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Cognition, movement and senses > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

Causes of reflex syncope:

A

Vasovagal
Carotid sinus syndrome
Situational (cough, micturition)
Ictal (post-seizure/stroke)

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2
Q

Causes of orthostatic syncope:

A

Drug-induced

Autonomic failure

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3
Q

Cardiac cause of syncope?

A

Arrhythmias

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4
Q

Which lesions can cause tumours?

A

Hippocampal sclerosis
Glionruronal tumours
Focal cortical dysplasia
Arterio-venous malformation

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5
Q

Seizures attributable to genetics:

A

Childhood absence
Juvenile myoclonic
Juvenile absence

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6
Q

Adult seizures:

A

Post-traumatic epilepsy
Symptomatic partial epilepsies
Malignant gliomas (5% of adult presentation)
Substance abuse
Elderly: stroke, malignant gliomas and degeneration

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7
Q

How is epilepsy defined clinically?

A

Two or more unprovoked seizures in under 24 hours/1 event + abnormal CTH

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8
Q

Examples of acute symptomatic seizures:

A

Febrile convulsions
Alcohol withdrawal
Metabolic
Eclampsia

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9
Q

What is a focal seizure?

A

Affects only one part of the brain e.g. one hemisphere

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10
Q

Types of focal seizures:

A

Partial with retained awareness
Partial with loss of awareness - TLE, FLE
Partial progressing to full tonic clonic (whole cortex)

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11
Q

Generalised seizures:

A

Tonic clonic
Tonic
Absence

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12
Q

80% of seizures arise or involve which region due to the hippocampus?

A

Parietal lobe

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13
Q

Temporal involvement causes what?

A 
Memory disturbances (deja vu)
Emotional disturbances (fear/elation)
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14
Q

Effect of seizure in Broca’s area?

A

Asphasia

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15
Q

Insula is buried under frontal and temporal lobes. Its involvement in a seizure causes what?

A

Autonomic involvement

Epigastric sensations, salivation, change in HR, palpitations

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16
Q

Seizure in lateral temporal lobe causes what?

A

Hallucinations
Dream recollection
Illusions

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17
Q

What do occipital seizures (rare) cause?

A

Visual symptoms

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18
Q

What do parietal seizures (very rare) cause?

A

Vertigo and pain

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19
Q

Aura in temporal lobe epilepsy:

A

Epigastric sensation
Autonomic involvement (palpitations, salivation)
Deja vu
Pungent smell - burning/pencilin
Hallucinations if lateral temporal/parietal lobe

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20
Q

Features of Jacksonian epilepsy:

A

Spread of motor seizure up/down one side of the body

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21
Q

Somatosensory aura:

A

+ve symptoms
Jacksonian jerks
Pins and needles
Rarely pain

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22
Q

Visual hallucinations in epilepsy vs migraine:

A

Coloured mobile blobs in epilepsy

Sparkly white and black lines in migraine

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23
Q

Temporal seizure character:

A

Motionless stare then automatisms
Unresponsive and unconscious
Red in face

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24
Q

Features of tonic clonic seizure:

A 
Go rigid and falls, cry as air squeezed out of lungs
Lateral tounge bites (differential)
Cyanosis
Clonic jerks
Salivation/frothing
Post-ictal confusion/unconscious
1-2 minutes
Occur after loss of sleep/alcohol
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25
Features of dissociative seizures:
Stress/anxiety driven Aware with bilateral directed movements, distractible Back arches, thrashes, hits out, grabs Need psychological intervention
26
History markers:
``` Lateral tounge bite Occur out of sleep Aura: epigastric rising, flashing lights Automatisms Rigid and violent jerks (not thrashing) Cyanosed/obstructed respiration Post-ictal unrousable/confused ```
27
Routine EEG procedure:
20-30 minutes | Photic stimulation and over breathing
28
Sleep EEG procedure:
60 minutes | Drug-induced sleep
29
Telemetry procedure:
Continuous | EEG with video/polysomnography
30
EEG of focal anterior temporal lobe seizures:
Spikes
31
EEG of generalised epilepsy:
Spike and wave at regular intervals
32
Diagnosis of epilepsy is...
Clinical | EEG is used for aetiology
33
When is epilepsy considered resolved?
Past age of age-dependent epilepsy | Seizure free for the last 10 years, off medication for last 5 years
34
Management of a provoked seizure?
Correct provoking factor | Benzos for alcohol withdrawal and delirium tremens
35
When are anti-epileptic drugs not indicated?
Prophylactically post-acute brain insult/neurosurgery Concussive convulsions Provoked 1st seizure with low risk of recurrence
36
1st seizure management:
Refer to first-fit clinic: EEG and MRI
37
Treatment for generalised seizures:
First line: VPA (mainstay as better tolerated than TPM and more efficacious than LTG) Second line: LTG, CBZ, TPM
38
Contraindication of sodium valproate?
Teratogenic so avoid in young women
39
Treatment for focal seizures:
``` LTG (mainstay) CBZ GBP TPM OXC ```
40
VPA =
Valproate
41
LTG =
Lamotrigine (reduces efficacy of progesterone component of COC pill)
42
TPM =
Topiramate
43
CBZ =
Carbamazepine
44
GBP =
Gabapentin
45
OXC =
Oxcarbamazepine
46
Combination of VPA and LTG?
Synergistic function
47
What reduces the absorption of phenytoin?
Nasogastric tube
48
Interaction between VPA and PHT?
Compete as both bind to albumin
49
Which AEDs are enzyme inducing?
CBZ PHB PHT (reduce efficacy of combined oral contraceptive pill but not progesterone only injectables)
50
Absence seizure medication:
VPA or ethosuximide
51
Myoclonic seizure medication:
VPA | Clanazepam, LTG
52
Risks of CBZ?
Will exacerbate absence and myoclonic seizures
53
Interactions of VPA?
Causes enzyme inhibition and will interfere with mainstay drugs e.g. warfarin Does not affect oral contraception
54
Allergic hypersensitivity reactions more common with...
Aromatic AEDs: CBZ, PHB, PHT also VPA Chinese with HLA B1502 react to CBZ
55
Severe skin reaction to AEDs:
Steven's-Johnson's syndrome
56
What counts as an "attack"?
Any event: major/minor/aura
57
DVLA policy:
After attack stop driving for 1 year if causative factor with risk of recurrence Otherwise 6 months after attack you can get a 3 year license If seizure free for 5 years then a "til 70 group 1 license"
58
What is AED hypersensitivity syndrome?
Multi-organ damage especially liver following skin rash
59
MFM:
Normal chance = 1-2% AED chance = 2-4% (don't stop AED) VPA chance = 6-9% (+ASD)
60
Pregnancy effects:
Slight association between AEDs and minor malformations and a drop in verbal reasoning IQ Maternal seizures are associated with drop in verbal reasoning IQ, small for gest age and sudden death Glucoronidation in pregnancy so most except CBZ decrease Give vitamin K to mother in last 4 weeks and newborn
61
Breastfeeding and AEDs:
Recommended PHT, CBZ and VPA are safe Monitor withdrawal/sedation and slow metabolism of benzos in foetus
62
Surgical options:
Hemispherectomy, callostomy, multiple sundial transections are all resective Vagal nerve stimulation is functional (better in children)
63
What is status epileptics?
Failure of termination/abnormally prolonged seizures
64
What do t1 and t2 indicate?
``` t1 = when treatment should be initiated t2 = when there are long-term consequences (neuronal damage at 30 minutes, spontaneous cessation unlikely after 5 minutes) ```
65
Stage 1 SE =
0-10 minutes
66
Stage 2 SE =
0-30 minutes
67
Stage 3 SE =
Established SE: 0-60 minutes
68
Stage 4 SE =
Refractory status: 30-90 minutes
69
Step 1 in treating SE =
Benzos in >5mins IV lorazepam/diazepam If not able then buccal/IM midazolam/rectal diazepam Basic bloods, AEDs, glucose and pabrinex
70
Step 2 in treating established SE (no response within 10 minutes) =
PHT/levetiracetam/VPA/PHB (risk of resp failure with PHB)
71
Step 3 in treating refractory convulsive SE (no response to step 2 within 30 minutes) =
ICU admission Anaesthesia - propofol, thiopentone, midazolam Monitor for 24-48 hours and withdraw if no seizures
72
Side-effects of PHT:
Hypotension Arrhythmia Precipitation of crystals

Cognition, movement and senses (20 decks)

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