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Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

Define epilepsy:

A

A spontaneous synchronus discharge of cerebral neurons which causes symptoms and signs that are apparent to either the patient or an observer.

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2
Q

What is another word for motor symptoms?

A

Convulsions

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3
Q

What is a simple focal seizure

A

When a patient suffers from focal motor or sensory symptoms, but does not lose awareness.

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4
Q

What is a complex focal seizure?

A

Patient suffers a loss of awareness while experiencing focal sensory or motor symptoms

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5
Q

What is important about a focal seizure?

A

They do not lose consciousness!

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6
Q

Where in the brain does a focal seizure occur?

A

Only acts on one hemisphere

Very common in temporal lobe

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7
Q

What is a generalised seizure?

A

This is when both hemispheres are simultaneously involved.

Patient will experience a loss of consciousness

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8
Q

What is an absent seizure?

A

This is a form of a generalised seizure
They are brief absences lasting <10seconds
Presents in childhood

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9
Q

Define tonic-clonic seizure:

A

Patient suffers loss of consciousness
Limbs stiffen (tonic) then begin to jerk (clonic)
Have post ictal confusion and drowsiness

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10
Q

Define myoclonic seizure

A

This is the sudden jerk of a limb, face or trunk

Patient may be violently thrown by it

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11
Q

What is an atonic seizure?

A

This is when the patient experiences a sudden loss in muscle tone causing them to fall over but there is no loss of consciousness.

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12
Q

What features are suggestive of parietal lobe involvement?

A

Sensory disturbances e.g. tingling, numbness and pain (rare)

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13
Q

What features would suggest involvement of the occipital lobe?

A

Any visual phenomena

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14
Q

What features would occur in frontal lobe involvement?

A 
Motor features such as posturing
Versive movements of the head
Dysphasia
Speech arrest
Peddling of the legs
Subtle behavioral disturbances
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15
Q

What symptoms would be indicative of a temporal lobe involvement?

A

Automatism’s* with impaired consciousness and no memory of the event after.

*complex motor phenomena e.g. lip smacking, chewing, fumbling, singing, dysphasia, violence etc

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16
Q

What would suggest hippocampal involvement?

A

Emotional disturbance

17
Q

What is important to know when asking about the seizure?

A

What it provoked by something

Usually provoked seizures tend not to reoccur and are not epilepsy

18
Q

List some causes of epilepsy?

A 
Idiopathic - (but familial)
Developmental problems
Vascular
Scarring
Trauma
Metabolic upset
Infections
Drugs
19
Q

What is the most common cause of epilepsy in 60< years old?

A

Vascular problems

20
Q

When does Juvenile Myoclonic epilepsy tend to present?

A

In teenage years

21
Q

What are some triggers for juvenile myoclonic epilepsy?

A

Strobe lights
Sleep deprivation
Alcohol

22
Q

What symptoms are displayed in JME?

A

Generalized tonic-clonic seizures
Myoclonic jerks
Absences (in 1/3rd)

23
Q

How is epilepsy diagnosed?

A

Mainly through the history
Bloods done to rule out metabolic causes
ECG must be done in people with LOC
MRI usually done unless clinical picture is definitive. (children less likely to need MRI)

24
Q

What drugs are first line treatment for both focal and generalised seizures?

A

Sodium Valproate
Lamotrigine
Carbamazapine

25
Q

What drugs are used second line for a focal seizure?

A

Clozabam
Gabapentin
Pregabalin

26
Q

What drugs are used second line for a generalized seizure?

A

Phenobarbital
Clozabam
Phenytoin

27
Q

What is status epilepticus?

A

This is when a generalized tonic clonic seizure has lasted more than 30 mins

28
Q

What is the mortality of a status epilepticus?

A

10-15%

29
Q

What are some of the severe outcomes of status epilepticus?

A

Permanent cerebral damage
Rhabdomyolysis –> AKI
Death

30
Q

What is the appropriate management for the first 30 mins of a seizure?

A

O2 and regular monitoring

IV bolus of lorazepam

31
Q

What drug options are there for a prolonged seizure?

A

Buccal Midazolam
IV lorazepam
Rectal diazepam

32
Q

How long must a seizure last to be prolonged?

A

> 5 mins

more than 30 mins is a status

33
Q

What is the appropriate management for a seizure lasting 30-90 mins?

A

IV phenytoin infusion

IF seizures are ongoing
Phenobarbital
Sodium valproate

34
Q

When can a patient start withdrawal from their anti-epileptics?

A

When a patient has had no seizures for at least 2-3 years

35
Q

What % of patients who withdraw from the AED’s end up seizing / requiring them again?

A

50%

36
Q

What things must a patient be warned/informed about when they’re diagnosed with epilepsy?

A

No driving until 1 year seizure free
Must tell the DVLA
No swimming

37
Q

What is significant about anti-epileptic drugs in women, other than their teratogenicity?

A

They induce liver enzymes
Will alter the efficacy of the COCP
Cannot have progesterone only pill or progesterone implant

38
Q

Women of child bearing age on teratogenic AEDs should also be on what supplements?

A

(Contraception)
Folic Acid
Vitamin K

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