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Medicine Phase 2a Neuro > Epilepsy 2 > Flashcards

Epilepsy 2 Flashcards

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1
Q

Define

A

The recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain, manifesting in seizures
Epilepsy is an ongoing liability to recurrent epileptic seizures
Chronic disorder

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2
Q

Define epileptic seizure

A

Paroxysmal/unprovoked event in which changes of behaviour, sensation or cognitive processes are caused by excessive, hypersynchronous (unusually synchronised) neuronal discharges in the brain

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3
Q

What are convulsions

A

Motor signs of electrical discharges

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4
Q

Give example of an abnormal metabolic circumstance that would result in a seizure

A

Low Sodium

Hypoxia

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5
Q

Since epilepsy is a chronic disorder, what does this mean for diagnosis

A

Need at least 2 seizures to be defined as epileptic

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6
Q

Epidemiology

A

Common
Incidence is age-dependent, it is highest at the extremes of life with most cases starting before 20yrs or after the age of 60yrs
Canoften go into remission

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7
Q

How long do epileptic seizures usually last

A

30-120 seconds

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8
Q

How many epileptic seizures are idiopathic

A

2/3rds are idiopathic, often familial

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9
Q

Aetiology - the 1/3 not idiopathic

A 
Cortical scarring
Space-occupying lesion e.g. tumour
Stroke
Tuberous sclerosis
Alzheimer’s or dementia - epilepsy more common
Alcohol withdrawal
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10
Q

Examples of cortical scarring that can cause epileptic seizures

A
  • Head injury years before onset
  • Cerebrovascular disease e.g. cerebral infraction or haemorrhage
  • CNS infection e.g. meningitis or encephalitis
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11
Q

Risk factors

A
  • Family history
  • Premature born babies who are small for their age
  • Abnormal blood vessels in brain
  • Alzheimer’s or dementia
  • Use of drugs e.g. cocaines
  • Stroke/brain tumour/infection
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12
Q

Elements of a seizure

A

Prodrome
Aura
Post-ictally (after seizure)

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13
Q

What is prodrome and how long does it last

A

Lasting hours or days may rarely precede the seizure

Not part of the seizure, results in change of mood or behaviour

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14
Q

What is aura

A

Part of seizure where the patient is aware and may precede its other manifestations
Strange feeling in the gut, deja vu or strange smells or flashing lights
(not necessarily due to temporal lobe damage)

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15
Q

Describe post-ictally (after seizure)

A

Headache, confusion, myalgia and a sore tongue
Temporary weakness after a focal seizure in motor cortex - Todd’s palsy
Dysphasia following a focal seizure in the temporal lobe

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16
Q

What is Todd’s palsy

A

Temporary weakness after a focal seizure in motor cortex

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17
Q

Classifications of seizures

A 
Primary generalised (40%)
Partial/focal seizures (57%)
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18
Q

Describe Primary generalised seizure

A

Simultaneous onset of electrical discharge throughout whole cortex (involving both hemispheres), with no localising features referable to only one hemisphere
Bilateral symmetrical and synchronous motor manifestations
Always associated with loss of consciousness or awareness

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19
Q

Describe partial/focal seziures

A

Focal onset, with features referable to a part of one hemisphere e.g. temporal lobe
Often seen with underlying structural disease
Electrical discharge is restricted to a limited part of the cortex of one cerebral hemisphere
These may later become generalised (e.g. secondarily generalised tonic-clonic seizures)

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20
Q

Types of primary generalised seizures

A 
Generalised tonic-clonic seizure
Typical absence seizure
Myoclonic seizure
Tonic seizure
Atonic (akinetic) seizure
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21
Q

Describe the Tonic and Clonic phase of generalised tonic-clonic seizure

A

Tonic phase = Rigid, stiff limbs - person will fall to floor if standing
Clonic phase = Generalised, bilateral, rhythmic muscles jerking lasting seconds-minutes

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22
Q

Describe clinical presentation of Generalised Tonic-Clonic seizure

A 
Often NO aura
Loss of consciousness
Tonic and Clonic phase
Eyes remain OPEN
Tongue often bitten
May be incontinence of urine/faeces
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23
Q

What follows a Generalised Tonic-Clonic seizure

A

period of drowsiness, confusion or coma for several hours post-ictally

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24
Q

Describe clinical presentation of Typical Absence seizure

A
  • Usually a disorder of childhood
  • Child ceases activity, stares and pales for a few seconds only
  • I.e. suddenly stops talking in mid-sentence, then carries on where left-off
  • Often do not realise that they’ve had an attack
  • Children with petit mal tend to develop generalised tonic-clonic seizures in adult life
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25
How would you characterise a typical absence seizure
On EEG characterised by a 3-Hz spike and wave activity
26
Clinical presentation of myoclonic seizure
Sudden isolated jerk of a limb, face or trunk | Patent may be thrown suddenly to the ground, or have a violently disobedient limb
27
Clinical presentation of tonic seizure
Sudden sustained increased tone with a characteristic cry/grunt Intense stiffening of body (tonic) Stiffening NOT FOLLOWED by jerking
28
Clinical presentation of atonic seizure
Sudden loss of muscle tone and cessation of movement resulting in a fall
29
Examples of partial/focal seizures
Simple partial seizure Complex partial seizure Partial seizure with secondary generalisation
30
Clinical presentation of Simple partial seizure
Not affecting consciousness or memory Awareness is unimpaired with focal motor, sensory (olfactory, visual etc.), autonomic or psychic symptoms No post-ictal symptoms
31
Clinical presentation of Complex partial seizure
- Affecting awareness or memory before, during or immediately after the seizure - Most commonly arise from the temporal lobe (understanding speech, memory & emotion) - Post-ictal confusion is common with seizures arising from the temporal lobe, whereas recovery is rapid after seizures in the frontal lobe (thought processing & movement)
32
Clinical presentation of Partial seizure with secondary generalisation
In 2/3rds of patients with partial seizures, the electrical disturbance, which starts focally (as either a simple or complex partial seizure), SPREADS WIDELY causing a secondary generalised seizure which is typically convulsive
33
Characteristics of partial/focal seizure depend on lobe affected. Clinical presentation of partial seizure if temporal lobe affected
memory, emotion & speech understanding Aura (80%) - Deja-vu, auditory hallucinations, funny smells, fear Anxiety or out of body experience, automatisms e.g. lip smacking, chewing, fiddling
34
Characteristics of partial/focal seizure depend on lobe affected. Clinical presentation of partial seizure if frontal lobe affected
motor and thought processing Motor features such as posturing or peddling movements of the leg Jacksonian march - seizure “marches” up or down the motor homunculus starting in face or thumb Post-ictal Todd’s palsy - paralysis of limbs involved in seizure for several hours
35
Characteristics of partial/focal seizure depend on lobe affected. Clinical presentation of partial seizure if parietal lobe affected
Interprets sensations Sensory disturbances - tingling/numbness
36
Characteristics of partial/focal seizure depend on lobe affected. Clinical presentation of partial seizure if occipital lobe affected
Vision Visual phenomena e.g. spots, lines or flashes
37
Functions of each lobe of cerebrum
Frontal - motor and thought processing Temporal - memory, emotion & speech understanding Parietal - interprets sensations Occipital - vision
38
What is syncope
loss of consciousness due to hypoperfusion to brain
39
Difference in presentation between epilepsy and syncope
Epilepsy - Tongue biting, head turning, muscle pain, loss of consciousness, cyanosis, post-ictal symptoms Syncope - Prolonged upright position e.g. long time standing, sweat prior to loss of consciousness, nausea, pre-syncopal symptoms
40
Difference between epileptic and non-epileptic seizure
Non-epileptic seizures are situational Non-epileptic is longer, closed mouth/eyes during tonic-clonic movements, pelvic thrusting, do not result from sleep, no incontinence or tongue biting There are pre-ictal anxiety symptoms in non-epileptic seizure
41
Differential diagnosis
``` Postural syncope Cardiac Arrhythmia TIA Migraine Hyperventilation Hypoglycaemia Panic attacks Non-epileptic seizure ```
42
Clinical diagnosis
from history there needs to be at least 2 or more unprovoked seizures occurring > 24hrs apart to DIAGNOSE EPILEPSY
43
Diagnosis
``` Electroencephalogram MRI (imaging of hippocampus) CT head Blood tests - FBC, electrolytes, Calcium, Renal function, Liver function, Urine biochemistry, blood glucose levels Genetic testing ```
44
WHat is the purpose of of an electroencephalogram
Not diagnostic but can support a clinical diagnosis | May also help determine seizure type and what epilepsy syndrome
45
What is the purpose of CT head
Rule out metabolic causes and discover comorbidities
46
Give example of when genetic testing can be used
juvenile myoclonic epilepsy
47
What are AEDs
Anti-Epileptic Drugs - help control seizures in about 70% of people
48
Common types of Anti-epileptic drugs
``` sodium valproate carbamazepine lamotrigine oxcarbazepine ethosuximide ```
49
Side effects of AEDs
``` drowsiness a lack of energy agitation headaches uncontrollable shaking (tremor) hair loss or unwanted hair growth swollen gums rashes ```
50
When would surgery be an option for treatment
AEDs aren't controlling your seizures Tests show that your seizures are caused by a problem in a small part of your brain that can be removed without causing serious effects
51
What tests are done before surgery
Brain scans Electroencephalogram - a test of your brains electrical activity Tests of your memory, learning abilities and mental health
52
Medical treatment of Generalised Tonic Clonic seizure
AEDs: Sodium valproate (not in child bearing age women); Lamtrigine Seizure control: Diazepam (or Lorazepam)
53
Medical treatment of Absence seizure
AED: Sodium valproate Ethosuximide
54
Medical treatment of Partial seizure
AED: Lamotrigine carbamazepine; Phenytoin | Seizure control: Diazepam (or lorazepam)
55
What other procedures can be done if AEDs aren't controlling your seizures and brain surgery isn't suitable for you
Vagus nerve stimulation (VNS) Deep brain simulation (DBS) Ketogenic diet
56
What is Vagus Nerve Stimulation (VNS)
A small electrical device (similar to a pacemaker) is placed under skin of chest A wire connects it to the vagus nerve and bursts of electricity are sent along the wire Helps control seizures by changing electrical signals in brain
57
Side effects of vagus nerve stimulation
Hoarse voice Sore throat Cough
58
What is deep brain simulation and what are side effects
Similar to VNS Wires run directly into brain Bursts of electricity sent along these wires can help prevent seizures by changing the electrical signals in the brain
59
1st line treatment of partial seizure
CARBAMAZEPINE
60
What is SUDEP
Sudden unexpected death epilepsy | More common in uncontrolled epilepsy
61
Treatment in emergency measures
Ensure patient harm themselves as little as possible - ABCDE Check glucose Prolonged seizure (longer than 3 minutes) or repeated seizures are treated with RECTAL/IV DIAZEPAM or LORAZEPAM - repeat x2 IV PHENYTOIN LOADING If still fitting then anaesthetist involvement for anaesthetic and ventilation
62
Generally drugs are NOT advised after just one fit, but when would you consider giving drugs anyway
If risk of recurrence is high

Medicine Phase 2a Neuro (28 decks)

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