11: Epilepsy

Question 0

Epilepsy- cc

Answer 0

Endogenous factor- neurological defect. esp in ion gated channels
Epileptogenic factor- space occupying lesion, metabolic conditions, alzheimers, trauma, alcohol withdrawal, injury from birth to a neonate
Precipitating factor- flashing lights (used as dx), sleep deprivation, loud sounds

Question 1

Epilepsy- info Ddx: seizure

Answer 1

Seizure: abnormal excessive excitation of neurons in brain
Epilepsy: 2 or more episodes of seizure

Question 2

Epilepsy- path

Answer 2

excess or lack of glutamate

EEG: spike and wave morphology at an episode

Question 3

Epilepsy- types

Answer 3

Partial- one part of brain: no loss of consciousness*

• Simple: pt is aware. can be motor, sensory, visual, psychogenic, etc
• Complex: impaired consciousness, cannot respond stimulus

Generalized- whole brain: loss of consciousness*
-Tonic clonic (Gran mal)
-Absence (Petit mal)
-Myotonic
Atonic
Secondary generalization*- start as partial and progress to generalized

Question 4

Epilepsy- simple partial- motor features

Answer 4

Motor**

• Jacksonian march (episode starts with one part and moves around the body)
• Epilepsia partialis continua (partial types epilepsy that continues. Ddx: status epilepsy: loss of consciousness)
• Todd’s palsy (temporary loss of sensation/paralysis)

Question 5

Epilepsy- partial complex- features

Answer 5

Starts with Aura
Does not respond to verbal command- disconnect from the environment-> motionless and stare into a space
Then the episode can be variable- lipsmacking, dishwashing etc

Question 6

Epilepsy- Complex- Tonic clonic features

Answer 6

Loss of consciousness
Tonus phase- sustained contraction of muscles, impaired respiration (cyanosis), tongue biting, cry/ moan, secretion
Clonic phase- contraction/relaxation, foaming (churned saliva)
Flaccid phase- urinate/defecate, strider, limp
Recovery of consciousness- confusion, body-ache
EEG: Tonus: multiple full waves, Clonus: hard waves and mild waves

Question 7

Generalized- Absence

Answer 7

Common in children
Outgrow as they grow
200-300 episodes a day for few seconds (stare in a space, blinking)
Hx: Day dreamer, Grades suddenly goes down
EEG: 3 spikes in 1 second

Question 8

Generalized- Atonic

Answer 8

Drop attack

Question 9

Generalized- Myoclonic

Answer 9

Loss of consciousness followed by jerky movements

Question 10

Secondary generalization

Answer 10

Complex partial-> Generalized
Aura** followed by Tonic clonic
Tx is different so needs to dx*

Question 11

Investigation

Answer 11

CBC
Electrolytes
EEG* (diagnostic)

Question 12

tx*

Answer 12

Partial: carbamezepine
2dary generalized: carbamazepine
Generalized: valproic acid
Absence: ethosuximide

Question 13

Status epilepticus

Answer 13

Epileptic attack anything above 15mins*
EEG: crazy polyspikes
Medical emergency due to complicatons;
Hyperthermia
Lactic acidosis
Hypoxia/Hypercapnia
Hyperkalemia/ Hyponatremia
Rhabdomyalysis-> acute renal failure

Question 14

Status epilepticus- tx

Answer 14

In this order as long as pt is under episode

1: Diazepam/ Lorazepam-> 2: second dose
3: Phenytoin-> 4: Phenytoin
5: Phenobarbital
6: Phenytoin
7: Anesthesia

Pregnant woman: increase folate to the above (minimum dose with one dose)
Mother of neonate: concentration of drug is low enough in breast milk so feeding to the baby is okay