Week 232 - Epilepsy Flashcards by Tom Lawson

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.

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

Generalized

* Partial (Focal)

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

Complex - Loss of awareness.

* Simples - No loss of awareness.

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

Tonic-clonic
Absence
Myoclonic

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Week 232 - Epilepsy: What is a cryptogenic seizure?

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

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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

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

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

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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

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Week 232 - Epilepsy: What is NEAD?

• Non-epileptic attack disorder.

- Psychologically mediated episodes of altered awareness.

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

• Non-epileptic attack

-NEAD

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

Epileptic seizure.

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

Video EEG

* Expensive and time consuming.

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

• Developmental malformations, perinatal injuries and infections.

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

Idiopathic generalised epilepsy.

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

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

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

Brain tumours

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

Cerebrovascular disease.

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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.

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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.

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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.

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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.)

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

Carbamazepine/lamotrigine/levetiracetam

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

Tiredness, fatigue, dizziness.

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

Carbamazepine

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

Sodium Valporate

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

Levetiracetam

Week 232 - Epilepsy: What is status epilepticus?

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

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

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

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.

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

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

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

Week 232 - Epilepsy: What is SUDEP?

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

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

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

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

Week 232 - Epilepsy: Give a definition of coma.

A state of unrousable unconsciousness.

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

≤8

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

* Locked-in syndrome - Arousal and awareness retained. | * Psychogenic coma

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

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

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.

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.

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

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.

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

To identify a possible cause of SAH or meningitis.

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

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.

Week 232 - Epilepsy: What is persistent vegetative state?

Recovery of arousal but not awareness.

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

Diffuse cortical or subcortical damage.

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

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.

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

Clobazam