Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Stage 3 > Neurology: Epilepsy + Febrile Seizures > Flashcards

Neurology: Epilepsy + Febrile Seizures Flashcards

1
Q

Most common form of focal epilepsy/partial seizure?

A

Temporal lobe epilepsy (TLE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the commonest form of TLE?

A

Mesial temporal sclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What condition is there often a history of in temporal lobe epilepsy?

A

Febrile seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How long can seizure auras last before consciousness is lost?

A

Seconds to 1-2 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What three ways can auras manifest in temporal lobe epilepsy?

A

1) Viscerosensory symptoms e.g. rising epigastric sensation
2) Experiential phenomena e.g. fear, deja vu, visual and auditory illusions
3) Hallucinations - complex auditory or visual, gustatory, or olfactory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which type of epilepsy is post-ictal amnesia (presents as disorientation) a feature of?

A

Temporal lobe epilepsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why does post-ictal amnesia occur in temporal lobe epilepsy?

A

Bilateral impairment of hippocampal function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which type of seizures are automatisms associated with?

A

Temporal lobe seizures (automatisms occur in ⅔ of TLE cases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are automatisms?

A

Coordinated, involuntary motor activity, stereotyped, almost always accompanied by altered consciousness and subsequent amnesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the two types of automatisms?

A

1) Release phenomena - include actions normally socially inhibited
2) Reactive phenomena - appear to be reactions to external stimuli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which two body parts do automatisms often involve?

A

1) Hands e.g. fumbling, picking, fidgeting
2) Mouth e.g. chewing, lip smacking, swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are two types of complex automatisms that can occur in frontal lobe seizures if prefrontal regions are involved?

A

1) Vocalisations
2) Behavioural e.g. crying (dacrystic) or laughing (gelastic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the key feature of occipital lobe seizures?

A

Visual hallucinations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a key feature of brainstem-onset seizures?

A

Myoclonus (sudden, brief involuntary twitching or jerking of a muscle or group of muscles. The twitching cannot be stopped or controlled by the person experiencing it)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What type of investigation is abnormal in ⅓ of individuals with TLE?

A

Inter-ictal EEGs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the imaging modality of choice in TLE and why?

A

MRI - looking for underlying cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What can be underlying causes of TLE?

A

Hippocampal or temporal sclerosis, temporal lobe dysplasia or tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the key feature of frontal lobe seizures?

A

Prominent motor signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are two additional features that can be seen in frontal lobe seizures?

A

1) Speech arrest
2) Dystonic posturing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the rarest type of focal seizure?

A

Parietal lobe seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the key feature of a parietal lobe seizure?

A

Somatosensory phenomena e.g. abnormal sensation travelling up limb over the course of a seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the two main types of epileptic syndromes?

A

1) Focal
2) Generalised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How are focal seizures classified (not by location)?

A

1) Complex - with impairment of consciousness
2) Simple - without impairment of consciousness
3) Secondary generalised - evolving to a bilateral, convulsive seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the clinical features of a complex focal seizure?

A

1) Patients lose consciousness either after an aura, or at seizure onset
2) These seizures most commonly originate at the temporal lobe
3) Post-ictal symptoms are common e.g. confusion in temporal lobe seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

From which type of seizure does a complex focal seizure most commonly originate?

A

Temporal lobe seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is a common post-ictal symptom in a temporal lobe complex seizure?

A

Confusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the clinical features of a simple focal seizure?

A

1) Patients do not lose consciousness
2) Patients only experience focal symptoms
3) Post-ictal symptoms do not occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the clinical features of a secondary generalised seizure?

A

1) Patients experience a focal seizure, which then evolves to a generalised seizure which is typically tonic-clonic
2) This occurs in ⅔ of patients with focal seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What type of generalised seizure typically occurs in a secondary generalised seizure?

A

Tonic-clonic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the specific features of temporal lobe focal seizures?

A

1) Automatisms (stereotyped behaviours) e.g. lip smacking
2) Deja vu or jamais vu
3) Emotional disturbance e.g. sudden terror
4) Olfactory, gustatory or auditory hallucinations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the specific features of frontal lobe focal seizures?

A

1) Motor features e.g. Jacksonian features/march (due to propagation of electrical activity through the primary motor cortex)
2) Dysphasia
3) Todd’s palsy/paresis (unilateral temporary focal paralysis/weakness following a seizure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the specific features of parietal lobe focal seizures?

A

1) Sensory symptoms e.g. tingling and numbness
2) Motor symptoms - due to spread of electrical activity to the pre-central gyrus in the frontal lobe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the specific features of occpital lobe focal seizures?

A

Visual symptoms e.g. spots and lines in the visual field

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is first line treatment for focal seizures?

A

Lamotrigine or levetiracetam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are second line treatments for focal seizures?

A

Carbamazepine, oxcarbazepine or zonisamide (third line = lacosamide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the four types of generalised seizure?

A

1) Absence
2) Tonic-clonic
3) Myoclonic
4) Atonic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How do absence seizures present?

A

Patients, often children, pause briefly for < 10 seconds and then carry on where they left off

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How do you treat absence seizures?

A

Sodium valproate or ethosuximide first line

39
Q

Which treatment do you avoid in absence and myoclonic seizures and why?

A

Carbamazepine - worsens seizures

40
Q

What are the features of tonic-clonic seizures?

A

1) Patients lose consciousness
2) Limbs stiffen (tonic) and start jerking (clonic)
3) Post-ictal confusion is common

41
Q

What are the first line treatments for tonic-clonic seizures?

A

Sodium valproate or lamotrigine

42
Q

How does a myoclonic seizure present?

A

Sudden jerk of a limb, trunk or face

43
Q

What is first line treatment for myoclonic seizures?

A

Sodium valproate unless patient is female of childbearing age where levetiracetam or topiramate is first line

44
Q

How do atonic seizures present?

A

Sudden loss of muscle tone, causing the patient to fall, whilst retaining consciousness

45
Q

What is first line treatment for atonic seizures?

A

Sodium valproate or lamotrigine

46
Q

What are examples of seizure triggers?

A

1) Poor sleep
2) Alcohol and drugs (and their withdrawal)
3) Stroke
4) Intracranial haemorrhage
5) Space-occupying lesions
6) Metabolic disturbances

47
Q

What are complications of epilepsy?

A

1) Status epilepticus
2) Depression
3) Suicide
4) Sudden unexpected death in epilepsy (SUDEP) - thought to be due to excessive electrical activity causing a cardiac arrhythmia and death

48
Q

What is status epilepticus?

A

> 5 minutes of continuous seizures or repetitive seizures without regaining consciousness, life threatening

49
Q

How do you manage status epilepticus?

A

1) IV lorazepam/buccal midazolam
2) If 2 doses of benzodiazepines doesn’t work - IV phenytoin/levetiracetam/valproate/phenobarbital + call anaesthetist

50
Q

What is the focus of drug therapy in epilepsy?

A

Optimisation of quality of life with control of seizure activity

51
Q

What are the principles of epilepsy management?

A

1) Any treatment must be balanced against potential side effects (in particular teratogenesis in women of childbearing age)
2) Initiation of medication is not always appropriate, especially after a “provoked” first seizure, and should be discussed with a specialist
3) Choice of antiepileptic drugs is a complex area, and often involves a degree of trial and error as very few randomised trials compare different medications head-to-head, and no single drug is clearly more effective or better tolerated

52
Q

What are the general rules of thumb for epilepsy management?

A

1) Lamotrigine, levetiracetam and valproate are good for all seizure types
2) Carbamazepine, gabapentin and phenytoin are better for focal (including secondary generalised) seizures
3) Ethosuximide is the drug of choice for absence seizures
4) Carbamazepine may worsen myoclonic seizures

53
Q

Which antiepileptic is a good choice in women of childbearing age and why?

A

Lamotrigine - issues regarding teratogenicity should be considered, particularly in the context of valproate use which has a high risk of neural tube defects

54
Q

What is the teratogenic risk with sodium valproate?

A

Neural tube defects

55
Q

Interaction with which medications in particular should be considered when deciding epilepsy management?

A

Phenytoin, carbamazepine

56
Q

What are side effects of topiramate?

A

Weight loss
Renal stones
Cognitive and behaviour changes

57
Q

What are side effects of lamotrigine?

A

Skin rash
Rarely Stevens-Johnson syndrome

58
Q

What are side effects of carbamazepine?

A

Ataxia
Skin rash
Dysarthria
Nystagmus

59
Q

What are side effects of sodium valproate?

A

Weight gain
Tremor
Teratogenicity

60
Q

What are side effects of phenytoin?

A

Ataxia
Peripheral neuropathy
Osteomalacia
Gum hypertrophy
Hirsutism

61
Q

What must you do with regards to the DVLA once you have had a seizure?

A

Surrender your license to the DVLA - you can reapply to get your license back depending on the seizures and certain timeframes

62
Q

For a car/motorbike license when can you reapply after surrendering your license to the DVLA after a one off seizure?

A

Reapply in 6 months

63
Q

For a car/motorbike license when can you reapply after surrendering your license to the DVLA after more than one seizure?

A

Reapply in one year

64
Q

For a car/motorbike license when can you reapply after surrendering your license to the DVLA after a seizure following change in antiepileptic medications?

A

Reapply to drive if seizure was more than 6 months ago or you’ve been back on previous medication for 6 months

65
Q

For a bus/coach/lorry license when can you reapply after surrendering your license to the DVLA after a one off seizure?

A

Reapply in 5 years or if you haven’t taken anti epileptic medications for 5 years

66
Q

For a bus/lorry license when can you reapply after surrendering your license to the DVLA after more than one seizure?

A

Reapply once you haven’t had a seizure for 10 years or you haven’t taken any anti-epileptic medication for 10 years

67
Q

Who does the DVLA epilepsy driving guidelines apply for?

A

The guidelines apply for all categories of license and are more strict for those that are Taxi and HGV drivers

68
Q

What are the features of a Jacksonian march (frontal lobe focal seizure)?

A

1) May complain of generic weird movements
2) Gradual onset and spread of motor symptoms e.g. right leg starts twitching, this movement moves up her right trunk to involve her right arm
3) Completely aware of these symptoms
4) May be no other symptoms and normal examination

69
Q

What % of children experience febrile seizures?

A

3% - relatively common

70
Q

Which age group are most susceptible to febrile seizures?

A

6 months-5 years

71
Q

How do febrile seizures present?

A

1) Short-live tonic-clonic seizure e.g. 2 mins episode of stiffness + shaking all 4 limbs + LOC, full recovery and fully alert
2) History of fever ± coryzal symptoms

72
Q

How are febrile seizures diagnosed?

A

History

73
Q

What is the prognosis of febrile seizures?

A

1) 1 in 3 children will have at least one more febrile convulsion
2) Simple febrile convulsions do not affect development and do not hugely increase the child’s likelihood of developing epilepsy (1% to 2%)
3) Complex febrile convulsions are associated with a significantly increased risk of epilepsy (around 4-12%)

74
Q

What are the features complex febrile convulsions?

A

Last for a long time and/or multiple times in the same febrile illness ( >1 seizure in < 24h as part of the same febrile illness)

75
Q

How do you manage febrile seizures?

A

1) Acute management is like all other seizures
2) Find the source of the fever - the suspected/confirmed source will depend on if the underlying cause requires any treatment
3) If complex seizure - consider admission for further observation

76
Q

What advise should be given to parents of children with febrile convulsions?

A

Parents should be advised on:
1) Appropriate anti-pyretic usage
2) Not to give anti-pyretics prophylactically
3) To avoid sponging a child to cool them down
4) Appropriate safetynetting advice should another seizure occur

77
Q

How do you manage status epilepticus in children?

A

1) Roll on side (if safe to do so) + high flow oxygen + check glucose
2) If seizure not resolved in 5 mins - IV lorazepam or buccal midazolam or rectal diazepam
3) If seizure continuing after 10 minutes - IV lorazepam, call for senior support incl. anaesthesia if not already done so
5) IV phenytoin
6) Rapid sequence induction with sodium thiopentone/propofol

78
Q

What medication do you give in status epilepticus instead of IV phenytoin if the patient normally takes phenytoin?

A

IV phenobarbitone

79
Q

What are complications of status epilepticus?

A

1) Focal neurological deficit (normally temporary)
2) Memory loss
3) Behavioural problems
4) Hypoxic brain injury

80
Q

What are side effects of phenytoin and therefore what should you monitor?

A

Bradycardia + hypotension so must monitor BP + ECG

81
Q

How is epilepsy diagnosed?

A

EEG - MRI and CT only to exclude structural abnormalities of the brain

82
Q

What is West syndrome also called?

A

Infantile spasms

83
Q

What is West syndrome?

A

Seizure syndrome which starts around age 4-8 months

84
Q

How does West syndrome present?

A

1) Children have seizures with myoclonic jerking, referred to as ‘jack knife’ spasms that occur in clusters
2) Violent spasms of the head and limbs which occur in bouts of 10-20

85
Q

What is the prognosis of West syndrome?

A

Associated with developmental regression/learning difficulties or disability and high morbidity

86
Q

How is West syndrome diagnosed?

A

History + characteristic EEG finding of hypsarrhythmia

87
Q

Which age group is affected by benign rolandic seizures?

A

Children aged 3-10 years

88
Q

How do benign rolandic seizures present?

A

Occur almost exclusively during sleep
1) Children characteristically have a tonic seizure overnight
2) Might be noticed by the parents if the child makes noises or falls out of bed
3) They might also go unrecognised, but parents note that they find the child sleeping on the floor or with messy bedsheets in the morning

89
Q

How is benign rolandic seizures diagnosed?

A

History + characteristic EEG findings during sleep of centro-temporal spikes

90
Q

What is the prognosis of benign rolandic seizures?

A

Excellent - most children completely outgrow the condition around puberty + no significantly increased risk of developing another seizure disorder later in life

91
Q

Which patients are typically affected by absence epilepsy

A

Girls aged 4-12 years

92
Q

What are drop attacks?

A

Sudden falls while walking or standing - child recovers in seconds or minutes, may be provoked

93
Q

What are the clinical features of juvenile myoclonic epilepsy?

A

1) Typically occurs in adolescence
2) Myoclonic episodes, usually in the morning
3) Absences and generalised tonic-clonic seizures may occur
4) Remission is rare

Stage 3 (61 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions