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MD2 Medicine > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is a seizure?

A

Sudden, abnormal, excessive, rapid, and repetitive discharges from cerebral neurons
Self-terminating but tends to recur
Clinically, intermittent stereotyped disturbance of
- Consciousness
- Behaviour
- Emotion
- Motor function/sensation

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2
Q

What is epilepsy?

A

Seizures recur, usually spontaneously

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3
Q

What is status epilepticus?

A

Seizure for >30 min

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4
Q

What is the difference between simple and complex partial seizures?

A

Simple - consciousness not impaired
Complex - consciousness impaired
- May start as simple partial seizure

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5
Q

What are the symptoms of partial seizures?

A

Motor
Somatosensory/special sensory
Autonomic
Psychological

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6
Q

Can partial seizures become generalised?

A

Yes, usually over years

= secondary generalisation

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7
Q

What are absence seizures often mistaken for, especially if they occur for only a few seconds?

A

Inattentiveness/distractedness

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8
Q

What are the common causes of seizures?

A 
50% idiopathic
Stroke
Alcohol abuse
Head injury
Neurodegenerative
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9
Q

What prenatal, or perinatal, factors predispose you to epilepsy?

A

Intrauterine drug use
Perinatal trauma
Anoxia
Trauma and surgery

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10
Q

What are the metabolic causes of seizures?

A

Electrolyte disturbances > cause neuronal irritability

  • Renal failure > uraemia
  • Hepatic failure
  • Acute hypoxia
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11
Q

What are the toxic causes of seizures?

A

Withdrawal of anti-epileptic drugs
Chronic alcohol abuse
CO/Pb/Hg poisoning

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12
Q

What are the triggers of seizures?

A 
Sedative/ethanol withdrawal
Sleep deprivation
Anti-epileptic reduction/inadequacy
Hormonal variations
Stress
Fever/systemic infection
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13
Q

What is the clinical assessment of presentation of first seizure?

A 
Seizure/not?
Focal onset?
Evidence of interictal CNS dysfunction?
Metabolic precipitant?
Seizure and syndrome type?
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14
Q

What are the differential diagnoses of seizures?

A 
Syncope
Migraine
Sepsis
Hypoglycaemia
Hypocalcaemia
Hypomagnesaemia
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15
Q

What are the investigations of presentation of first seizure?

A 
FBE
- Anaemia
- WCC
UEC
LFT
ABG
Glucose
CMP
ECG
Brain imaging
Lumbar puncture
Blood/urine drug screen
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16
Q

What brain imaging is used to assess presentation of first seizure?

A

Mostly MRI, rather than CT

Rule out space-occupying lesion

17
Q

What does an EEG show in epilepsy?

A 
Background abnormalities
- Significant asymmetries
- Slowing inappropriate for clinical state/age
Interictal abnormalities
- Spikes
- Sharp waves
- Spike-wave complexes
Ictal EEG most useful
- Distinguish between seizure and pseudoseizure
18
Q

What investigations can be used to distinguish between a seizure and a pseudoseizure?

A

Ictal EEG

Serum prolactin

19
Q

What are the considerations when determining whether to treat or not treat after the first seizure?

A 
Vast range of recurrence within 5 years
Relapse rate may be reduced with treatment
Abnormal findings > increased risk of recurrence
- Imaging
- Neurological exam
- EEG
- FHx
Quality of life important factor
20
Q

What are the mechanisms of action of the drugs used to treat epilepsy?

A

Blockers of repetitive activation of Na channel
Enhancers of slow inactivation of Na channel
GABA-A receptor enhancers
NMDA receptor blockers
AMPA receptor blockers

21
Q

What medications are commonly used in the treatment of partial onset seizures?

A

Levetiracetam
Lamotigrine
Carbamezapine
- Less efficacious in generalised seizures
Valproate
- Better efficacy in generalised seizures than carbamezapine

22
Q

What is the only specific treatment for absence seizures?

A

Ethosuximide

23
Q

What medications are commonly used in the treatment of myoclonic seizures?

A

Benzodiaepines

Levetiracetam

24
Q

What medications are commonly used in the treatment of tonic-clonic seizures?

A

Valproate
Lamotrigine
Levetiracetam

25
Q

What are the advantages of monotherapy in the treatment of epilepsy?

A

Simplifies treatment

Reduces adverse effects

26
Q

How are therapeutic and toxic ranges for medications in epilepsy defined?

A

Individual patients define their own ranges

27
Q

What should be discussed with the patient when initiating and monitoring medications in epilepsy?

A 
Likely and unlikely, but important adverse effects
Likelihood of success
Recording/reporting
- Seizures
- Side effects
28
Q

What does the evaluation after seizure recurrence involve?

A

Progressive pathology?
Avoidable precipitant?
If on medications
- Problem with compliance/pharmacokinetic factors?
If not on medication, consider starting drug treatment

29
Q

What is the management of status epilepticus?

A

IV anti-epileptic drugs; eg: phenytoin
If phenytoin not available, benzodiazepines can be given per rectal
Eventually, general anaesthesia with propafol/thiopentone should be commenced

MD2 Medicine (18 decks)

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