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3C week 3 - headaches and tingly toes > epilepsy (see DM) > Flashcards

epilepsy (see DM) Flashcards

1
Q

what is an epileptic seizure

A

a transient episode of abnormal neurological function caused by sudden excessive or hypersynchronous cortical neuronal activity

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2
Q

6 types of generalised seizure

A
  1. absence;
  2. myoclonic;
  3. tonic;
  4. atonic;
  5. clonic;
  6. tonic clonic;
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3
Q

syncope (6) vs seizure (9)

A

syncope:
1. prodromal symptoms (light headedness etc.);
2. pallor;
3. fall;
4. hypotonia;
5. brief duration;
6. no post-ictal confusion

seizure:
1. variable warning;
2. fall
3. initial tonic phase;
4. cyanosis;
5. clonic jerking;
6. duration (minutes);
7. tongue biting;
8. incontinence;
9. post-ictal confusion

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4
Q

what is status epilepticus

A

a dangerous condition in which epileptic fits follow one another without recovery of consciousness between them- medical emergency

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5
Q

status epilepticus Mgx

A
  1. ABCDE
  2. benzodiazepine given e.g. buccal midazolam, PR diazepam or IV lorazepam
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6
Q

what is SUDEP

A

sudden unexplained death in epilepsy

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7
Q

absence (6) vs complex partial (6) seizure

A

absence:
- brief
- no warning
- EEG generalised 3Hz spike wave
- abrupt onset
- abrupt cessation
- specific drug treatment

complex partial:
- prolonged
- may have warning
- EEG focal abnormalities
- post-ictal period
- automatisms
- most AED used for treatment

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8
Q

what is an epilepsy syndrome?

A

a syndrome defines by non-random clustering of clinical features which occur consistently together

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9
Q

what hormone can be used to distinguish between a seizure and pseudoseizure

A

prolactin (raise in seizure)

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10
Q

if a pt has one seizure and normal brain scan what is the chance of recurrance

A

40% chance and increases in risk as number of seizures increases

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11
Q

7 epilepsy syndromes

A
  1. childhood absence epilepsy;
  2. juvenile myoclonic epilepsy;
  3. autosomal dominant nocturnal frontal lobe epilepsy;
  4. benign childhood focal epilepsy;
  5. west syndrome;
  6. lennox-gastaut syndrome;
  7. temporal lobe epilepsy due to mesial temporal scelrosis;
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12
Q

how might benign childhood focal epilepsy present

A

mouth abnormalities - mouth area of the homonculous is affected

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13
Q

west syndrome presentation

A

Violent flexor spasms of the head, trunk and limb followed by extension of the arms; severe brain impairment

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14
Q

what drugs does childhood absence epilepsy respond well to

A
  1. ethosuximide
  2. sodium valporate
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15
Q

how does childhood absence epilepsy present

A

frequent absence seizures (up to 100/day) seen in children -> onset is usually 5-8 and more common in girls

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16
Q

when does childhood absence epilepsy usually remit at

A

puberty

17
Q

what is juvenile myoclonic epilepsy

A

myoclonic seizures that arise in teenage years -> these are usually preceded by absence seizures (may even be up to 10 years prior); generalised tonic-clonic seizures may also arise at the same time as myoclonus

18
Q

4 precipitating factors of juvenile myoclonic epilepsy

A
  1. sleep deprivation
  2. fatigue
  3. alcohol
  4. emotional stress/excitement
19
Q

juvenile myoclonic epilepsy EEG (3)

A
  1. irregular 3-6Hz spike/poly spike and slow way discharge;
  2. photoparoxysmal responses;
  3. focal abnormalities
20
Q

juvenile myoclonic epilepsy prognosis

A

lifelong seizures though generally well controlled with medication

21
Q

juvenile myoclonic epilepsy Mgx

A
  1. lifestyle advice
  2. sodium valporate
  3. lamotrigine
  4. clonazepam
  5. levetiractem
22
Q

what drugs should be avoided in juvenile myoclonic epilepsy

A

vigabatrin, tiagabine, carbamezapine (may exacerbate myoclonus)

23
Q

what is temporal lobe epilepsy

A

the most common form of focal epilepsy - seizures arise in the temporal lobe

24
Q

what are the two types of temporal lobe epilepsy

A
  1. mesial temporal lobe (limbic);
  2. lateral temporal lobe (neocortical)
25
Q

mesial temporal lobe epilepsy presentation examples

A
  1. olfactory/gustatory hallucinations
  2. fear
  3. deja vu/jamais vu
  4. epigastric sensation
  5. behavioural arrest
  6. altered awareness/consciousness
  7. contralateral dystonic arm posturing
  8. lip smacking, swallowing etc. automatisms
26
Q

mesial temporal lobe seizure duration/post-ictal

A

duration of minutes, followed by post-ictal confusion, dysphagia and gradual recovery

27
Q

what will MRI show of someone with mesial temporal lobe epilepsy

A

hippocampal atrophy/sclerosis

28
Q

what facial abnormality might be seen in someone with mesial temporal lobe epilepsy

A

facial asymmetry - flattening of the contralateral naso-labial fold

29
Q

mesial temporal lobe epilepsy mgx

A

seizures usually still occur with medication -> surgery my be the only option

30
Q

what may cause SUPED to occur (4)

A
  1. breathing - A seizure typically may cause a person to briefly stop breathing -> can result in hypoxia if last too long;
  2. heart rhythm - Rarely, a seizure may cause a dangerous heart rhythm or cardiac arrest;
  3. brain function - Seizures may suppress or interfere with the function of vital areas in the brainstem;
  4. other (unknown)
31
Q

causes of excess mortality in epilepsy (7)

A
  1. underlying disease
  2. suicide
  3. seizure related accidents
  4. status epilepticus
  5. drug reactions
  6. aspiration pneumonia
  7. SUDEP
32
Q

risk factors for SUDEP (6)

A
  1. young;
  2. generalised tonic-clonic seizures;
  3. uncontrolled epilepsy
  4. learning diability
  5. seizures occuring during sleep
  6. poor adherence to antiepileptic drug regimens
33
Q

causes of depression in epilepsy (4)

A
  1. underlying cause of seizure;
  2. physiological effects of recurrent seizures;
  3. iatrogenic factors (AEDs, post operative, force normalisation);
  4. psychosocial consequences of epilepsy
34
Q

treatment pathway for epilepsy (basic)

A

first monotherapy AED -> second monotherapy AED trial -> polytherapy AED trial -> epilepsy surgery evaluation

35
Q

what type of epilepsy is most suitable to surgery

A

lesional temporal lobe epilepsy

36
Q

why are areas of the brain temporarily lesioned in the epilepsy surgery work up

A

to see what the side effects of this lesion are prior to permanent resection

37
Q

contraindications for epilepsy surgery (4)

A
  1. multi focal epileptogenic regions
  2. non-localisable epileptogenic zone
  3. epileptogenic region in eloquent cortex
  4. patient reluctance
38
Q

4 ways of neuromodulation in epilepsy (if surgery and AED not sutiable)

A
  1. vagal nerve stimulation
  2. responsive neurostimulation
  3. deep brain stimulation
  4. trigeminal nerve stimulation
39
Q

side effects of vagal nerve stimulation (4)

A
  1. hoarsness/voice alteration
  2. coughing
  3. dyspnoea
  4. parasethesia

i.e. effects of CN X stimulation

3C week 3 - headaches and tingly toes (7 decks)

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