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Neurology > Epilepsy: Seizures, Syndromes and Management > Flashcards

Epilepsy: Seizures, Syndromes and Management Flashcards

(53 cards)

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1
Q

what kind of questions would you ask about onset of fall?

A

what were they doing?

light-head or other syncopal symptoms?

what did they look like? eg pallor, breathing, posturing of limbs, head turning

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2
Q

what kind of questions would you ask about the event itself?

A

types of movements - tonic phase, clonic movements, carpopedal spasms, rigor

responsiveness and awareness throughout

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3
Q

what kind of questions would you ask about after the fall?

A

speed of recovery
sleepiness / disorientation
deficits

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4
Q

what are the risk factors for epilepsy?

A 
birth 
development 
seizures in past (inc febrile fits)
head injury (including LOC)
family history 
drugs and alcohol
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5
Q

what drugs are most known to precipitate epileptic seizures?

A

aminophylline / theophylline

analgesics eg tramadol

antibiotics eg penicillins, cephalosporins, quinolones

anti-emetics eg prochlorperazine

opioids eg diamorphine, pethidine

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6
Q

you don’t usually examine patients in 1st seizure clinic as it has little benefit but when would an examination be important?

A

syncope - cardio exam and L + SBP

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7
Q

who with a fall gets a CT scan acutely?

A 
clinical or radiological skull fracture
deteriorating GCS
focal signs 
head injury with seizure 
failure to be GCS15/15 after 4 hours
suggestion of other pathology eg SAH
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8
Q

what investigations take place for the fallen?

A

ECG - mandatory

Imagine - MRIb vs CTb

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9
Q

what is EEG used for?

A

classification of epilepsy
confirmation of non-compulsive status
surgical evaluation
confirmation on non-epileptic attack

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10
Q

when should you never use EEG?

A

just because someone has collapsed and you are unsure about the cause

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11
Q

seizure does not always mean epilepsy - true or false?

A

true

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12
Q

how long should you wait until driving after 1st seizure?

A

6 months for car

5 years for HGV / PCV

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13
Q

how long should you wait until driving when you have epilepsy?

A

1 year seizure free
or 1 year with seizures that you still retain consciousness
or 3 years seizures only during sleep
10 years off medication for HGV/PCV

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14
Q

do most people have a genetic predisposition to generalised epilepsy?

A

yes

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15
Q

when does generalised epilepsy normally present?

A

in childhood and adolescence

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16
Q

what is the pattern on EEG in generalised epilepsy?

A

generalised spike wave abnormalities

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17
Q

what can be seen on ECG which is fatal and makes patients prone to seizures?

A

long QT

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18
Q

raising a limb and turning of the head indicates a seizure in what part of brain?

A

frontal lobe seizure phenomenon

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19
Q

tongue biting and loss of urinary continence are specific features of generalised seizures - true or false?

A

false

these symptoms are not seizure specific - patient can lose urinary continence during vaso-vagal episode

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20
Q

what are the differential diagnoses for epilepsy?

A

syncope
non-epileptic attack disorder
panic attacks
sleep phenomena

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21
Q

what is the treatment of choice for primary generalised epilepsy?

A

sodium valproate treatment of choice but is teratogenic

lamotrigine as alternative

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22
Q

describe the usual symptoms of juvenile myoclonic epilepsy?

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A

early morning jerks

generalised seizures

23
Q

what are the risk factors for juvenile myoclonic epilepsy?

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A

sleep deprivation

flashing lights

24
Q

describe the pathophysiology of focal onset epilepsy?

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A

due to underlying structural cause (bran injury / haemorrhage)
area around this becomes irritated
causes abnormal discharges of energy - seizures

25
focal seizures can also become generalised - true or false?
true - if a focal seizure excited a neighbouring pathway which can spread activity around the brain, then seizures can become generalised
26
what treatment is first line for focal epilepsy?
carbamazepine (interacts with basically all drugs) or lamotrigine sodium valproate works as well but not first line due to SE
27
what is the most common cause of focal / partial epilepsy in patients <30?
complex partial seizures due to hippocampal sclerosis
28
why should carbamazepine not be used for generalised seizures?
it can make them worse
29
what are the different types of generalised seizures?
``` myoclonic - jerks atonic - loss of tone tonic tonic / clonic absence - pt goes black ```
30
why is lamotrigine sometimes unsuitable at the beginning of generalised epilepsy treatment?
it can take around 2-3 months to reach peak action
31
what other treatment with less side effects than sodium valproate can be used in generalised epilepsy is lamotrigine is taking too long to work?
levetiracetam (keppra)
32
what age group is more likely to get focal seizures?
>50 as they are more likely to have structural damage
33
carbamazepine is a well tolerated - true or false?
false - not well tolerated, patients feel dizzy and unsteady
34
why should sodium valproate and lamotrigine be given together with caution?
sodium valproate makes the lamotrigine dose higher, therefore a lower dose of lamotrigine should be prescribed if dural therapy used
35
what anticonvulsant medications are considered old?
phenytoin sodium valproate carbamazepine
36
what anticonvulsants are considered new?
lamotrigine levetiracetam topiramate gabapentin / pregabalin (not widely used anymore)
37
what side effects can occur from older anticonvulsants?
phenytoin - unwanted cosmetic change sodium valproate - above but also teratogenic carbamazepine - dizzy / unsteady
38
what side effects can occur from newer anti-convulsants?
lamotrigine - steven johnson syndrome (check for rash) levetiracetam - mood swings topiramate - sedation, dysphasia and weight loss gabapentin / pregabalin - addictive
39
when should anti convulsants be prescribed?
if patient has epilepsy - not just seizures unless extremely high risk of seizure recurrent in non epileptic seizures
40
what anticonvulsants affect hepatic enzymes and therefore causing problems for females?
``` carbamazepine oxcarbazepine phenobarbitol phenytoin primidone topiramate ```
41
what contraceptives are affected by anticonvulsant drugs?
combined OCP DONT use progesterone only pill depot progesterone injection needs more frequent dosing progesterone implants not effective
42
morning after pill dose should be increased or decreased in those on anticonvulsants?
increased
43
why should all females of child bearing age be given pre-conceptual counselling?
allows them to balance risk of uncontrolled seizures if not taking medication or teratogenicity if continue with medication
44
if females with epilepsy do wish to conceive, what medication must they start 3 months prior to conception?
folic acid and vitamin K
45
what is status epilepticus?
recurrent epileptic seizures without full recovery of consciousness between them can last for over 30 mins
46
what are the different types of status epilepticus?
generalised convulsive non convulsive status - conscious but in altered state epilepsia partialis continua (continual conscious focal seizures)
47
what can precipitate a status epilepticus?
severe metabolic disorders - hyponatraemia, pyridoxine deficiency infection head trauma / sub arachnoid haemorrhage abrupt withdrawal of anti-convulsants
48
generalised convulsive status epilepticus can cause what further effects on body?
respiratory insufficiency and hypoxia hypotension hyperthermia rhabdomylosis
49
how should status epilepticus be investigated?
ABCDE identify cause - emergency blood tests +/- CT if suspicious of hypoglycaemia give 50mls 50% glucose
50
how is status epilepticus treated?
benzodiazepines x2 doses (10 mins, then 15 mins) - usually buccal midazolam phenytoin if unresolving + sodium valproate + levetiracetam (keppra)
51
when should you consider transferring a patient in status epilepticus into ITU?
when requiring to give phenytoin as it has been unresolved for a prolonged period
52
how would you confirm a patient with acute confusion is in partial status epilepticus?
EEG
53
how do benzodiazepines work to reverse status epilepticus?
they suppress the area of the brain which is over-excited and impairing consciousness consciousness returns when electrical activity is sedated

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