Neurology > Epilespsy > Flashcards

Epilespsy Flashcards

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1
Q

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

A

Sodium Valporate

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

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2
Q

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

A

Carbemazepine

Lamotrigine

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3
Q

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

A

Sodium valporate

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4
Q

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

A

Sodium valporate

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5
Q

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

A

Sodium valporate

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6
Q

When would you usually start prophylactic anti epileptics?

A

After a second epileptic seizure

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7
Q

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

A

Partial seizure

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8
Q

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

A

Generalised seizure

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9
Q

What is the commonest site of origin for partial seizures?

A

Temporal lobe

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10
Q

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

A

Frontal lobe. Parietal and Occipital seizures are rare

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11
Q

What is meant by a simple partial seizure?

A

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

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12
Q

What is meant by a complex partial seizure?

A
  • 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
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13
Q

What is a secondarily generalised seizure?

A

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

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14
Q

When do patients having a generalised seizure usually lose consciousness?

A

At the seizure onset

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15
Q

Briefly describe a tonic - clonic seizure

A
  • 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
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16
Q

How long do most seizures last?

A

Less than 2 minutes

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17
Q

Describe an absent seizure?

A

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.

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18
Q

What is a myoclonic seizure?

A

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

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19
Q

What is an atonic seizure?

A

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

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20
Q

What is a febrile convulsion?

A

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

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21
Q

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

A

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

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22
Q

How would you treat a febrile convulsion?

A
  • Rectal/IV diazepam
  • Supportive treatment
  • Treatment of the underlying condition.
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23
Q

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

A

Hippocampus

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24
Q

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

A

Absent seizures

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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
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