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Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

(51 cards)

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1
Q

Definition of epilepsy

A

Sudden paroxysmal uncontrolled synchronous discharge of cerebral neurons which produces symptoms either visible to patient or observer

Excludes gradual onset and discharge without symptoms

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2
Q

Prevelance

A

0.7-0.8% - higher in developing countries

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3
Q

Most common epilepsy causes in children

A

Perinatal problems, genetic or congenital disorders

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4
Q

Most common epilepsy causes in adults

A

Trauma, alcohol abuse, drugs, brain infection

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5
Q

Most common epilepsy causes in elderly

A

Cerebrovascular disease and mass lesions

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6
Q

Pre and perinatal risk factors x4

A

Intrauterine infections (including rubella, toxoplasmosis) maternal drug abuse, irradiation in early gestation, severe perinatal trauma or anoxia

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7
Q

Trauma/surgery and epilepsy

A

Highest risk with depressed skull fracture, penetrating injury or intracranial haemorrhage

Can be early or late when chronic epilepsy is most common

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8
Q

Metabolic causes of epilepsy x5

A

Electrolyte: Hyponatraemia, hypocalcaemia, hypomagnesaemia and hypoglycaemia

Uraemia
Hepatic failure
Acute hypoxia
Porphyria

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9
Q

Main pathological cause of temporal lobe epilepsy

A

Hippocampal sclerosis -childhood febrile convulsions are big risk factor - can treat surgically if medical not effective

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10
Q

Drugs which increase risk of epilepsy - 6x medication

3 x poisoning

A

Phenothiazines, tricyclics, MAO inhibitors, amphetamines, lidocaine and nalidixic acid

Lead, CO, Mercury

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11
Q

Infectious/inflammatory causes of epilepsy x6

A 
Encephalitis
Meningitis 
Tuberculomas 
Cerebral abscess
Neurosyphilis

Neurocysticercosis - tapeworm - in countries where it is epidemic - major cause of epilepsy

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12
Q

Circulatory cause of epilepsy

A

Anoxic encephalopathy due to cardiac arrest or respiratory arrest

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13
Q

Seizure triggers

A

Photosensitivity, stress, sleep deprivation

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14
Q

Partial (focal) seizure definition

A

Electrical discharge limited to one region of cortex. Simple = no LOA, Complex = LOA

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15
Q

Generalised seizure definition

A

Simultaneous involvement of both hemispheres always associated with LOC or LOA

Focal can become secondary generalised

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16
Q

Features of absence seizures

A

Age of onset typically 4-12 - rarely beyond adolescence

Family history in 40% of patients

30% get TC in adolescence

Loss of awareness and vacant expression for

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17
Q

Tonic Clonic seizures features

A

Prodrome - no warning or may be an aura including tingling

Sudden LOC and drop to ground
Epileptic cry

Tonic - body stiff, elbows flexed, arms extended, eyes open, jaw clenched, pupils dilated - about 10 seconds - associated with rapid neuronal discharge

Clonic - neuronal discharge slows, jerking of limbs, increasing size but decreasing frequency, eyes open and roll backwards, might bite tongue and have urinary/faecal incontinence - lasts about 1-2mins

Post-ictal phase - flaccid unresponsiveness, confusion and drowsiness (15mins-1hour), headache, feel exhausted for days after including muscle ache due to CPK

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18
Q

What are myoclonic jerks?

A

Momentary brief contractions of a muscle or muscle group - commonest disorder = benign juvenile myoclonic epilepsy - onset in puberty - typically in the morning and affecting the upper limb.

Family hx may be present as is hereditary

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19
Q

What are tonic seizures?

A

Stiffening of the body - sustained muscle contraction - no jerking afterwards just LOC

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20
Q

Atonic seizures?

A

Sudden collapse with loss of muscle tone and LOC

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21
Q

Frontal Lobe Seizures?

Study These Flashcards
A

eg. Focal motor seizure - Jacksonian march from mouth or hand quite rare

Sometimes followed by Todd’s paralysis - local temporary paralysis of limbs

22
Q

What is an adversive seizure ?

Study These Flashcards
A

Conjugate gaze deviates away from epileptic focus and head turns away too with some frontal seizures

23
Q

What happens in supplementary motor cortex seizures?

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A

Can get more complicated stereotyped movements eg. cycling motion

24
Q

Occiptal lobe seizures?

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A

Uncommon - elementary visual hallucinations

25
Parietal lobe seizures?
Sensory cortex therefore paraesthesia or tingling in extremities or face
26
Features of complex partial seizure (temporal lobe seizure)?
Start with aura - rising epigastric feeling and nausea with a wide range of sensory disturbances: - memory - visceral (olfactory or gustatory eg. lip smaking) - visual - affective/emotional disturbance Followed by period of complete or partial loss of awareness (1-2mins vs 10secs of absence seizure) Loss of awareness occurs with automatisms and speech arrest May be followed by a short-period of post-ictal confusion and headache
27
Causes of epilepsy.
50% cryptogenic, 10-20% genetic, 30-40% structural or metabolic
28
What are febrile convulsions?
Not typically epilepsy but are epileptic seizures Can be simple or complex
29
Incidence of febrile convulsions and prognosis?
Affect 3% of between ages of 6 months and 6 years Only 5% go on to have epilepsy
30
Medications which lower seizure threshold x2
Anti-malarials and antidepressants
31
Clinical discriminator between epilepsy and syncope x4 and 2 which occur in both
Injury and urinary incontinence occur in both Prolonged recovery period, bitten tongue and stereotyped attacks = epilepsy Colour change - pallor = syncope and cyanosis = epilepsy
32
EEG findings in epilepsy
50% presenting with epilepsy will have normal EEG inter-ictal If drug induced sleep EEG, sleep-deprived EEG or prolonged/ambulatory EEG then 85% show activity
33
Recurrence risk after first seizure
70-80% will have 2nd seizure and highest risk during first 6months - majority who have second will continue to have seizures if not treated
34
Epilepsy and psychiatric illness
Same risk of psychiatric disease as other illnesses but increased risk of psychosis
35
Tonic-clonic drug treatment
1st line - Sodium valproate then 2nd - Lamotrigine and Carbamazepine Others - Oxcarbamazepine - Levetiracetam (Keppra)
36
Focal first line drugs
- Carbamazepine or Lamotrigine Then - Levetiracetam - Sodium valproate - Oxcarbamazepine
37
Myoclonic drugs
1st - valproate 2nd - clonazepam, lamotrigine but not carbamazepine, gabapentin, phenytoin or oxcarbamazepine as these can make it worse (same as absence)
38
Absence treatment
1st line - Sodium valproate and ethosuximide 2nd - lamotrigine not carbamazepine, gabapentin, oxycarbazepine, phenytoin etc
39
Juvenile myoclonic treatment
Sodium valproate
40
Two other treatment options - not drugs
Surgery | neurostimulation (vagal nerve or trigeminal - works in 10%)
41
Status epilepticus definition
Medical emergency Continued seizure for 30mins or more - or two without recovery of consciousness Can be convulsive, absence or focal
42
Prognosis and incidence of status epilepticus
Mortality 10-15% | 50% occur with no previous history of seizures
43
Treatment of status epilepticus
Early: O2 and monitoring, lorazepam IV, midazolam buccal or diazepam rectal Established (30-90mins): Phenytoin IV or fosphenytoin If ongoing: Phenobarbitol or valproate Last line: Paralyse and ventilate
44
SUDEP
Sudden unexplained death in epilepsy Night time seizure could cause heart arrhythmia which will result in patient not waking up More common in uncontrolled epilepsy & alcohol drinking
45
Valproate side effects
``` Valproate Appetite increase and weight gain Liver failure Pancreatitis Reversible hair loss (curly when grows back) Oedema Ataxia Teratogenicity, thrombocytopenia, tremor Encephalopathy (ammonia increase) ```
46
Lamotrigine side effects
Maculopapular rash - in 10% 1 in 1000 develop stevens-johnson syndrome /toxic epidermal necrolysis Also diplopia, blurred vision, tremor, agitation vomiting, aplastic anaemia
47
Phenytoin side effects
No longer first line for epilepsy because of toxicity | Nystagmus, diplopia, tremor, dysarthria, ataxia
48
Keppra/levetiracetam side effects
Psychiatric common - depression and agitation
49
Carbamazapine side effects
Leucopenia, diplopia, blurred vision, imbalance, drowsiness, rash
50
Tonic and atonic seizure treatment
Valproate first line 2nd lamotrigine not carbmazepine etc
51
Management of essential tremor
Propanolol first line | Primidone

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