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232 Epilepsy > Disease and Clinical Features of Epilepsy > Flashcards

Disease and Clinical Features of Epilepsy Flashcards

1
Q

What is the definition of an epileptic seizure?

A

A transeint event experienced by a subject as a result of a synchronous and excessive discharge of cerebral neurones

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2
Q

What do the following mean?

Prodrome

Aura

Post-ictal

A

Prodrome - hours/days - may rarely precede seizure: change in behaviour

Aura - part of the seizure, where the patient is aware - strange feeling in gut, dejavu, strange smells/flashing lights

Post-ictal - symptoms follow seizure -

  • headache, confusion, myalgia, sore tongue
  • temporary weakness after focal seizure in motor cortex (Todd’s Palsy)
  • Dysphasia - following focal seizure in temporal lobe
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3
Q

What are strong clues when assessing whether someone has had an epileptic seizure?

A

Tongue biting and slow recovery

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4
Q

What is a primary generalised seizure?

A

Simultaneous involvement of both hemispheres, associated with Loss of consciousness/awareness

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5
Q

What are the different types of generalised seizures?

A

Absence

Tonic Clonic

Myoclonic

Tonic

Atonic

Infantile

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6
Q

What is an absence seizure?

A

Begins in childhood

Loss of awareness and vacant expression <10s, return to normal as if nothing has happened

May go on to develop generalised convulsive seizures

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7
Q

What is a tonic clonic seizure and what are the stages involved?

A

Prodrome - Often no warning, may be aura if 2o generalised seizure

Tonic-clonic - Tonic stiffening ⇆ clonic synchonous jerking of the limbs → until convulsion stops

Eyes remain open, tongue bitten, incontinence

Post-ictal phase - flaccid unresponsiveness → gradual return of awareness with confusion and drowsiness +/- headache

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8
Q

What is a myoclonic seizure?

A

Brief contractions of muscle or muscle groups → sudden involuntary twitch of finger/hand

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9
Q

What is a tonic seizure?

A

Consistent stiffening of the body, without jerking

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10
Q

What is an atonic (akinetic) seizure?

A

Sudden loss of muscle tone → fall, without LoC

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11
Q

What are infantile spasms?

A

West syndrome - a triad of:

Infantile spasms

  • Severe myoclonic convulsions
  • Nodding attack (head drawn inward)
  • Salaam/Jackknife - bending neck and raising arms

EEG (hypsarrhythmia)

Developmental regression

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12
Q

What is a partial seizure?

A

Electrical discharge restricted to a limited part of cortex of one cerebral hemisphere

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13
Q

What are the different types of partial seizure?

A

Simple

Complex

Secondary generalisation - starts as partial seizure, spreads widely

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14
Q

What is a simple partial seizure?

A

Without LoC

e.g. focal motor seizure (Jacksonian)

  • Originate in motor cortex
  • Jerking begins in one side of mouth/hand → spread (march of the seizure)
  • Local temporary paralysis sometimes follows (Todd’s)

With frontal seizures, can get forceful, sustained turning to one side by eyes, head or body = Adversive seizure

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15
Q

What is a complex partial seizure?

A

Loss of consciousness

Arise from temporal lobe or frontal lobe

Awareness impaired

Temporal lobe → post-ictal confusion (takes time)

Frontal lobe → rapid (fast) recovery

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16
Q

What are the characteristics of a Temporal Seizure?

A

Automatisms - complex motor phenomena, impaired awareness and no recollection afterwards

Abdominal rising sensation/pain

Dysphasia

Memory phenomena

Emotional disturbance - Hippocampus - sudden terror

Uncal involvement - hallucinations or taste or smell and dream like state

Delusional behaviour

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17
Q

What characterises frontal lobe seizures?

A

Motor features - posturing, versive movements of head and eyes

Jacksonian march

Motor arrest - Dysphasia or speech arrest

Subtle behavioural disturbance

Post-ictal Todd’s palsy

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18
Q

What characterises occipital lobe seizures?

A

Visual phenomena - spots, lines, flashes

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19
Q

What characterises parietal lobe seizures?

A

Sensory disturbances - tingling, numbness, pain

Motor symptoms

20
Q

What structural changes can causes epilepsy?

A

Cortical scarring (head injury)

Developmental (tumour)

Space-occupying lesion

Stroke

Hippocampal sclerosis

Valscular malformations

21
Q

What are non-epileptic causes for seizures?

A

Trauma, Stroke, Haemorrhage, raised ICP,

alcohol/benzo withdrawal,

metabolic disturbance, liver diease,

infections: meningitis, encephalitis, syphilis, HIV,

raised temperature,

drugs: tricyclics, cocaine, tramadol, theophylline

22
Q

What are the differentials for epilepsy?

A

Syncope - Reflex (vasovagal) or cardiogenic

Non-epileptic attacks (psychogenic)

Panic attacks

Sleep disorders, Migraines, TIAs, Hypoglycaemia

23
Q

What investigations are conducted for epilepsy?

A

ECG - rule out cardiac cause

EEG - low sensitivity, high specificity. Useful for classification, localisation. Video EEG = Gold standard

Imaging - find cause, response to anti-epileptic drugs, prognosis

24
Q

What causes of epilepsy are associated to onset at the following ages?

Infants

Children/Adolescent

Young adults

30-50

50+

A

Infants - Developmental malformation, perinatal injury, infection

Children/Adolescent - Idiopathic Generalised Epilepsy

Young adults - IGEs, Various: head injury, alcohol, vascular malformations, hippocampal sclerosis

30-50 - brain tumours

50+ - Cerebrovascular disease, mass lesions - neoplasms

25
Q

What is idiopathic generalised epilepsy?

A

Mixture of generalised seizures

Start in childhood, teen or young adulthood

Imaging normal (structurally)

EEG abnormal - abnormal firing

Seizures triggered by alcohol excess and sleep deprivation

[Juvenile Myoclonic Epilepsy, Childhood Absence Epilepsy]

26
Q

What is Juvenile Myoclonic Epilepsy? And how is it treated?

A

Upper limb jerks, GTCS, Absences

Seizures on waking, precipitation by alcohol excess and sleep deprivation

EEG - spike and wave, photosensitivity common

MRI normal

Treatment: Sodium Valporate; (2nd) Lamotrigine; (3rd) Levetiracetam

27
Q

What is hippocampal sclerosis?

A

Scarring and atrophy to the hippocampus and surrounding cortex

Main cause of temporal lobe epilepsy

Childhood febrile convulsions are the main RF

visible on MRI

Refractory epilepsy - resection of damaged temporal lobe may be an option

28
Q

What is a hamartoma?

A

Benign local malformation which resembles a neoplasm

29
Q

How may traumatic brain injury be linked to epilepsy?

A

May cause epilepsy, sometimes years after event

Risk does not increase after mild injury

Depressed skull, penetrating injury, intracranial haemorrhage increase risk significantly

30
Q

How is cerebral palsy related to epilepsy?

A

1/3 of children with cerebral palsy have epilepsy

31
Q

How does prematurity and foetal hypoxia relate to epilepsy?

A

They may cause periventricular leukomalacia which can cause early-onset epilepsy

32
Q

In which part of the brain are mass lesions likely to cause epilepsy?

A

The grey matter

33
Q

After age 60, what is the commonest cause of epilepsy?

A

Stroke and small vessel cerebrovascular disease

34
Q

what is a cavernoma?

A

Cavernomas (cluster of abnormal dilated vessels) usually present with epilepsy

35
Q

How are inflammatory conditions related to epilepsy?

A

Often seizures are presenting feature of encephalitis, cerebral abscesses or tuberculomas

Also in chronic meningitis

36
Q

What does pork tapeworm cause?

A

Neurocyticercosis - major cause of seizures in countries where pork tapeworm is endemic

37
Q

How are alcohol and drugs related to epilepsy?

A

Chronic alcohol use - whilst drinking heavily/during period of withdrawal

Alcohol-induced hypoglycaemia/head injury can also → seizures

Drugs: Antipsychotics, SSRIs, Lithium, Lidocaine, Ciclosporin, Cocaine

Withdrawal of anti-epileptics or benzodiazepines may cause seizures

38
Q

What metabolic abnormalities can cause seizures?

A

Hypoglycaemia, hypocalcaemia, hyponatraemia

Acute hypoxia

Uraemia, hepatic encephalopathy

Pophyria (abnormal metabolism of Hb)

39
Q

What are the treatments for Generalised TC seizures?

A

1 - Sodium Valporate/Lamotrigine

  1. Carbamazepine (Na+ channels)/Topiramate

Others: Levetiracetam, oxycarbazepine, clobazam

40
Q

What are the treatments for Absence Seizures?

A

Sodium Valporate

Lamotrigine

Ethosuximide

41
Q

What is the treatment for tonic, atonic or myoclonic seizures?

A
  1. Sodium valporate/Lamotrigine
  2. Topiramate

Other: Levetiracetam, Clobazam

(same as GTCS, but avoid carbamazepine/oxcarbazepine)

42
Q

What is the treatment for partial seizures?

A
  1. Carbamazepine
  2. Sodium Valporate/Lamotrigine/Oxcarbazine/Topiramate

Others: Levetiracetam, GABApentin, Tigabine, Phenytoin, Clobazam

43
Q

What is status epilepticus?

A

Seizure or series of seizures lasting for 30mins without regaining consciousness

MEDICAL EMERGENCY

Seizures lasting >5min need treating

Mortality 20%

44
Q

What is the immediate management for status epilepticus?

A

Secure airway, monitor vital signs

IV access

Oxygen

U+Es, Ca, Mg, ABGs, ECG +/- anti-epileptic drug levels

IV glucose and thiamine (if alcohol suspected)

45
Q

What are the treatments for early, established and refractory status epilepticus?

A

Early - IV Lorazepam 4mg, repeated once after 10 mins

  • alternatives: Diazepam, Buccal Midazolam

Established - IV Phenytoin - Monitor BP and Cardiac

  • alternatives: valporate, levetiracetam, phenobarbitone

Refractory - ITU, GA. IV Propofol, Thiopental, Midazolam

EEG, continue treatment + existing AEDs

46
Q

What is non-convulsive status epilepticus?

A

Electrographic status (diagnose with EEG), but no convulsions

Confusion, reduced GCS, psychiatric symptoms

Responds well to benzodiazepines

47
Q

What is SUDEP?

A

Sudden Unexpected Death in Epilepsy

  • non-traumatic unwitnessed death
  • post-mortem normal
  • Cardiac arrhythmias, perictal hypoxia, postictal cerebral depression → hypoventilation and bradycardia

232 Epilepsy (3 decks)

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