Epilepsy Flashcards
1
Q
Definition of an epileptic seizure
A
An intermittent stereotyped disturbance of consciousness, behaviour, emotion and motor function or sensation which, on clinical grounds, is believed to result from abnormal neuronal discharges
2
Q
Definition epilepsy
A
A condition in which seizures recur, usually spontaneously
3
Q
What age does epilepsy occur?
A
J shaped curve
- high in infancy and - childhood
- then falls in adulthood
- increases when older (mostly due to CVS problems)
4
Q
What % of people with learning disorders have epilepsy?
A
22%
5
Q
What classifies epilepsy?
A
International league against epilepsy (ILAE)
6
Q
What classifies epilepsy into groups?
A
Clinical data
EEG
7
Q
What does EEG stand for?
A
Electroencephalogram
8
Q
Two broad types of epileptic seizures
A
Generalized
Focal
9
Q
Types of generalised seizures
A
Tonic-clonic Myoclonic Clonic Tonic Atonic Absence
10
Q
Features of tonic clonic seizures
A
Usually start tonic (stiff - may stop breathing for a while)
Then go into jerking clonic (and start breathing again)
11
Q
Features of myotonic seizures
A
Very clumsy and jerky especially in the mornings
12
Q
Features of clonic seizures
A
Jerking movements
13
Q
Features of tonic seizures
A
Stiffening movement
14
Q
Features of atonic seizures
A
Collapse to the floor very rapidly
15
Q
Features of absence seziures
A
Lasts seconds, may not see even see if not looking for it
16
Q
What age do children usually grow out of absence seizures?
A
12
17
Q
What is very common with atonic seizures?
A
Facial / head injuries
18
Q
What are focal seizures characterised by?
A
Aura
Motor features
Autonomic features
Degree of awareness or responsiveness
19
Q
What may focal seizures evolve into?
A
Generalized convulsive seizures
20
Q
Definition of status epilepticus
A
Prolonged or recurrent tonic-clonic seizures persisting for more than 30 minutes with no recovery period between seizures
21
Q
What will status epilepticus cause unless intervention?
A
Brain damage
22
Q
Who does status epilepticus usually occur in?
A
No previous history or epilepsy (r.g. caused by stroke, tumour, alcohol)
23
Q
Mortality of status epilepticus
A
5 - 10%
24
Q
Do most people who have a first seizure go onto develop epilepsy?
A
NO
25
Where does epilepsy develop in the brain?
Grey matter
26
What does SUDEP stand for?
Sudden unexplained death in epilepsy
27
What does TCSE stand for?
Tonic clonic status epilepticus
28
Who has the greatest mortality in TCSE?
Very young
| Very old
29
How many people with epilepsy have SUDEP?
1 in 1000 every year
30
Differential diagnosis of blackouts
```
Syncope
First seizure
Hypoxic seizure
Concussive seizure
Cardiac arrythmia
Non-epileptic attack (narcolepsy, movement disorder, migraine)
```
31
What questions should be asked in the history about a seizure from the patient?
What were they doing at the time?
What if any warning feelings did they get?
What were they doing the night before?
Have they had anything similar in the past?
How did they feel afterwards?
Any injury, tongue biting or incontinence?
32
What questions should be asked in the history about a seizure from a witness?
Detailed description of observations before and during attacks - including level of responsiveness, motor phenomena, pulse, colour, breathing, vocalisation
Detailed description of behavior following the attack
33
What additional information to ask about which may potentially be relevant?
```
Age
Sex
PMH
- head injury
- birth trauma
- febrile convulsions
Past psychiatric history
Alcohol and drug use
FH
```
34
What is the most common cause of fainting?
Vasovagal syncope
35
Prodrome for vasovagal syncope
```
Light headedness
Nausea
Tinnitus
Hot, sweating
Tunnel vision
```
36
Triggers for vasovagal syncope
```
Prolonged standing
Standing up quickly
Trauma
Venepuncture
Watching/experiencing medical procedures
Micturition
Coughing
```
37
Definition of micturition
Act of passing urine
38
Presentation of syncope
Upright posture
Pallor common
Prodromal symptoms
39
Onset of syncope
Gradual onset
40
Results of syncope
Injury rare
| Incontinence rare
41
Are precipitants common in syncope?
Yes
42
How quick is recovery in syncope?
Rapid
43
Presentation of seizure
Any posture
Pallor uncommon
Movements
44
Onset of seziure
Sudden onset
45
Results of a seizure
Injury common
| Incontinence common
46
Recovery time of a seizure
Slow
47
Are precipitants common for a seizure?
No
48
When do hypoxic seizures occur?
When individuals are kept upright in a faint - then the faint turns into a seizure
49
Where are common places for hypoxic seizures to occur?
Aircrafts on the upright chairs
| Someone catching someone who is fainting and help them to their feet
50
When do concussive seizures occur?
After any blow to the head
51
Why are you unlikely to have a seizure during exercise?
Because the brain is very busy
52
Can seizures cause cardiac arrythmias?
Yes
53
Which gender are non epileptic attacks more common in?
Women
54
Most epileptic attacks are over in how long?
5 minutes
55
If a seizure if over 5 minutes long, what is it not likely to be?
An epileptic attack
56
Clues in the history pointing towards a non epileptic attack
History of other medically unexplained symptoms
| History of abuse
57
Presentation of a non epileptic attack
Well in between attacks
May look bizarre
May superficially resemble a generalised tonic clonic seizure
Movement of arm and legs and movement of head from side to side
May resemble a "swoon" (flat on the ground looking pale)
May involve bizarre movements
58
What is the most common ages for getting primary generaised seziures?
< 25 y/o
59
What is common to get before a focal/partial seizure?
Aura
60
What age is common for getting focal seizures?
Any age
61
What can simple partial and complex partial seizures become?
Secondary generalised
62
Types of focal seizures
Simple partial
| Complex partial
63
What is a simple partial seizure?
You are still aware but e.g. arm may be jerking
64
What is a complex partial seizure?
When there is any loss of consciousness at all
65
What may show a cause when there is a focal/partial seizure?
MRI
66
Investigations of possible first seizures
Blood glucose
ECG
Alcohol / drugs
CT head
67
Features suggestive of primary generalised epilepsy
History of myoclonic jerks, especially first thing in the morning
Absences of feeling strange with flickering lights
68
Features suggestive of focal onset epilepsy
History de ja vu rising in sensation from abdomen
| Episodes where look blank with lip smacking, fiddling with clothes
69
Stimulants for EEG for primary onset epilepsy
Hyperventilation
Photic stimulation
Sleep deprivation
70
What % of primary generalised seizures are picked up on EEG?
70%
71
What do patients need to get advise on when have a seizure?
Employment
Potentially dangerous leisure activities
Driving regulations
72
First line treatment of juvenile myoclonic epilepsy
Sodium valproate
73
Who is sodium valproate avoided in and why?
Young women
| Teratogenic
74
First line treatment for primary generalised epilepsy
Levetiracetam
75
First line treatment for partial and secondary generalised seizures
Lamotrigine
| Carbamazepine
76
First line treatment for absence seziures
Ethosuximide
77
First line treatment for status epilepticus
```
Lorazepam
Midazolam (diazepam)
Valproate
phenytoin
Levetiracetam IV
```
78
Second line treatment for generalised epilepsy
Topiramate
| Zonisamide
79
Second line treatment for partial seziures
```
Sodium valproate
Topiramate
Leviteraetam
Gabapentin
Pregabilin
Zonisamide
Lacosamide
perampanel
Benzodiazepines
```
80
Side effects of sodium valproate
```
Tremor (in high doses)
Weight gain
Ataxia
Nausea
Drowsiness
Transient hair loss
Pancreatitis
Hepatitis
```
81
Side effects of carbamazepine
```
Ataxia
Drowsiness
Nystagmus
Blurred vision
Low serum sodium levels
Skin rashes
```
82
Side effects of lamotrigine
Skin rash
| Sleep difficulties
83
Side effects of levetiracetam
Irritability
| Depression
84
Side effects of topiramate
Weight loss
Word finding difficulties
Tingling in hands and feet
85
Side effects of zonisamide
Bowel upset
| Cognitive problems
86
Side effects of lacosamide
Dizziness
87
Side effects of pregabilin
Weight gain
88
Side effects of vigabatrin
Behavioural problems
| Visual field defects
89
Treatment of TCSE
```
1st line
- midazolam
- lorazepam
- diazepam
2nd line
- phenyotin
- valproate
3rd line
- anaesthesia usually with propofol or thopentone
```
90
What are the driving regulations with epilepsy?
After a first seizure
- can drive after 6 months if investigations are normal and have no further events
- if scan or EEG abnormal or seizure likely alcohol related, cannot drive for one year
- can drive HGV or PSV after 5 years if investigations are normal, have no further events and are not on anti-epileptic medication
91
What is the most common first line medication for terminating acute seizures?
Benzodiazepines
92
1st line treatment for focal seizures
Carbamazepine
| Lamotrigine
93
1st line treatment for a male with generalised tonic clonic seizures
Sodium valproate
94
1st line treatment for a male with myoclonic seizures
Sodium valproate
95
What is the protocol for stopping anti epileptic drugs?
Can be considered if seizure free > 2 years, with AEDs being stopped over 2 - 3 months
96
If a one of seizure (no diagnosis of epilepsy), how long can they not drive for?
6 months
97
If diagnosis of epilepsy, how long do they have to be seizure free before driving?
12 months
98
What is carbamazepine generally INEFFECTIVE in treating?
Absence seizures
99
What are localising features of a temporal lobe seizure?
Lip smacking
| Post ictal dysphagia
100
What do jacksonian movements in children indicate?
Frontal lobe epilepsy
101
Indications of temporal lobe seizure
Aura
Lip smacking
Clothes plucking
102
Indications of parietal seizures
Sensory abnormalities
103
First line treatment for patients with early status epilepticus
IV lorazepam
104
What is likely to represent a pseudoseizure / psychogenic non epileptic seizure?
Widespread convulsions without conscious impairment
105
Stepwise treatment of paediatric status elipticus
1. Buccal midazolam / IV lorazepam
2. IV lorazepam
3. IV phenytoin
4. Rapid sequence induction of anaesthesia using thiopental sodium
106
Anti epileptic medication should NOT be started after a first seizure before review except in certain cases, which are....
1. Seizure activity observed on EEG
2. Presence of a neurological deficit
3. Presence of a structural brain abnormality
4. Patient, carer or parent considers the risk of a further seizure to be unacceptable
107
What would buccal midazolam be used for and who would it be prescribed to?
For status elipticus
| Only prescribed to patients who have had a previous episode of prolonged or sequential generalised seizures
108
When a patient is in status elipticus, what two most important causes should be ruled out 1st as a cause?
Hypoxia
| Hypoglycaemia
109
What are psychogenic non epileptic seizures also known as?
Pseudoseizures
110
Factors favouring pseudoseizures
```
Pelvic thrusting
Family member with epilepsy
Much more common in females
Crying after seizure
Don't occur when alone
Gradual onset
```
111
What blood test can indicate that it was a true epileptic seizure and not a pseudoseizure?
Raised serum prolactin 10 - 20 mins after an episode
112
Describe jacksonian march with secondary generalisation
Characteristically starts by affecting a peripheral body part such as a big toe, finger or section of the lip and then spreads quickly ' marches ' over the respective foot, hand or face
The electrical disorder can then spread over larger areas of the brain causing the seizure to develop into a tonic clonic seizure
113
What type of seizure is a jacksonian march?
Focal aware seizure
114
What diet is used in treatment of epilepsy in children that is hard to control and is generally unresponsive to antiepileptic medications?
Ketogenic diet
115
What does the ketogenic diet consist of?
High fat
Low carb
Controlled protein
