q

List the 3 types of focal seizure

A

Simple - without impairment of consciousness
Complex - with impairment of consciousness
Secondary generalised - Evolving to bilateral, convulsive seizure

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12
Q

Describe the features of a simple seizure

A

Awareness unimpaired
Focal motor, sensory, autonomic or psychic symptoms
No post ictal symptoms

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13
Q

Describe the features of a complex seizure

A

Awareness is impaired
Either at seizure onset or following a simple partial aura. Most commonly arise from the temporal lobe in which post ictal confusion is a feature

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14
Q

Describe the features of a secondary generalised seizure

A

In 2/3 patients with partial seizures, the electrical disturbance, which starts focally, spreads widely, causing a generalised seizure, which is typically convulsive

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15
Q

Describe focal seizures

A

Originating within networks linked to one hemisphere and often seen with underlying structural disease

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16
Q

Describe generalised seizures

A

Originating at some point within and rapidly engaging bilaterally distributed networks leading to simultaneous onset of widespread electrical discharge with no localising features referable to a single hemisphere

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17
Q

List some examples of generalised seizures

A 
Absence seizure
Tonic-clonic seizure
Myoclonic seizure 
Atonic (akinetic seizure) 
Infantile spasms
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18
Q

Describe absence seizures

A

Brief (<10s) pauses

Presents in childhood

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19
Q

Describe tonic-clonic seizures

A

Loss of consciousness
Limbs stiffen (tonic) then jerk (clonic)
May have one without the other, Post ictal confusion and drowsiness

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20
Q

Describe myoclonic seizures

A

Sudden jerk of the limb, face and trunk

The patient may be suddenly thrown to the ground or have a violently disobedient limb

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21
Q

Describe atonic seizure

A

Sudden loss of muscle tone causing fall

No LOC

22
Q

What are infantile spasms commonly associated with?

A

Tuberous sclerosis

23
Q

Give some features of a temporal lobe seizure

A 
Automatisms
Dysphasia
De ja vu 
Emotional disturbance 
Hallucinations of smell, taste and sound 
Delusional behaviour 
Bizarre associations
24
Q

Give some features of a frontal lobe seizure

A

Motor features such as posturing or peddling movements of the legs
Jacksonian march - spreading focal motor seizure with retained awareness often starting with the face or thumb
Motor arrest
Subtle behavioural disturbance
Dysphasia or speech arrest
Post ictal todds palsy

25
Q

Give some features of a parietal lobe seizure

A

Sensory disturbance - tingling, numbness, pain

Motor symptoms - due to spread to the pre central gyrus

26
Q

Give some features of occipital lobe seizure

A

Visual phenomena such as spots, lines and flashes

27
Q

Describe non-epileptic attack/pseudo seizure

A 
Gradual onset
Prolonged duration 
Abrupt termination
Closed eyes
Resistance to eye opening 
Rapid breathing
Fluctuating motor activity 
Episodes of motionless unresponsiveness
CNS exam, CT, MRI and EEG are normal 
May coexist with true epilepsy
28
Q

List some provoking causes of seizures

A 
Trauma
Stroke
Haemorrhage
Increased ICP 
Alcohol
Benzo withdrawal 
Metabolic disturbance
Infection
High temp 
Drugs
29
Q

What investigations are done to investigate seizures

A 
CT/MRI 
EEG
Drug levels if on anti-epileptics 
Drugs screen
LP - if considering infection
30
Q

How long must someone abstain for driving for

A

> 1 year seizure free

31
Q

What does antiepileptic drug choice depend on?

A 
Seizure type
Epilepsy syndrome
Comorbidities
Lifestyle 
Patient preferences
32
Q

Describe focal seizure antiepileptic drug choice

A

1st line - Carbamazepine and Lamotrigine

2nd - levetiracetam or topiramate

33
Q

Describe generalised tonic clonic seizure drug choice

A

1st line - sodium valproate or lamotrigine

2nd line - carbamazepine, clobazam, levetiracetam or topiramate

34
Q

Describe absence seizure drug choice

A

1st line - sodium valproate or ethosuximide

2nd line - lamotrigine

35
Q

Describe myoclonic seizure drug choice

A

1st line - sodium valproate

2nd line - Levetiracetam or topiramate

36
Q

Describe tonic or atonic seizure drug choice

A

Sodium valproate or lamotrigine

37
Q

How long should antiepileptic drugs be built up over

A

2-3 months until seizures are controlled or maximum dosage is reached

38
Q

When should antiepileptic drugs be switched?

A

If ineffective or not tolerated, switch to next appropriate drug

39
Q

How do you switch between antiepileptic drugs?

A

Introduce the new drug slowly and only withdraw the first drug when established on the second

40
Q

When can antiepileptics be stopped

A

> 2years seizure free and after assessing the risks and benefits for the individual

41
Q

How do you stop antiepileptics

A

Decrease dose slowly (over 2-3 months) or >6months with benzodiazepines and barbiturates

42
Q

Describe sudden unexpected death in epilepsy

A

More common in uncontrolled epilepsy

May be related to nocturnal seizure associated apnoea or asystole

43
Q

List the side effects of carbamazapine

A 
Leucopenia
Diplopia
Blurred vision
Impaired balance
Drowsiness
Mild generalised erythematous rash 
SIADH (rare)
44
Q

List the side effects of lamotrigine

A 
Maculopapular rash 
TENS/SJS
Diplopia
Blurred vision 
Photosensitivity 
Tremor
Agitation 
Vomiting
Aplastic anaemia
45
Q

List the side effects of levetiracetam

A 
D&V
Dyspepsia
Drowsiness
Diplopia
Blood dyscrasia
46
Q

List the side effects of sodium valproate

A 
Teratogenic
Nausea
Liver failure
Pancreatitis 
Hair loss 
Oedema
Ataxia
Tremor
Thrombocytopenia 
Encephalopathy
47
Q

List the side effects of phenytoin

A

Toxicity - nystagmus, diplopia, tremor, dysarthria, ataxia

48
Q

Which antiepileptics are liver enzyme inducing

A

Carbamazepine
Phenytoin
Barbiturates

49
Q

How much folic acid should women of child bearing age take?

A

5mg/day

50
Q

Which antiepileptic is preferred in pregnancy and breast feeding?

A

Lamotrigine

51
Q

How do oestrogen containing contraceptives effect lamotrigine?

A

Decrease lamotrigine levels

52
Q

How do liver inducing enzymes affect progesterone containing contraception?

A

Make it less reliable

Neurology finals (32 decks)

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