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Year Two - Neurology System > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is epilepsy?

A

It is defined as a condition in which individuals have a tendency to experience recurrent seizures

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2
Q

What are seizures?

A

They are transient episodes of abnormal electrical discharges

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3
Q

What are the three pathophysiological causes of seizures?

A

Neuronal Overexcitation

Neuronal Damage

Neuronal Under Inhibition

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4
Q

What are the four abnormalities that can cause neuronal overexcitation?

A

Glutamate receptor pathologies

Sodium ion channel pathologies

Calcium ion channel pathologies

Excitatory amino acid pathologies

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5
Q

What abnormality can cause neuronal under inhibition?

A

GABA receptor pathologies

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6
Q

What are the nine causes of epilepsy?

A

VINDICATE

Vascular

Infection

Neoplasms

Drugs

Iatrogenic

Congenital

Autoimmune

Trauma

Electrolyte Imbalances

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7
Q

What is the vascular condition associated with epilepsy?

A

Stroke

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8
Q

What three infections are associated with epilepsy?

A

Meningitis

Encephalitis

HIV

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9
Q

Which neoplasms are associated with epilepsy?

A

Brain

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10
Q

Which two drugs are associated with epilepsy?

A

Alcohol

Illicit Drugs

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11
Q

Which antibiotic is known to lower the seizure threshold?

A

Ciprofloxacin

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12
Q

What is an iatrogenic cause of epilepsy?

A

Drug withdrawal

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13
Q

What three congenital conditions are associated with epilepsy?

A

Tuberous Sclerosis

Cerebral Palsy

Mitochondrial Disease

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14
Q

What are the three clinical features of tuberous sclerosis?

A

Epilepsy

Depigmented skin

Roughened patches of skin over the lumbar spine

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15
Q

What autoimmune condition is associated with epilepsy?

A

Vasculitis

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16
Q

What three electrolyte imbalances are associated with epilepsy?

A

↓Na+

↓Ca2+

↑Glucose

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17
Q

What are the two general classifications of seizures?

A

Focal

Generalised

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18
Q

What is another term for focal seizures?

A

Partial seizures

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19
Q

What are focal seizures?

A

They are defined as seizures that involve networks within a specific region of the brain, in one cerebral hemisphere

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20
Q

Which cerebral lobe is most commonly affected by focal seizures?

A

Temporal

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21
Q

What are the two subclassifications of focal seizures?

A

Simple focal seizures

Complex focal seizures

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22
Q

How do we sub classify focal seizures into simple and complex seizures?

A

It is based upon the level of awareness individuals experience during the seizure

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23
Q

What are simple focal seizures?

A

They are defined as focal seizures that don’t impair consciousness or cause postictal clinical features

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24
Q

What is the posticital phase?

A

It refers to the period of time immediately following a seizure

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25
How long can the posticital phase last for?
It can last from seconds to days
26
What is a common posticital clinical feature?
Todd's palsy
27
What is Todd's palsy?
It is transient post-ictal paralysis
28
What clinical features do simple focal seizures result in - motor or non-motor?
Motor
29
What are the four clinical features associated with simple focal seizures?
Uncontrollable Fit Jacksonian March Hallucinations Paraesthesia
30
What is Jacksonian March?
It is is defined as a phenomenon in which a seizure spreads from the distal part of the limb toward the ipsilateral face
31
What are complex focal seizures?
They are defined as focal seizures that impair consciousness or cause postictal clinical features
32
Describe the timeline of complex focal seizures
Individuals tend to experience aura features prior to the seizure onset, have no memory of the seizure itself and then experience postictal confusion
33
What clinical features do complex focal seizures result in - motor or non-motor?
Non-motor
34
What are the four clinical features associated with complex focal seizures?
Automatism Staring Into Space Déjà Vu Jamais Vu
35
What is automatism?
It is defined as the performance of non-purposeful repetitive movements without being aware of what is happening, such as lip smacking, blinking, grunting, etc
36
In what two ways do we localise focal seizures?
We can look at the patient's clinical features We can conduct an EEG scan
37
What are the four clinical features that indicate focal seizures are localised to the frontal lobe?
JPJP Jerky movements Posturing Jacksonian march Posticital weakness
38
What clinical feature indicates focal seizures are localised to the parietal lobe?
Paraesthesia
39
What four clinical features indicates focal seizures are localised to the temporal lobe?
HEAD Hallucinations Epigastric Rising Aura/Emotional Automatisms Deja Vu/Dysphasia
40
What two clinical features indicates focal seizures are localised to the occipital lobe?
Floaters Flashing lights
41
What are the two first line management options for focal seizures?
Lamotrigine Levetiracetam
42
What are the three second line management options for focal seizures?
Carbamazepine Oxcarbazepine Zonisamide
43
What is another term for generalised seizures?
Complete seizures
44
What are generalised seizures?
They are defined as seizures that involve networks within both cerebral hemispheres – with no localising features referable to a single hemisphere
45
What are the five subclassifications of generalised seizures?
Generalised Tonic Clonic Seizures Absence Seizures Atonic Seizures Myoclonic Seizures Infantile Seizures
46
How do we sub classify generalised seizures?
In all subclassifications, generalised seizures result in a loss of consciousness They are instead classified based upon whether they result in motor or non-motor clinical features
47
What is another term for generalised tonic clonic seizures?
Grand mal seizures
48
What are generalised tonic clonic seizures?
They are defined as those that result in motor clinical features, specifically tonic (muscle tensing) and clonic (muscle jerking) episodes
49
What usually occurs first in generalised tonic clonic seizures - the tonic or clonic phase?
Tonic THEN Clonic
50
Are generalised tonic clonic seizures motor or non-motor?
Motor
51
What are the five additional clinical features observed in generalised tonic clonic seizures?
Groaning Eye Rolling/Deviation Urinary Incontinence Mouth Foaming Tongue Biting
52
What four postictal features occur following generalised tonic clonic seizures?
Confusion Drowsiness Irritability Depression
53
What is the first line management option for generalised tonic clonic seizures?
Sodium valproate
54
What are the two second line management options for generalised tonic clonic seizures?
Lamotrigine Levetiracetam
55
What is another term for absence seizures?
Petit mal seizures
56
Are absence seizures motor or non-motor?
Non-motor
57
Which patient group tends to be affected by absence seizures?
Children
58
What are the two triggers for absence seizures?
Hyperventilation Photosensitivity
59
Describe the clinical features observed during absence seizures
Individuals become blank, stare into space and then abruptly return to normal During the episode they are unaware of their surroundings and become unresponsive
60
How long do absence seizures tend to last? How many times can they occur a day?
5-10 seconds 100 times per day
61
What is the feature of abscence seizures on EEG scans?
3Hz spike and wave
62
What is the first line management option for absence seizures?
Ethosuximide
63
What is the second line management option for absence seizures - in males?
Sodium valproate
64
What are the two second line management options for absence seizures - in females?
Lamotrigine Levetiracetam
65
What happens to absence seizures as individuals get older?
They spontaneously stop
66
What is another term for atonic seizures?
Drop seizures
67
Are atonic seizures motor or non-motor?
Motor
68
Which patient group tends to be affected by atonic seizures?
Children 1-5 years old
69
What do atonic seizures usually indicate?
Lennox-Gastaut syndrome
70
How does Lennox Gastaut syndrome present on an EEG?
Slow spike
71
How do we manage Lennox Gastaut syndrome?
Ketogenic diet
72
Describe the clinical features observed during atonic seizures
Individuals experience a brief lapse in muscle tone within the legs – causing the individual to suddenly collapse or fall down
73
How long do atonic seizures last?
They usually last less than 3 minutes
74
What is the first line management option used for atonic seizures?
Sodium valproate
75
What is the second line management option used for atonic seizures?
Lamotrigine
76
Are myoclonic seizures motor or non-motor?
Motor
77
Which patient group tend to be affected by myoclonic seizures?
Children
78
What do myoclonic seizures indicate?
Juvenile myoclonic epilepsy
79
What is another term for juvenile myoclonic epilepsy?
Janz syndrome
80
Which patient group tends to be affected by juvenile myoclonic epilepsy?
Female Teens
81
When does juvenile myoclonic epilepsy tend to present?
Morning There are no daytime seizures
82
Describe the clinical features observed during myoclonic seizures
Individuals experience sudden brief muscle contractions, like a sudden jump
83
What is the first line management option for myoclonic seizures?
Sodium valproate
84
What is the second line management option for myoclonic seizures?
Levetiracetam
85
What is another term for infantile spams?
West syndrome
86
Are infantile spasms motor or non motor?
Motor
87
Which gender tend to be affected by infantile spasms?
Males
88
Which age group tend to be affected by infantile spasms?
Those between 4 -8 months old
89
What do infantile spasms indicate?
A secondary neurological abnormality, such as tuberous sclerosis, encephalitis or birth asphyxia
90
What is a feature on clinical examination of infantile seizures?
Salaam attack
91
What is a Salaam attack?
This is when individuals experience clusters of full body spasms, resulting in flexion of the head, trunk and limbs and extension of the arms
92
How long do infantile seizures last? How many times can they occur a day?
1-2 seconds 50 times per day
93
What EEG feature indicates infantile seizures?
Hypsarrhythmia in 2/3rd of infant
94
What are the two first line management options for infantile seizures?
Prednisolone Vigabatrin
95
What is benign rolandic epilepsy?
It is a form of childhood epilepsy charactersised by partial seizures, which tend to occur during sleep
96
What is a risk factor of benign rolandic epilepsy?
Family History
97
What are the three clinical features assoacited with benign rolandic epilepsy?
Hemifacial Paraesthesias Oropharyngeal Manifestations Hypersalivation
98
What are the three other common causes of seizures other than epilepsy?
Febrile convulsions Alcohol withdrawal Psychogenic non-epileptic seizures
99
What are febrile convulsions?
They are defined as brief generalised tonic-clonic seizures that occur early in a viral infection as the temperature rises rapidly
100
Which age group tend to be affected by febrile convulsions?
6 months - 5 years old
101
When should parents be advised to call an ambulance during a febrile convulsaion?
When febrile convulsions last longer than 5 minutes
102
What is a red flag of febrile convulsions, which should prompt referral to paediatrics?
Droswy > 2 hrs of seizure
103
What can be administered by specialists in those with recurrent febrile convulsions?
Rectal Diazepam Buccal Midazolam
104
What are alcohol withdrawal seizures?
These are seizures that occur in patients with a history of alcohol excess who suddenly withdraw alcohol
105
How soon after alcohol withdrawal does seizures onset occur?
36 hrs
106
What drug class is administered to prevent the development of alcohol withdrawal seizures?
Benzodiazepines
107
What is another term for psychogenic non-epileptic seizures?
Pseudo seizures
108
What are psychogenic non-epileptic seizures?
They describe patients who present with epileptic like seizures that do not have characteristic electrical discharges
109
Which patient group tend to be affected by psychogenic non-epileptic seizures?
Those with mental health problems
110
What is a feature indicative of psychogenic seizure?
Widespread convulsions without conscious impairment
111
What investigation can be used to differentiate between psychogenic non-epileptic seizures and true seizures?
Prolactin levels True seizures = increased
112
When do we usually initiate pharmacological management of epilepsy?
After the second epileptic seizure
113
In which three circumstances do we initiate pharmacological management of epilepsy after the first epileptic seizure?
If the patient has a neurological deficit, brain imaging shows a structural abnormality If the EEG shows unequivocal epileptic activity If the patient/family/carers consider the risk of having a further seizure unacceptable
114
In general, what anti-epileptic is used as a first line management option for generalised seizures?
Sodium valproate
115
In general, what anti-epileptic is used as a first line management option for focal seizures?
Carbamazepine
116
What are the two investigations used to diagnose epilepsy?
Electroencephalogram (EEG) MRI Scan
117
What is an EEG?
It involves the attachment of electrodes to the scalp in order to record electrical activity of the brain
118
What EEG feature indicates epilepsy?
Abnormal electrical activity
119
How are MRI scans used to diagnose epilepsy?
It is used to diagnose structural problems that may be associated with seizures and other pathologies, such as tumours
120
When do we acutely manage epilepsy?
When seizures don’t self-terminate within 5-10 minutes
121
How do we acutely manage epilepsy?
We administer benzodiazepines, such as diazepam
122
What two routes are used to administer benzodiazepines for acute treatment of epilepsy?
Rectally Intranasally
123
What is the first line acute pharmacological management option of epilepsy? What dose?
Rectal diazepam 10mg
124
What is status epilepticus?
This is when seizures continues for more than 5 minutes or there are more than 3 seizures in one hour despite intervention This is a medical emergency requiring hospital treatment
125
What two causes of status epilepticus must be ruled out before other causes are considered?
Hypoxia Hypoglycaemia
126
What are the seven management steps used to treat status epilepticus in hospital?
Secure Airway Administer High Concentration O2 Assessment of Cardiac/Respiratory Function Check Blood Glucose Levels Insert IV Cannula Administer IV Lorazepam 4mg (Repeat After 10 Minutes If Seizure Continues) Administer IV Phenytoin (If Seizures Persist With Lorazepam)
127
What investigation is required when starting IV phenytoin? Why?
Cardiac monitoring This is due to the pro-arrythmogenic effects
128
What are the two management steps used to treat status epilepticus in the community?
Administer Buccal Midazolam 10mg (Repeat After 10 Minutes If Seizure Continues) Administer Rectal Diazepam (If Seizures Persist With Midazolam)
129
What is sodium valporate's mechanism of action?
It is involved in increasing the activity of GABA, which produces a relaxing effect on the brain
130
When is sodium valproate used to manage epilepsy?
It is used as a first line agent in generalised seizures
131
What are the five side effects of sodium valproate?
Weight Gain Alopecia Liver Damage (P450 Enzyme Inhibitor) Tremor Teratogenic
132
What is carbamazepine's mechanism of action?
It binds to sodium ion channels, which increases their refractory period
133
When is carbamazepine used to manage epilepsy?
It is used as a first line agent in focal seizures
134
What are the six side effects of carbamazepine?
Agranulocytosis Leucopoenia Aplastic Anaemia Ataxia Liver Damage (P450 Enzyme Inducer) Visual Disturbances (Diplopia)
135
Due to being a P450 enzyme inductor, what effect does carbamazepine have on warfarin?
It decreases INR
136
What two seizure classifications can carbamazepine exacerbate?
Absence seizures Myoclonic seizures
137
What is lamotrigine's mechanism of action?
It binds to and inhibits sodium ion channels
138
When is lamotrigine used to manage epilepsy?
It is used as a second line agent for a variety of generalised and focal seizures
139
What are the three side effects of lamotrigine?
Stevens Johnson Syndrome DRESS Syndrome Leukopenia
140
What is ethosuximide's mechanism of action?
It binds to calcium ion channels of the thalamic neurons, which decreases the electrical activity of these neurones
141
When is ethosuximide used to manage epilepsy?
It is used as a second line agent for a variety of generalised seizures
142
What are the two side effects of ethosuximide?
Night Terrors Rash
143
Which two anti-epileptics do we need to carefully review the patient's other prescribed medications? Why?
Sodium valproate Carbamazepine Due to the fact that they induce/inhibit the P450 system, which can result in varied metabolism of other medications - such as warfarin and COCP
144
What anti-epileptic is prescribed in females of childbearing age? Why?
Lamotrigine Due to the typical teratogenic effect of antileptics, particularly sodium valproate
145
What are the teratogenic effects of sodium valproate?
Neural tube defects
146
In comparison to normal pregnancies, what should patients on anti-epileptics be aware of when trying to conceive?
They should receive folic acid 5mg instead of 400mcg
147
In cases where pregnant patients are being administered phenytoin, what should be administered in the last month of pregnancy? Why?
Vitamin K To prevent clotting disorders in the newborn
148
Is breastfeeding safe in mothers taking anti-epileptics?
Yes The only exception is if they are taking barbiturates
149
Why is it important to discuss contraception options with epileptic patients of childbearing age?
This is due to the fact that the effect of anti-epileptics can reduce the effectiveness of contraceptive pills, vice versa
150
What general contraceptive advice is given to those taking anti-epileptics?
They should use condoms in addition to other forms of contraception
151
What are the three first line contraception methods advised in those administered phenytoin, carbamazepine, barbiturates, primidone, topiramate or oxcarbazepine?
Depo-Provera IUD IUS
152
What are the five first line contraception methods advised in those administered lamotrigine?
POP Implant Depo-Provera IUD IUS
153
In cases where epilepsy patients select the COCP, what dose should be administered?
It should contain a minimum of 30 µg of ethinylestradiol
154
How long is driving suspended for group one vehicles in individuals who experience a single seizure, without an epilepsy diagnosis? What other criteria must these individuals meet? How long is driving suspended for when these criteria are not met?
6 months No relevant structural abnormalities on brain imaging or EEG 12 months
155
How long is driving suspended for group two vehicles in individuals who experience a seizure, without an epilepsy diagnosis?
5 years
156
How long is driving suspended for group one vehicles in individuals who experience a seizure, with an epilepsy diagnosis?
12 months
157
How long is driving suspended for group two vehicles in individuals who experience a seizure, with an epilepsy diagnosis?
10 years with no medication administration
158
What criteria must be obtained before anti-epileptic drugs can be stopped?
In cases where individuals are seizure free for > 2 years, with AEDs being stopped over 2 - 3 years
159
Can individuals drive whilst anti-epileptic drugs are being withdrawn?
No This includes 6 months until after last dose
160
What are the five complications associated with epilepsy?
Sudden Unexplained Death in Epilepsy (SUDEP) Depression Anxiety Injuries Brain Damage
161
What drug is contraindicated in individuals with epilepsy?
Bupropion
162
What condition can present similarly to epilepsy? How do we differentiate between the two?
Syncope The posticital period in epilepsy is prolonged, however does not exist in syncopal episodes In addition, syncopal episodes are usually associated with stress and reduced nutritional intake

Year Two - Neurology System (25 decks)

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