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Flashcards in Epilespsy Deck (69)
1

What is the first line treatment for people who suffer from generalised seizures?

Sodium Valporate
If this is poorly tolerated then lamotrigine and topiramate should be tried

2

What is the first line treatment for people who suffer from focal onset seizures?

Carbemazepine
Lamotrigine

3

What is the first line treatment for people who suffer from absent seizures?

Sodium valporate

4

What is the first line treatment for people who suffer from myoclonic seizures?

Sodium valporate

5

What is the first line treatment for people who suffer from generalised tonic clonic seizures?

Sodium valporate

6

When would you usually start prophylactic anti epileptics?

After a second epileptic seizure

7

What is the term for a seizure that arises from a localised region of the cerebral cortex?

Partial seizure

8

What is the term for a seizure that has bilateral involvement of the cortex at the onset of the seizure?

Generalised seizure

9

What is the commonest site of origin for partial seizures?

Temporal lobe

10

What is the second commonest site of origin for partial seizures ( After temporal lobe)

Frontal lobe. Parietal and Occipital seizures are rare

11

What is meant by a simple partial seizure?

An epileptic event where consciousness is fully preserves and in which the discharge remains localised.

12

What is meant by a complex partial seizure?

- Initially start as a partial seizure (referred to as the seizure aura) but will always involve impairment of consciousness.
- The patient may display aletered automatic behaviour such as lip smacking, chewing or wandering
- Patient may be able to carry on with simple tasks
- Will have amnesia of the seizure itself afterwards, though they may recall the aura
- Will usually suffer from a post ictal period where they are confused and drowsy

13

What is a secondarily generalised seizure?

Partial seizures where the epileptic discharge spreads to both hemispheres of the brain so that a generalised (usually tonic clonic) seizure does occur.

14

When do patients having a generalised seizure usually lose consciousness?

At the seizure onset

15

Briefly describe a tonic - clonic seizure

-Usually no warning (sometimes general malaise
- Rigidity (tonic phase)
- Apnoea (patient may become cyanosed at this point)
- Clonic movements involving all four limbs occur followed by relaxation of the limbs
- Frequency decreases until the seizure has subsided
- Incontinence may occur at the end of the clonic phase
- Post ictal period of drowsiness and confusion

16

How long do most seizures last?

Less than 2 minutes

17

Describe an absent seizure?

These occur almost exclusively in childhood and the child appears blank and suddenly stares. Fluttering of the eyelids and flopping of the head may occur.

18

What is a myoclonic seizure?

Abrupt brief involuntary movements that can involve the whole body or just parts of it (such as the arm or leg)

19

What is an atonic seizure?

Sudden loss of tone in the postural muscles causing the patient to fall to the ground. There are no convulsive movements.

20

What is a febrile convulsion?

Seizures occuring in the context of a febrile illness in children between 6 months and 6 years.

21

What kind of seizure do you get in a febrile convulsion?

Generalised tonic clonic seizure without other features and a body temperature of over 38 degrees.

22

How would you treat a febrile convulsion?

- Rectal/IV diazepam
- Supportive treatment
- Treatment of the underlying condition.

23

Where is the temporal lobe do epileptic seizures most commonly arise from?

Hippocampus

24

In which type of seizure do you see a three per second spike and wave discharge?

Absent seizures

25

What is status epilepticus?

A seizure lasting for 30 mins or more wither continuously or intermittently without recovery

26

If a 64 year old women presents with new onset of focal seizure what tests would you order and why?

CT or MRI to exclude a focal structural lesion

27

How long does a patient have to be seizure free for before they can drive?

12 months

28

When should prophylactic treatment for epilepsy be initiated?

After the patient has had two seizures.

29

What anti epileptic drugs are known to be teratogenic?

Carbamazepine
Phenytoin
Phenoarbital
Sodium valporate
Topiramate

30

A 25 year old women has just been diagnosed with focal epilepsy. She is in a serious relationship and they are considering having children within the next year. What drug would be the best for her?

Lamotrigine

31

What three anti epileptic drugs are potent liver enzyme inducers?

1. Carbamazepine
2. Phenytoin
3. Phenobarital

32

What three anti epileptic drugs might reduce the efficacy of the contraceptive pill and why?

1. Carbamazepine
2. Phenytoin
3. Phenobarital
They are potent liver enzyme inducers

33

Through what system are gabapentin, topiramate and levitiracetam excreted?

Renal

34

A patient who has generalised seizures has been started of sodium valporate and it has been titrated up to highest tolerated dose however he is still having frequent seizures. What might you do next?

Stop sodium valporate and start lamotrigine.

35

When should you consider combination therapy in the treatment of epilepsy?

When two first line anti epileptic drugs have not worked or if there is improved control during the process of phased substitution.

36

When is gabapentin used in the treatment of epilepsy?

An an adjunctive treatment in focal epilepsy

37

What anti epileptic drug is most sensitive to the effects of liver inducing and liver inhibiting?

Lamotrigine

38

Which anti epileptic inhibits liver metabolism of some drugs such as lamotrigine?

Sodium valporate

39

Which anti epileptic drug is most commonly associated with weight gain?

Sodium valporate

40

Which anti epileptic drugs are most commonly associated with GI side effects?

Carbamezipine
Sodium Valporate

41

Which anti epileptic drugs are most commonly associated with a rash?

Carbamezpine
Lamotrigine
Phenytoin

42

What is the first line treatment for status epilepticus?

Rectal diazepam or IV lorazepam or diazepam.
Loading dose of phenytoin by IV infusion

43

A 34-year-old female presents due to a number of 'funny-dos'. She describes a sensation that her surroundings are unreal, 'like a dream'. Following this she has been told that she starts to smack her lips, although she has no recollection of doing this. What is the most likely diagnosis?

Complex partial seizure.
Complex as there is a disturbance of consciusness

44

How long before you can drive if you have had one isolated seizure?

6 months

45

What investigation must you always do after a first collapse?

ECG

46

What are risk factors for getting a seizure if you have primary generalized epilepsy?

Sleep deprivation
Flashing lights

47

When does primary generalized epilepsy usually first present?

Childhood or tens

48

When is phenytoin used in the treatment of epilepsy?

Only is acute situations (sttus epilepticus when rectal lorezapm hasn't worked)

49

List some of the side effects of sodium valporate

Weigth gain
teratogenic
Hair loss
Gatigue

50

Which medication, used for focal onset seizures, can make generalized epilepsy worse?

Carbamazepine

51

A 17 year old girl is taken to A&E after having had a generalized seizure.
She had been out partying the night before. No past Hx of note, although
her mother reported that she had been a bit clumsy and jerky in the
mornings recently, e.g. dropping her hairbrush or coffee cup.

History is suggestive of a primary generalized epilepsy.

52

A 17 year old girl is taken to A&E after having had a generalized seizure.
She had been out partying the night before. No past Hx of note, although
her mother reported that she had been a bit clumsy and jerky in the
mornings recently, e.g. dropping her hairbrush or coffee cup. What would be the treatment of choice?

Sodium valporate or lamotrigine

53

Which type of epilepsy is associated with hippocampal sclerosis?

Focal onset epilepsy

54

What are the symptoms of juvenile myoclonic epilepsy?

Early morning jerks
Generalized seizured

55

Which antiepileptic causes weight loss?

Topiramate

56

Why should phenytoin be avoided in young women?

Cosmetic effects - weight gain, hirsutism

57

Which anticonvulsant has the highest teratogenic risk?

Sodium valporate

58

What anticonvulsants are sodium channel blockers?

Carbamazepine
Phenytoin
Lamotrigine

59

What is the main disadvantage of lamotrigine treatment?

Takes a long time to titrate to the correct dose

60

What is the mechanism of action of sodium valporate?

Increases GABA activity

61

What is the mechanism of action of sodium valporate?

Binds to sodium channels and increases the refactory period

62

What is the mechanism of action of lamotrigine?

Sodium channel blocker

63

What is the mechanism of action of phenytoin?

Binds to sodium channels and increases the refactory period

64

What is the main side effect of levetiracetam?

Mood swings

65

What are the main side effects of topiramate?

Sedation
Dysphasia
Weight loss

66

If you are on carbamazepine, phenytoin, topiramate or phenoarbitol can you use the progesterone implant?

No it is ineffective due to the liver inducing effects of these drugs

67

If you are on carbamazepine, phenytoin, topiramate or phenoarbitol can you use the morning after pill?

Yes but dose needs to be increased

68

What is epilepsia partialis continua?

Continued focal seizured with preserved consciousness

69

What can happen if you treat absent seizures with carbemazepine?

Status epilepticus