Epilepsy Flashcards

Question

WHat are factors that increase seizure risk?

Answer 1

Missed medications (most common) Sleep disturbance, fatigue Hormonal changes Drug/alcohol use, drug interactions Stress/anxiety Photosensitivity in a small group of patient ^{Rare reflex epilepsies (visual patterns, music)}

Answer 2

Generalised seizures - affect both cerebral hemispheres (sides of the brain) from the beginning of the seizure Focal seizures - occur when there is a disruption of electrical impulses in one part of the brain

Answer 3

* Absence seizures * Generalised tonic-clonic seizures * Myoclonic seizures * Juvenile myoclonic epilepsy * Atonic seizures

Answer 4

* Simple partial seizures * Complex partial seizures * Secondary generalised * Or by localisation of onset (temporal lobe, frontal etc)

Answer 5

* No warning * \< 25 years * May have history of absences and myoclonic jerks as well as GTCS e.g in juvenile myoclonic epilepsy * Generalised abnormality on EEG * May have family history

Answer 6

* May get an “aura” * Any age – cause can be any focal brain abnormality * Simple partial and complex partial seizures can become secondarily generalised * Focal abnormality on EEG * MRI may show cause

Answer 7

a disturbance in the functioning of both sides of your brain. This disturbance is caused by electrical signals spreading through the brain inappropriately. Often this will result in signals being sent to your muscles, nerves, or glands

Answer 8

Unpredictable, tend to cluster PMH- complications at birth, Febrile convulsions, trauma, menigitis, brain injuries

Answer 9

May have vague warning Irritability before them

Answer 10

Lateral (severe) Tongue biting, incontinence First recollection in ambulance or hospital Muscle pain

Answer 11

Groaning sound Tonic (rigid phase) - then generalised jerking in all four limbs Eyes open - staring/roll upwards Foaming at the mouth Jerking for a few minutes and then groggy for 15-30mins May be agitated afterwards May have a cluster of episodes, stopping and starting

Answer 12

Often in children (unaware of them) Sudden arrest of activity for a few seconds ^{- Brief staring} ^{- May have eye-lid fluttering} May be provoked by hyperventillation/Photic stimulation (light through trees while in car) Re-start what they were doing

Answer 13

Adolescence/early adulthood Provoked by alcohol, sleep deprivation Can have absence and GTC seizures Will often have early morning myoclonus Drop things in the mornings Brief jerks in limbs

Answer 14

Rising feeling in stomach, Funny smell/taste De ja vu (familiar experience)

Answer 15

no recollection

Answer 16

disorientated for a spell

Answer 17

Sudden arrest in activity Staring blankly into space Automatisms - Lip smacking, Repetitive picking at clothes May be disorientated for a spell afterwards

Answer 18

Refer to first seizure clinic * Do an ECG, routine bloods (Glc) * A+E will often arrange a CT From Neurology clinic: ^{May arrange an MRI for focal lesion} ^{May arrange EEG (Usually in <40yrs)} ^{Discuss Anti-epileptic drugs} ^{Refer to Epilepsy nurse (post diagnostic information)} ^{Discuss driving (inform DVLA)}

Answer 19

Incidence: 50 - 120 per 100 000 per year “J-shaped” curve 3 - 5% of the population will experience at least one seizure in their lifetime Prevalence: 5 – 8 per 1000 (Aberdeen 0.9%) 22% of patients with LD have Epilepsy There are over 300 000 people in the UK with active epilepsy

Answer 20

EEG for primary generalised epilepsies including hyperventilation and photic stimulation: sometimes sleep deprivation MRI for patients under age 50 with possible focal onset seizures: CT usually adequate to exclude serious causes over this age Video-telemetry if uncertainty about diagnosis

Answer 21

* **Sodium Valproate, Lamotrigine, Levetiracetam** for primary generalised epilepsies * **Lamotrigine, Carbamazepine, Levetiracetam** for focal and secondary generalised seizures * **Ethosuximide** for absence seizures Acutely: * **Lorazepam, midazolam (diazepam) first line**: * **Valproate** or **phenytoin** second line for status epilepticus

Answer 22

Topiramate Zonisamide Clobazam (carbamazepine)

Answer 23

Sodium valproate Topiramate Gabapentin Pregabilin Zonisamide Lacosamide Perampanel Long acting Benzodiazepines (Clobazam) Vigabatrin

Answer 24

* Phenytoin – Arrythmia, hepatitis, medication interactions * Sodium Valproate - tremor, weight gain, ataxia, nausea, drowsiness, hepatitis - try and avoid in women of childbearing age * Carbamazepine - ataxia, drowsiness, nystagmus, blurred vision, low serum sodium levels, skin rash. * Lamotrigine –skin rash, difficulty sleeping * Levetiracetam – irritability, depression

Answer 25

After a single seizure, a patient may drive a car after 6 months if their investigations are normal and they have had no further events They may drive an HGV or PSV after 5 years if their investigations are normal, they have no further events and they are not on anti-epileptic medication Patients with epilepsy can drive a car once they have been seizure free for a year or have only had seizures arising from sleep for a year If they have ever had a day time seizure but then the pattern becomes noctural, this must be established for three years before they can drive They can only hold a HGV or PSV licence if they have been seizure free for 10 years and are not on anti-epileptic medication

Answer 26

Prolonged or recurrent tonic-clonic seizures persisting for more than 30 minutes with no recovery period between seizures 9 000 - 14 000 cases /year in the U.K. usually occurs in patients with no previous history of epilepsy (stroke, tumour, alcohol) Mortality : 5-10% Be wary of non-convulsive status epilepticus - Prolonged unresponsiveness following a seizure

Answer 27

First line: Midazolam: 10mg by buccal or intra-nasal route, repeated after 10mins if necessary Lorazepam: 0.07mg/kg, usually 4mg bolus repeated once after 10 mins Diazepam: 10 - 20mg iv or rectally, repeated after 15 mins if necessary Second line Phenytoin - slow infusion of 15 – 18mg/kg at 50mg/min Valproate – 20 -30mg/kg iv at 40mg/min ? Leviteracetam 30mg/KG Third line Anaesthesia usually with propofol or thiopentone

Answer 28

Mortality greatest in very young and very old (29% of those \< 1 year) 90% of deaths are a result of a underlying cause Mortality is highest secondary to strokes, encephalitis, mass lesions and trauma - 90% of deaths are a result of the underlying cause Avoid secondary damage - neurological problems reported in 24% of children following episode of status

Answer 29

Events may occur at times of stress or while at rest Will often give lots of detail of others reaction and little of events themselves

Answer 30

May recall what people said during episode May be prolonged episode, waxing and waining May describe dissociation

Answer 31

others reactions

Answer 32

May recognise stress as a trigger (even if patient doesn’t) May report signs of patient retaining awareness Tracking eye movements, still some verbalisation during episodes Movements not typical of seizures - Pelvic thrusting, Asynchronous movements, tremor, Episodes waxing and waining Ideally we try and capture a typical episode on EEG - Important to make diagnosis to avoid iatrogenic harm

Answer 33

Tongue biting, particularly if it is lateral, is highly specific to **_generalized tonic-clonic_** seizures

Epilepsy Flashcards

(57 cards)