Week 232 - Epilepsy Flashcards Preview

Revision Cards > Week 232 - Epilepsy > Flashcards

Flashcards in Week 232 - Epilepsy Deck (50):
1

Week 232 - Epilepsy: What is epilepsy?

• The continuing tendency to have epileptic seizures.
• Epileptic seizures are a transient event experienced due to excessive and synchronous discharge of cerebral neurones.

2

Week 232 - Epilepsy: What are the two major categories of epileptic seizures?

• Generalized
• Partial (Focal)

3

Week 232 - Epilepsy: What are the two types of partial seizure?

• Complex - Loss of awareness.
• Simples - No loss of awareness.

4

Week 232 - Epilepsy: What are the three types of generalized seizure?

• Tonic-clonic
• Absence
• Myoclonic

5

Week 232 - Epilepsy: What is a cryptogenic seizure?

• A seizure whose characteristics would suggest underlying cause, but which has not yet been identified.

6

Week 232 - Epilepsy: What are the differentials for epilepsy?

1) Syncope
2) Non-epileptic attacks
3) Panic attacks
4) Sleep disorders
5) Migraine
6) Transient ischaemic attacks
7) Hypoglycaemia

7

Week 232 - Epilepsy: What is the typical prodrome of syncope?

Nausea, clammy, blurring or loss of vision, deafness, tinnitus.

8

Week 232 - Epilepsy: What are the red flags for cardiogenic syncope?

- Occurence on exercise
- Family history of sudden death
- Past history of IHD
- No warning
- Rapid recovery

9

Week 232 - Epilepsy: What is NEAD?

• Non-epileptic attack disorder.
- Psychologically mediated episodes of altered awareness.

10

Week 232 - Epilepsy: If, during a seizure, someone developed irregular and asynchronous jerks what would the likely diagnosis be?

• Non-epileptic attack
-NEAD

11

Week 232 - Epilepsy: Tongue biting and incontinence is common in which of the following, seizure, syncope of NEAD?

Epileptic seizure.

12

Week 232 - Epilepsy: What is the gold standard for investigation of seizures? Why is it not commonly used?

• Video EEG
• Expensive and time consuming.

13

Week 232 - Epilepsy: What are the causes of epilepsy in infants?

• Developmental malformations, perinatal injuries and infections.

14

Week 232 - Epilepsy: What are the causes of epilepsy in children/adolescents?

Idiopathic generalised epilepsy.

15

Week 232 - Epilepsy: What are the causes of epilepsy in Young adults?

IGEs (Idiopathic), Head injury, alcohol, vascular malformations, hippocampal sclerosis.

16

Week 232 - Epilepsy: What are the leading causes of epilepsy in 30-50 yr olds?

Brain tumours

17

Week 232 - Epilepsy: What are the leading causes of epilepsy in the over 50s?

Cerebrovascular disease.

18

Week 232 - Epilepsy: What are the characteristics of Juvenile Myoclonic Epilepsy?

• Upper limb jerks, generalised tonic-clonic seizures, absences.
• Onset 8-18
• Seizures on waking, precipitated by alcohol and sleep deprivation.
• Good response to sodium valproate.

19

Week 232 - Epilepsy: What is heterotopic grey matter?

• This is a developmental malformation where islands of grey matter have failed to migrate to the gyrae leaving a rim around the ventricles.
• This is very epileptogenic.

20

Week 232 - Epilepsy: What is neurocycticercosis?

• Probably the most common cause of epilepsy world wide.
- Eggs of the pork tape worm migrate to the brain where they form cysts.

21

Week 232 - Epilepsy: What is the first line treatment of idiopathic generalised epilepsy?

• Sodium valporate
- In females - Lamotrigine or levetiracetam (Since sodium valporate has a high risk of birth defects.)

22

Week 232 - Epilepsy: What is the first line treatment for focal/partial epilepsy?

Carbamazepine/lamotrigine/levetiracetam

23

Week 232 - Epilepsy: What are the common side-effects of all anti-epilepsy drugs?

Tiredness, fatigue, dizziness.

24

Week 232 - Epilepsy: Which anti-epilepsy drug has side effects including rash, ataxia and double vision?

Carbamazepine

25

Week 232 - Epilepsy: Which anti-epilepsy drug can cause weight gain, tremor and is teratogenic?

Sodium Valporate

26

Week 232 - Epilepsy: Which anti-epileptic drug is associated with psychiatric problems?

Levetiracetam

27

Week 232 - Epilepsy: What is status epilepticus?

A seizure or series of seizures lasting for 30 minutes without regaining consciousness in between.

28

Week 232 - Epilepsy: What are the causes for status epilepticus?

• New - 50% (Encephalitis, trauma, tumours)
• Established eplilepsy - 50% (missed doses, infections)

29

Week 232 - Epilepsy: What are the general measures for the treatment of status epilepticus?

- Secure airway and monitor pulse, Bp, respiration.
- IV access
- Oxygen
- Check U+Es, Ca, Mg, ABGs, ECG
- iv glucose and thiamine.

30

Week 232 - Epilepsy: What medication should be given early on in the treatment of status epilepticus?

IV Lorazepam 4mg.
(alternatives include diazepam or buccal midazolam)

31

Week 232 - Epilepsy: Once status epilepticus is established what medication should be given? What dosage?

IV phenytoin 15mg/kg at 50mg/minute.

32

Week 232 - Epilepsy: What is SUDEP?

Sudden unexplained death in epilepsy.
- Non-traumatic death unwitnessed death in patient with epilepsy.

33

Week 232 - Epilepsy: What are the proposed causes of SUDEP?

- Cardiac arrhythmias
- Perictal hypoxia
- Postictal cerebral depression with hypoventialition and bradycardia.

34

Week 232 - Epilepsy: What are the risk factors for developing SUDEP?

• High seizure frequency
• AED polytherapy
• Young age at onset
• Male
• Poor compliance
• Long history of epilepsy
• Seizures from sleep
• Living/sleeping alone

35

Week 232 - Epilepsy: Give a definition of coma.

A state of unrousable unconsciousness.

36

Week 232 - Epilepsy: What score on the Glasgow coma scale is classed as coma?

≤8

37

Week 232 - Epilepsy: What are the two coma mimics?

• Locked-in syndrome - Arousal and awareness retained.
• Psychogenic coma

38

Week 232 - Epilepsy: What physiological brain dysfunctions can cause coma?

• Hypothermia
• Sudden hypertension
• Prolonged status epilepticus
• Drugs, toxins, poisonings.

39

Week 232 - Epilepsy: What is the initial management of coma?

• Improve oxygenation (Intubate if necessary)
• Correct hypotension and extreme hypertension.
• Correct body temperature.
• Glucose and thiamine
• Identify and treat the underlying cause.

40

Week 232 - Epilepsy: What four things will prevent you from performing a reliable neurological assessment of a patient in coma?

1) They are metabolically deranged.
2) They are hypothermic.
3) They have sedative drugs in their circulation.
4) They have an endocrine disturbance.

41

Week 232 - Epilepsy: Why do you check for papilloedema in a coma patient?

This can help to identify if there is raised intracranial pressure / SAH

42

Week 232 - Epilepsy: What is the relevance of checking whether the motor response is symmetrical?

To identify if there are unilateral signs indicating a hemisphere or brainstem lesion.

43

Week 232 - Epilepsy: What is the purpose for checking meningism in coma patients?

To identify a possible cause of SAH or meningitis.

44

Week 232 - Epilepsy: How do you test for brain stem function in coma patients?

• Pupils
• Corneal response
• Gag reflex
• Response to hypercapnia
• Vestibulo-ocular response

45

Week 232 - Epilepsy: What is the difference between arousal and awareness?

Arousal - Level of consciousness/alertness
Awareness - Content of consciousness, awareness of self and environment.

46

Week 232 - Epilepsy: What is persistent vegetative state?

Recovery of arousal but not awareness.

47

Week 232 - Epilepsy: What is persistent vegetative state mainly due to?

Diffuse cortical or subcortical damage.

48

Week 232 - Epilepsy: What is a minimally conscious state?

Patients may,
- Make eye contact/turn head when spoken to
- Grasp an object when asked
- Mouth words
- Track objects with eyes
- Have some intelligent verbalisation

49

Week 232 - Epilepsy: What is the vestibulo-ocular response?

When an ear is irrigated with cold water the eyes should deviate towards that ear.
- An abnormal response indicates pontine damage, drugs/metabolic, CN palsy.

50

Week 232 - Epilepsy: Which anti-epileptic drug does not reduce the efficacy of the oral contraceptive pill?

Clobazam