[epilepsy] Flashcards by Johannes Staufenberg

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Temporal Lobe

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sore tongue due to severe tongue bite

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cortex

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cortical scarring

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1 year

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“you must contact the DVLA”

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idiopathic

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Partial

Primary generalised

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Partial

The attack ONSET is key for Dx

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A seizure with features referable to one part of one hemisphere

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Simultaneous onset of electrical discharge throughout the cortex i.e. no localising features (at onset)

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simple partial
complex partial
Partial with secondary generalisation

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absence
tonic-clonic
myoclonic
atonic (akinetic)
infantile

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temporal

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awareness unimpaired
focal symptoms
post ictal symptoms usually absent

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Awareness impaired
focal symptoms
post-ictal symptoms common

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headache
confusion
sore tongue
myalgia
temporary weakness (can get in partial)

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temporary weakness due to focal cortical seizure

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temporal

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Frontal

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temporal

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focal start (either simple/complex)
spreads to generalised
usually convulsive

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[epilepsy]: If a child patient stopped talking for a few seconds then picked up where he left off what seizure would you suspect

generalised -absence

[epilepsy]: What are the characteristics of tonic-clonic seizures (4)

Loss of consciousness limbs stiffen (tonic) limbs jerk (clonic) post-ictal confusion

[epilepsy]: What are the characteristics of myoclonic seizures (1)

sudden jerk of face/limb/trunk

[epilepsy]: What are the characteristics of an akinetic seizure (1)

sudden loss of tone (fall?)

[epilepsy]: partial seizures: what lobe would be suspected if the patient reported visual spots/lines & phenomena

occipital

[epilepsy]: partial seizures: post-ictal todds palsy indicates ... lobe involvement

frontal

[epilepsy]: partial seizures: frontal lobe involvement is likely to cause ... features

motor

[epilepsy]: partial seizures: Describe a 'Jacksonian march'

spreading motor seizure from a distal part of a limb to the ipsilateral face. retained awareness

[epilepsy]: partial seizures: dysphasia can be due to localised seizures in which 2 lobes

frontal | Temporal

[epilepsy]: partial seizures: what is an automatism

brief unconscious behaviours | motor behaviours with no recollection

[epilepsy]: partial seizures: what is the opposite of deja vu

``` jamais vu (strangely unfamiliar) ```

[epilepsy]: partial seizures: jamais and deja vu are signs of ... lobe involvement

temporal lobe

[epilepsy]: partial seizures: delusional behaviour is indicative of which lobe

temporal

[epilepsy]: partial seizures: what is the difference between motor involvement in the frontal and temporal lobes

frontal retains awareness

[epilepsy]: partial seizures: emotional fluctuating states are found in ... lobe seizures

temporal

[epilepsy]: partial seizures: smell or taste hallucinations are found in .... lobe seizures

temporal

[epilepsy]: Mx: after how many fits can treatment with drugs be an option (in the absence of high risk factors)

[epilepsy]: Mx: 1st line for generalised tonic clonic, myoclonic, atonic and tonic seizures (2)

Sodium valproate | Lamotrigine

[epilepsy]: Mx: 1st line for absence seizures (3)

Sodium valproate lamotrigine ethosuximide

[epilepsy]: Mx: what must you NOT use in myoclonic, atonic or tonic seizures

Carbemazepine oxcarbazepine *worsen seizures)

[epilepsy]: Mx: 1st line for all partial seizures (inc. secondary general)

Carbamazepine 100mg/12hr intitial increase by 200mg every 2weeks max 1000mg

[epilepsy]: Mx: 2nd line for all partial seizures (inc. secondary general)

Sodium valproate | lamotrigine

[epilepsy]: Mx: if the 1st line drug is not tolerated/SE are very bad/seizures not controlled, what is the protocol for switching to 2nd line?

Concurrently administer 1st and 2nd line and only withdraw 1st once established on 2nd line

[epilepsy]: Ix: when are EEGs useful?

risk of recurrence following a 1st time unprovoked seizure

[epilepsy]: Ix: what Ix would be most useful to identify a single epilepticogenic focus

MRI

[epilepsy]: Mx: if a single epilepticogenic focus is found e.g. tumour what is 1st line treatment?

neurosurgical resection (70% seizure free)

[epilepsy]: Mx: what are the 2 non-pharmacological Mx options

neurosurgical resection | Vagus nerve stimulation

[epilepsy]: Mx: what is the most common cause of SUDEP (sudden unexpected death in epilepsy)

nocturnal seizure apnoea

[epilepsy]: Mx: T/F drugs are given at low doses and then increased steadily until the optimum dose is found or SEs become unbearable

[epilepsy]: Mx: what is the dosing regimens for carbamazepine

100mg/12hr intitial increase by 200mg every 2weeks up to a max 1000mg

[epilepsy]: Mx: what is the dosing regimens for lamotrigine

IF MONOTHERAPY: initial 25mg/d increase by 50mg every 2 weeks Max 250mg

[epilepsy]: Mx: lamotrigine monotherapy doses should be halved if co-administered with ...

Sodium valproate

[epilepsy]: Mx: lamotrigine monotherapy doses should be doubled if co-administered with ... (2)

Carbamazepine | phenytoin

[epilepsy]: Mx: what is the dosing regimens for sodium valproate

initial 300mg/12hrs | increase by 100mg/12hrs every 3 days

[epilepsy]: Mx: which epileptic drugs are liver enzyme inducers

carbamazepine phenytoin barbituates

[epilepsy]: Mx: What are the SEs of Valproate (9)

``` VALPROATE appetite increase Liver failure Pancreatitis reversible hair loss Oedema Ataxia Teratogenic, thrombocytopenia, Tremor Encephalopathy Nausea ```

[epilepsy]: Mx: what are the SEs of carbamazepine (3)

Leucopenic vision problems (diplopia/blurred) Impaired balance

[epilepsy]: Mx: what are the SEs of lamotrigine(3)

Maculopapular rash Stevens-johnsons syndrome (0.1%) visual problems

[epilepsy]: Mx: what are the SEs of phenytoin (5)

``` reduced IQ depression coarse facial features visual problems dysarthria ```

[epilepsy]: Mx: what is the 1st line drug in pregnancy (general and partial)

lamotrigine for general | Carbamazepine for partial

[epilepsy]: Mx: what should be presecribed alongside AEDs in pregnany women

folic acid

[epilepsy]: Mx: when can anticonvulsant drugs be stopped? (4)

seizure free for > 2years normal EEG normal CNS exam other (e.g. the need to drive)

[epilepsy]: seizures can be caused by withdrawal from which 2 substances? (2)

alcohol | benzodiazapines

[epilepsy]: emotional involvement is due to involvement of what structure

hippocampus

[epilepsy]: Mx: parietal lobe involvement often results in what symptoms (2)

sensory loss | motor (spread to precentral gyrus)