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Med 4 > CNS Week 5 Epilepsy > Flashcards

CNS Week 5 Epilepsy Flashcards

(65 cards)

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1
Q

Define seizure

A

A transient occurrence of signs and or symptoms due to abnormal excessive or synchronous neuronal activity in the brain

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2
Q

Define epilepsy

A

A pathologic and enduring tendency to have recurrent seizures
And
By the neuro-biologic, cognitive, psychological and social consequences of this condition

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3
Q

What is the difference between seizures and epilepsy

A

Seizures are a pathological pattern of neural activity and epilepsy is a tendency to recurrent seizures

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4
Q

What are the 2 main types of seizure

A

Generalised seizures: starts simultaenously in both hemispheres

Focal seizures: seizure starts in a focus and then spreads

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5
Q

What are the 3 types of common generalised seizures

A

Typical absence

Myoclonic

Tonic- clonic

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6
Q

What are absence seizures

A

Mainly childhood in onset

Frequent brief attacks (1-30s)

Sudden loss and return of consciousness

No aura and no post-ictal state

Some involuntary movements

Respond to some anti-epileptic drugs and not others

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7
Q

What are myoclonus seizures

A

Sudden brief shock like muscle contractions

Usually bilateral arm jerks

Often worse in the mornings

Precipitated by sleep deprivation and alcohol

Respond to particular anti epileptics

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8
Q

Describe tonic clonic seizures

A

Sudden onset, gasp, fall

Tonic phase with cyanosis

Clonic phase

Post-ictal phase (recovery is not instant)

Tongue bitten and incontinence, fractured shoulder

Noisy breathing

Headache and muscle pain afterwards

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9
Q

What are focal seizures

A

Often aura or warning at onset

As seizures spreads -> loss of awareness and involuntary movement

Often caused by brain lesions -> tumour, abscess, trauma

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10
Q

Describe temporal lobe seizures

A

Auras: rising sensation in stomach, olfactory and gustatory hallucinations, deja vu

As the seizure spreads the person suddenly stops and blank stares, loss of responding and awareness, mouth movements, fidgeting or postures- automatisms

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11
Q

What is idiopathic epilepsy

A

No brain lesions, no intellectual impairment, often generalised seizures
Easy to treat, seizures usually controlled

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12
Q

What is symptomatic epilepsy

A

Sign of underlying lesion or brain disorder, often cognitive problems, abnormal MRI common
Seizures not controlled

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13
Q

What are the key regulators of neuronal excitability

A

Non gated ion channels
- resting membrane potential

Voltage gated ion chanels
- Na+, K+, Ca2+, Cl-
Dendrite information processing
Action potential and repolarisation

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14
Q

What are epileptiform discharges due to

A

Neuronal bursting (an ion channel property)

Synaptic effects (both glutamate and GABA)

Glia effects

Non synaptic effects (eg extracellular K+)

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15
Q

What is epileptogenesis

A

The process following an injury that leads to the first of a series of spontaenous and recurring seizures

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16
Q

What structural changes occur in epileptogenesis

A

Cell loss inhibitory

Axonal sprouting

Neurogenesis

Gliosis

Neuro - inflammation

BBB breakdown

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17
Q

What molecular changes occur in epileptogenesis

A

Neuronal changes (Na, K, Ca, Cl, HCO3)

Neurotransmitter transporters

Neuro-modulators

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18
Q

What functional changes occur in epileptogenesis

A

Gap junctions

Glia: buffering of extracellular environment

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19
Q

How was the first anti epileptic drug developed (phenytoin)

A

Electrodes to rodents head
Shocked with electricity to induce seizure

Loaded with drug beforehand to see if it prevents electrical current from causing a seizure

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20
Q

Mode of action of vigabatrin

A

GABA transaminase inhibitor

Higher GABA levels prevent fading of inhibiton

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21
Q

Mode of action of tiagabine

A

GABA reuptake inhibitor

Higher GABA levels prevent fading of inhibition

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22
Q

In summary what are seizures caused by

A

Abnormal burst firing and synchronisation in normal / modified neural circuits

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23
Q

Steps for the management of epilepsy

A

Ensuring a correct diagnosis

Determining the cause

Deciding on treatment

Advising on lifestyle issues

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24
Q

4 different types of seizures

A

Absences

Myoclonus

Tonic clonic

Focal

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25
Differentials for blackouts and funny turns
Epilepsy Fainting Cardiac causes Psychological causes
26
Why is valporate a risk in women
Has a 6-10% malformation rate in pregnancy with subtle facial abnormalities 30-40% associated with low IQ and autism Never give valporate to a woman 12-55 without specialist adivce There is a valporate pregnancy prevention program where it is not prescribed unless the woman is fitted with a highly active contraceptive coil
27
Non pharmacological epilepsy treatments
Resection of epileptic focus Vagal nerve stimulation Ketogenic diet
28
Social consequences of epilepsy
Loss of driving licence Loss of employment Stigmatization and anxiety Needing antiepileptic drugs Problems with contraception and conception
29
Describe idiopathic epilepsy
Milder No lesion Easier to control Often generalised
30
Describe symptomatic epilepsy
Can vary with age: - brain malformations - inherited metabolic / gene disorders - birth trauma / stroke - infection and immune disorders - trauma - tumours - stroke
31
What is language lateralisation
Most humans (70-95%) have a left hemisphere lateralisation for language abilities Broca identified area in left hemisphere that plays primary role in speech production Wernicke identified another part of left hemisphere associated with speech comprehension
32
Different tests used for determining language lateralisation
Wada test Functional imaging Event related potentials Transcranial magnetic stimulation
33
Describe the wada / sodium amytal test
Procedure used by neuropsychologists prior to surgery for temporal lobe epilepsy to determine hemispheric specialisation for key language skills Injection of sodium amytal into 1 of the hemispheres produces transient ipsilateral hemiparesis - when the speech dominant hemisphere is injected there is clear but transient speech impairment
34
What are the 4 types of hearing impairment
Normal hearing: you can hear quiet sounds of less than 20dB Mild hearing loss: loss between 20-40 dB (Difficulty following speech in noisy situations Moderate hearing loss: between 41-70 dB (Difficulty following speech) Severe hearing loss: between 71-95 dB (Severe difficulty following speech without a hearing aid)
35
Describe the make up of the external auditory meatus
Lateral third- cartilaginous, ceruminous and sebaceous glands produce cerumen (earwax) Medial 2/3s - bony lined with thin skin continuous with the tympanic membrane
36
What is the tympanic membrane
Thin semitransparent membrane externally lined by thin skin and internally lined by mucous membrane all sandwiching radial and circumferential collagen fibres
37
Measurements of the tympanic membrane
Not quite 1cm across and 0.1mm thick
38
What are the 3 ossicles
Malleus (hammer) 8mm, 0.025g Incus (anvil) 10mm, 0.025g Stapes (stirrup) 3x1mm, 0.002g
39
Combined role of the ossicles
Increase the force and reduce the amplitude of vibrations needed to drive the inner ear
40
What is the stapedius
The bodys smallest muscle. Inserts to the stapes and when tense reduces the amplitude of vibrations
41
What is the tensor tympani
Inserts into the malleus and when tense it reduces the amplitude of the vibrations
42
Describe the process of ear syringing
Used to clear blocked ear canals from wax Water 37c is forced into the external auditory meatus Aimed posterosuperiorly to prevent perforation of the tympanic membrane Hold a bowl inferiorly to the auricle to catch any material dislodged from the meatus including the returning water
43
What are otoscopes
Used to view the tympanic membrane Straighten out the meatus by pulling the tip of the pinna posteriorly and superiorly Use little finger against the patients cheek as a guage of depth
44
3 problems that can arise in the external auditory meatus
Wax: 50% skin, 50% cerumen which is translucent on secretion but turns yellow golden brown black in time Otitis externa: inflammation of the ear canal- eg caused when a foreign body becomes dislodged Bony growths: arise by the formation of the benign new bone
45
2 conditions that can arise in the tympanic membrane
Tympanosclerosis- scarring of the tympanic membrane causing calcium deposits to form Perforation in the membrane
46
What is conductive hearing loss
Loss by air conduction but not by bone conduction (an air borne gap) Generally indicates a problme in the outer / middle ears that hinders normal sound getting ot the inner ear Can usually be fixed by ENT surgery
47
What is otitis media and how can it be treated
Inflammation of the mucus membrane lining the middle ear Treated by a grommet surgically inserted in the tympanic membrane (commonest surgery for young children)
48
What are some abnormalities of the outer ear
Microtia: congenital abnormality. Failure of the auricle and external auditory meatus to develop Pre-auriciular appendage - accessory cartilaginous appendage formed just anterior and superior to the tragus Haematoma- result of blunt trauma causing subcutaenous bleeding (cauliflower ear)
49
Describe the method of sound delivery
The outer hair cells actively amplify sounds Which releases energy into the cochlea Which vibrate everything in reverse order Which vibrates the eardrum and so vibrates the air Which is sound emissions
50
What is tinnitus
The conscious perception of an auditory sensation in the absence of a corresponding external stimulus No treatment to successfully eliminate
51
Negatives of hearing aids
They dont restore normal hearing They dont sound natural or transparent Dont distinguish wanted vs unwanted sounds Dont properly fix the difficulty focusing on wanted sounds
52
Features of a temporal lobe seizure
Olfactory hallucinations (imagining smells) and smacking lips together
53
Features of an occipital lobe seizure
Flashes / floaters
54
Features of a juvenile myoclonic seizure
Infrequent generalised seizures and daytime absences
55
Features of a parietal lobe seizure
Paraesthesia (burning or prickling sensation in hands, arms, legs or feet)
56
Features of frontal lobe seizures
Posturing and head / leg movements
57
Symptoms of idiopathic intracranial hypertension
Blurred vision and headache worsened by coughing and changing position Difficulty abducting right eye (lateral rectus eye muscle impaired) and bilateral papilloedema visible on fundoscopy Classically seen in overweight women
58
Symptoms of giant cell arteritis
Left sided vision loss, headache and scalp tenderness High temperature Jaw claudication Relative afferent pupillary defect
59
Treatment for giant cell arteritis
High dose prednisolone
60
Which monoclonal antibody treatment is directed against vascular endothelial growth factor (VEGF)
Bevacizumab
61
What is conduction dysphasia
Fluent speech but poor repetition with relatively intact comprehension Is the result of a lesion to the arcuate fasciculus which connects broca and wernicke’s areas
62
What is drusen
Yellow deposits on the retina | Is a characteristic sign of dry age related macular degeneration
63
Role of astrocytes
Remove excess potassium ions from CSF in the CNS Provide physical support for neurons Help form BBB Help with physical repair of neuronal tissues
64
What neurotransmitter is involved in photophobia, lacrimation and redness and pupil constriction
Acetylcholine | As these are parasympathetic pathway activity and acetylcholine is the main transmitter of this pathway
65
What is the ordinary function of ependymal cells
Provide the inner lining of the ventricles and are responsible for CNS production

Med 4 (12 decks)

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