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Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

(59 cards)

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1
Q

Light headedness before a collapse is suggestive of what cause

A

Cardiac cause

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2
Q

Vertigo before a collapse is suggestive of what cause

A

ENT

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3
Q

Unsteadiness before a collapse is suggestive of what cause

A

Neurological issue

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4
Q

What features need to be covered in the history of a collapse

A 
Any symptoms before hand 
Environmental factors 
What did they look like - pallor, breathing 
Type of movement 
Responsiveness throughout 
Speed of recovery
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5
Q

People will usually lose awareness in a tonic clonic seizure - true or false

A

True

Therefore need a collateral history

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6
Q

After syncope recovery is usually fast - true or false

A

True

Will come round quickly and wont be too disorientated

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7
Q

Describe recovery after a seizure

A

Takes a while to fully recovery

Will be drowsy or disorientated for a significant time after

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8
Q

What are the risk factors for epilepsy

A 
Difficult birth 
Time in the ICU as a baby 
Past seizures including febrile 
Head injury 
Family history 
Drug and alcohol use
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9
Q

Febrile seizures increase your risk of epilepsy - true or false

A

True

2 or more febrile seizures leads to an increased risk

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10
Q

What are the rules for driving with epilepsy

A

Can’t drive for 6 months after 1 seizure and 1 year if you’ve had 2
If you’ve only had nocturnal seizures for 3 years you can return to driving
HGV drivers are more restricted even if well controlled - cant drive for 5 years after 1st one

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11
Q

Which common drugs can precipitate epileptic seizures

A 
Antibiotics – penicillin, cephalosporins, quinolones 
Painkillers – tramadol 
Anti-emetics 
Opioids – diamorphine  
Aminophylline/theophylline
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12
Q

What investigation must always be carried out when someone collapses

A

ECG

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13
Q

Who need an acute CT scan

A

If there are clinical or radiological signs of a skull fracture
Deteriorating GCS
Focal signs
Head injury with a seizure
Failure to be at GCS 15/15 after 4hrs in hospital

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14
Q

How is EEG used

A

Classify epilepsy
Confirms non-epileptic attacks and non-convulsive states
Can be used for surgical evaluation

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15
Q

Is an EEG diagnostic for epilepsy

A

Not really
Can have positive result but not be epileptic
Some epileptics will have a normal EEG

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16
Q

Which other common conditions can present like epilepsy/seizures

A 
Syncope 
Non-epileptic disorders - pseudo seizures 
Panic attacks 
Sleep phenomena 
TIAs 
Migraines 
Hypoglycaemia 
Paroxysmal movement disorders 
etc etc
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17
Q

What is the risk of having a further seizure in the year after your 1st

A

Around 1 in 5 chance

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18
Q

Does a seizure always mean its epilepsy

A

NO

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19
Q

What is epilepsy

A

A tendency to recurrent, usually spontaneous, epileptic seizures

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20
Q

What is an epileptic seizure

A

Abnormal discharge of electrical activity in the brain
It interrupts normal brain activity
Usually excitatory

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21
Q

What causes an epileptic seizure

A

Too much excitation or too little inhibition of electrical activity
Changes in synaptic function or the channels
Genetics - in kids
Electrolyte abnormalities - metabolic
Toxins
Some environmental factors
Acquired brain injuries

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22
Q

Which age groups tend to get epilepsy

A

Seen in infants

Also peaks in the elderly

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23
Q

What is SUDEP

A

Sudden unexplained death in epilepsy

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24
Q

What is the normal underlying reason for death in older epileptics (over 60s)

Study These Flashcards
A

Usually due to the underlying cause of the epilepsy – e.g. brain tumour or injury

25
Suicide is a big killer in those with epilepsy - true or false
TRUE Slightly higher than population average Seen in the younger patients
26
Focal seizures can lead onto a generalised one - true or false
TRUE | Some seizures will start in a certain area but can trigger a specific pathway that triggers a secondary generalised one
27
How are seizures classified by location
Generalised - affects whole brain | Focal/partial - specific site of origin
28
How can you determine the location of origin of a seizure
EEG | Will tell you if its generalised or focal
29
What are the further classifications of partial epilepsy
Simple: without impaired consciousness Complex: with impaired consciousness
30
What are the further classifications of generalised epilepsy
``` Absence Myoclonic Atonic Tonic Tonic clonic ``` These are all generalised seizure types
31
What are the motor signs of epileptic seizures
``` Rhythmic jerking Other involuntary movement - cycling Posturing Head and eye deviation Vocalisations ```
32
What are the sensory/psychological signs of a seizure
``` Altered memory Depersonalisation Aphasia Complex visual hallucinations Somatosensory disturbance Olfactory and gustatory changes ```
33
Who gets generalised epilepsy
Those with a genetic predisposition | Presents in childhood and adolescence
34
How do you treat generalised epilepsy
Sodium valproate is the first choice | Lamotrigine as an alternative
35
What are the potential triggers/risk factors for a seizure in generalised epilepsy
Sleep deprivation | Flashing lights
36
What are the side effects of sodium valproate
Extremely teratogenic Makes you gain weight Hair loss Fatigue
37
What are the drawbacks of using lamotrigine
It takes about 2/3 months of treatment before it reaches the target dose
38
How do you treat focal/partial seizures
Carbamazepine or lamotrigine first line | Sodium valproate works but isn't as used due to side effects
39
What are the adverse effects of carbamazepine
It reduces the efficacy of all types of contraception Including the morning after pill Can make generalised epilepsy worse
40
What causes focal onset epilepsy
Usually an underlying structural cause - e.g. following a stroke or injury Therefore can affect any age
41
Which drugs reduce pre-synaptic excitability
Carbamazepine Lamotrigine These reduce the ability of AP's to spread
42
What is the mechanism of action of sodium valproate
It enhances GABA synthesis | As this is an inhibitory NTT it reduces excitation
43
How do you treat absence seizures
sodium valproate | ethosuximide
44
How do you treat myoclonic seizures
sodium valproate levetiracetam clonazepam
45
How do you treat atonic, clonic and tonic clonic seizures
sodium valproate levetiracetam topiramate lamotrigine
46
How is phenytoin used in the treatment of epilepsy
For acute management only | 6 weeks to 3 months as it causes significant cosmetic changes if taken long term
47
How is levetiracetam used in the treatment of epilepsy
Very popular - used in certain types of generalised seizures Few interactions Well tolerated Can cause mood swings
48
How is topiramate used in the treatment of epilepsy
Used for tonic clonic, clonic and atonic Quite effective Not well tolerated - sedation, dysphasia and weight loss
49
When is someone given anti-epileptics
If they have a confirmed diagnosis of epilepsy | If they have had one seizure but a high chance of recurrence - brain tumour
50
Why do some anti-epileptics affect contraception
They induce hepatic enzymes so the efficacy of contraceptive drugs is reduced Will need higher dose
51
What must you consider in an epileptic female who wants to get pregnant
Many of the drugs are teratogenic - need to alter Uncontrolled seizures are also very risky for pregnancy – damage to placenta or foetus themselves - so must balance this with drugs side effecst Must put them on high dose folic acid for at least 3 months prior to conception
52
What is status epilepticus
Continuous seizure activity lasting more than 30mins Recurrent seizures without full recovery of consciousness Can occur with generalised or focal seizures
53
At what point would you start treating status epilepticus
Treat after 10 mins of seizure activity as they wont stop by themselves after that point Early treatment is key - ABCDE
54
What can precipitate status epilepticus
``` Severe metabolic disorders Infection - CNS particularly Head trauma SAH Abrupt withdrawal of anti-epileptics Treating an absence seizure with carbamazepine ```
55
What is a convulsive status
Ongoing tonic-clonic activity without stopping - generalised convulsions This puts a huge metabolic demand on the body
56
What are the outcomes of convulsive status epilepticus
Huge metabolic and fluid shifts - massive energy demand Use up all glycogen, hyperthermia, can lead to rhabdomyolysis etc within 30-60mins Can go onto organ failure after 60mins Cerebral oedema and brain exhaustion can occur after hours
57
How do you manage status epilepticus
Stabilise patient - ABC Must find the underlying cause – bloods and CT Check blood glucose to exclude hypo MUST start treatment early – after 10 mins Give benzodiazepines to stop - can give a second dose after 5mins DO NOT give more than 2 doses Give phenytoin or normal AED treatment at full dose Send to intensive care if they don’t recover after 30mins
58
If someone has just starting seizing what do you do
Monitor the person carefully | It should stop on its own, but treat as status if it goes on longer than 10 mins
59
At what age does generalised epilepsy typically present
Commonly presents in | childhood & adolescence

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