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Flashcards in [epilepsy] Deck (69)
1

[epilepsy]: seizures are usually stereotyped for each individual T/F

T

2

[epilepsy]: deja vus, gut feelings and flashing lights = auras. Which part of the brain is implicated?

Temporal Lobe

3

[epilepsy]: post-ictally what tongue symptoms may be present

sore tongue due to severe tongue bite

4

[epilepsy]: temporary weakness post-ictally suggests a seizure localised to which aspect of the brain

cortex

5

[epilepsy]: How can trauma cause epilepsy

cortical scarring

6

[epilepsy]: for how long after your seizure must you avoid driving

1 year

7

[epilepsy]: after a seizure who has responsibility to contact the DVLA

"you must contact the DVLA"

8

[epilepsy]: 2/3s of epilepsy has what cause

idiopathic

9

[epilepsy]: What are the 2 broad classifications of seizures? (2)

Partial
Primary generalised

10

[epilepsy]: if a seizures initially starts with a focal onset and very quickly progresses to generalised what classification of seizure is this

Partial

(The attack ONSET is key for Dx)

11

[epilepsy]: what is the definition of a partial seizure

A seizure with features referable to one part of one hemisphere

12

[epilepsy]: what is the definition of a generalised seizure

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

13

[epilepsy]: what are the 3 types of partial seizures (3)

simple partial
complex partial
Partial with secondary generalisation

14

[epilepsy]: what are the 5 types of generalised seizures

absence
tonic-clonic
myoclonic
atonic (akinetic)
infantile

15

[epilepsy]: post ictal confusion is commonly associated with seizures arising from which lobe

temporal

16

[epilepsy]: What are the characteristics of a simple partial seizure (3)

awareness unimpaired
focal symptoms
post ictal symptoms usually absent

17

[epilepsy]: What are the characteristics of a complex partial seizure (3)

Awareness impaired
focal symptoms
post-ictal symptoms common

18

[epilepsy]: What constitutes post-ictal symptoms (5)

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

19

[epilepsy]: What is Todd's palsy

temporary weakness due to focal cortical seizure

20

[epilepsy]: Dysphasia post-ictally suggests a seizure in which brain lobe

temporal

21

[epilepsy]: ... lobe seizures are less likely to have confusion due to its rapid recovery in comparison with the temporal lobe.

Frontal

22

[epilepsy]: from which lobe is a complex partial seizure most likely to occur

temporal

23

[epilepsy]: What are the characteristics of a partial seizure with secondary generalisation (3)

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

24

[epilepsy]: What are the characteristics of an absence seizure (2)

25

[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

26

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

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

27

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

sudden jerk of face/limb/trunk

28

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

sudden loss of tone (fall?)

29

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

occipital

30

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

frontal

31

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

motor

32

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

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

33

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

frontal
Temporal

34

[epilepsy]: partial seizures: what is an automatism

brief unconscious behaviours
(motor behaviours with no recollection)

35

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

jamais vu
(strangely unfamiliar)

36

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

temporal lobe

37

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

temporal

38

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

frontal retains awareness

39

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

temporal

40

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

temporal

41

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

2

42

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

Sodium valproate
Lamotrigine

43

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

Sodium valproate
lamotrigine
ethosuximide

44

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

Carbemazepine
oxcarbazepine

*worsen seizures)

45

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

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

46

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

Sodium valproate
lamotrigine

47

[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

48

[epilepsy]: Ix: when are EEGs useful?

risk of recurrence following a 1st time unprovoked seizure

49

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

MRI

50

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

neurosurgical resection (70% seizure free)

51

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

neurosurgical resection
Vagus nerve stimulation

52

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

nocturnal seizure apnoea

53

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

T

54

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

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

55

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

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

56

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

Sodium valproate

57

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

Carbamazepine
phenytoin

58

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

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

59

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

carbamazepine
phenytoin
barbituates

60

[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

61

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

Leucopenic
vision problems (diplopia/blurred)
Impaired balance

62

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

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

63

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

reduced IQ
depression
coarse facial features
visual problems
dysarthria

64

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

lamotrigine for general
Carbamazepine for partial

65

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

folic acid

66

[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)

67

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

alcohol
benzodiazapines

68

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

hippocampus

69

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

sensory loss
motor (spread to precentral gyrus)