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Epilepsy Flashcards

(26 cards)

1
Q

What is epilepsy?

A

A neurological condition characterised by recurrent seizures due to episodes of abnormal electrical activity in the brain.

Defined as 2 or more unprovoked epileptic seizures more than 24 hours apart.

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2
Q

What are the differentials for epilepsy?

A
  1. Non epileptic attack disorder
  2. Alcohol withdrawal
  3. Hypoglycaemia/metabolic
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3
Q

What are seizures?

A

Transient episodes of abnormal electrical activity in the brain.

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4
Q

What types of seizure are generally seen in adults?

A
  1. Generalised tonic-clonic seizures
  2. Focal seizures
  3. Myoclonic seizures
  4. Tonic seizures
  5. Atonic seizures
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5
Q

What types of seizure are more common in children?

A
  1. Absence seizures
  2. Infantile spasms
  3. Febrile convulsions
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6
Q

What are tonic-clonic seizures?

A

Involve** tonic (muscle tensing) and clonic (muscle jerking) movements** associated with complete loss of consciousness.

Patients may experience aura before, and there may be **tongue biting, incontinence, groaning & irregular breathing.
- Prolonged post-ictal period where person is confused, tired, irritable or low.

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7
Q

What are focal seizures?

A

Occur in an isolated brain area, often temporal lobes, affecting hearing, speech, memory & emotions. Patients remain awake.

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8
Q

How can focal seizures present?

A
  1. Hallucinations
  2. Memory flashbacks
  3. Deja vu
  4. Doing strange things on autopilot
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9
Q

What are myoclonic seizures?

A

Sudden, brief muscle contractions (jerk, twitch, like a sudden jump) but the patient remains awake.

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10
Q

What are tonic seizures?

A

Sudden onset of increased muscle tone where the entire body stiffens, causing a fall, but lasts only a few seconds.

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11
Q

What are atonic seizures?

A

Sudden loss of muscle tone, often resulting in a fall, also known as ‘drop attacks’. They don’t last more than 3 minutes.

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12
Q

What are absence seizures?

A

Usually seen in children where the patient becomes blank, stares into space, and then returns to normal.

They are unaware of surroundings and don’t respond, typically lasting 10-20 seconds.

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13
Q

What are infantile seizures?

A

West syndrome, which is rare, characterised by clusters of full body spasms.

Hypsarrhythmia is a characteristic EEG finding and is associated with developmental regression.

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14
Q

At what age do infantile spasms start?

A

In infancy at around 6 months.

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15
Q

What is the characteristic EEG finding for infantile spasms?

A

Hypsarrhythmia.

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16
Q

What are febrile convulsions?

A

Tonic-clonic seizures that occur in children during a high fever and are not caused by epilepsy or other pathology.

They typically occur between the ages of 6 months to 5 years.

17
Q

What are the differentials for seizures?

A
  1. Vasovagal syncope
  2. Pseudoseizures
  3. Cardiac syncope
  4. Hypoglycaemia
  5. Hemiplegic migraine
  6. TIA
18
Q

What investigations are done for seizures?

A
  1. EEG - electroencephalogram
  2. MRI brain
  3. ECG - to exclude heart problems
  4. Serum electrolytes
  5. Blood glucose
  6. Blood cultures, urine cultures & lumbar puncture if sepsis, encephalitis or meningitis is suspected.
19
Q

What information does a patient need to know when diagnosed with epilepsy?

A
  1. DVLA remove license until seizure criteria are met.
  2. Showers > baths - drowning is a major risk factor.
  3. Caution with swimming, heights, traffic.
  4. Caution with heavy, hot or electrical equipment.
20
Q

What is the treatment for epilepsy?

21
Q

How does sodium valproate work?

A

Increases activity of GABA.

22
Q

What are the side effects of sodium valproate?

A
  1. Teratogenic
  2. Liver damage
  3. Hair loss
  4. Tremor
  5. Reduced fertility
23
Q

What is status epilepticus?

A

A medical emergency defined as either a **seizure lasting more than 5 minutes **or multiple seizures without regaining consciousness.

24
Q

What is the management for status epilepticus?

A
  1. Secure airway
  2. High concentration O2
  3. Check blood glucose levels
  4. IV access
25
What is the medical treatment for status epilepticus?
1. **Benzodiazepine** first line, repeated if seizure continues. 2. **IV levetiracetam, phenytoin or sodium valproate**. 3. **Phenobarbital** or **general anaesthesia**.
26
What benzodiazepines can you use for status epilepticus?
1. Buccal midazolam 2. Rectal diazepam 3. IV lorazepam