4. Epilepsy

Question 1

What is

Epilepsy

Answer 1

A sudden surge of electrical activity of Neurons in the brain

Question 2

What are

Non-epileptic seizures?

Answer 2

Unrelated to abnormal electrical activity in the brain.

(nothing to do with epilepsy)

2 types

Organic = hypoglycaemia, fever

psychogenic (mental/emotional) =
Distressing thoughts

Question 3

Define

Seizure

Answer 3

“Sudden attack of disease” usually caused by a sudden surge of electrical activity

Question 4

Define

Epilepsy syndrome

Answer 4

a group of features usually occuring together.

The features in a syndrome may include types of seizures 
commonly seen, 
age when seizures commonly begin, 
part of the brain involved, 
usual course, 
genetic information, 
and much more

Question 5

If epilepsy syndrome is not clear

How do we determine what to prescribe?

Answer 5

The type of seizure

Question 6

How do we consider what to prescribe in epilepsy

Answer 6

1. Epilepsy syndrome

If that is not clear then

2. Type of seizures

Question 7

Epileptic seizures

Types 2

Name them

Answer 7

Partial/forcal seizures

Generalised seizures

Question 8

Epileptic seizure

Partial/ forcal

Define:

Answer 8

The seizure activity is centralised in 1 part of the brain.

Sometimes the seizure activity spreads to other parts of the brain (secondary generalised seizures)

The person remains conscious.

Question 9

What is

secondary generalised seizure

Answer 9

In partial/ forcal seizures (where the seizure is centralised in 1 part of the brain)

Sometimes the seizure activity spreads to other parts of the brain this is secondary generalised seizure

Question 10

Define

Generalised seizure

Answer 10

The seizure affects the whole brain 🧠

The person loses consciousness

Question 11

Types of seizures

5

List them

Answer 11

1 forcal / partial seizures (with/without secondary generalisation) 1 part of the brain 🧠 person conscious.

2. Tonic-clonic seizures (generalised, unconscious)
3. Absence seizures (generalised, unconscious)
4. Myoclonic seizures (generalised, unconscious)
5. Atonic/tonic seizures (generalised, unconscious)

Question 12

What is

Tonic-clonic seizure?

1st line meds

Answer 12

(generalised, unconscious)

When muscles go stiff & starts jerking

1st line:

Valproate (if not suitable give: lamotrigine)

Also 1st line: carbamazepine

Question 13

What is

Partial/ forcal seizures?

First line meds?

Answer 13

Seizure in 1 part of the brain, sometimes it spreads to other parts ( secondary generalised seizure)

Patient conscious

1st line: lamotrigine/ carbamazepine

Alternatively

Valproate
Oxcarbazepine
Levetiracetam

Question 14

What is

Absence seizure ?

First line?

Answer 14

Pt looks blank, staring into space (daydreaming)

(unresponsive)

1st line:

Ethosuximide

valproate (especially if high risk of tonic-clonic seizures)

Alternatively: lamotrigine

Question 15

What is

Myoclonic seizure ?

First line?

Answer 15

Muscle jerking

1st line: valproate

Alternatively:

Topiramate

Or

Levetiracetam

Question 16

What is

Atonic/ tonic seizure?

1st line?

Answer 16

Atonic : Muscles go floppy

Tonic seizures : stiff muscles

Mainly seen in childhood

1st line: valproate

Question 17

Most teratogenic anti-epileptic

Answer 17

Valproate

Therefore avoid In premenopausal females

Question 18

When prescribing in epilepsy

remember 3 factors:

Answer 18

Age

Gender

Concomitant medication

Question 19

What is a

Febrile seizure

Answer 19

A febrile seizure is a convulsion in a child that’s caused by a fever. The fever is often from an infection. Febrile seizures occur in young, healthy children who have normal development and haven’t had any neurological symptoms before

they are harmless to the child. Febrile seizures do not cause brain damage, nervous system problems, paralysis, intellectual disability, or death

Symptoms of febrile convulsions
loss of consciousness (black out)
twitching or jerking of arms and legs.
breathing difficulty.
foaming at the mouth.
going pale or bluish in skin colour.
eye rolling, so only the whites of their eyes are visible.
your child may take 10 to 15 minutes to wake up properly afterwards.

Question 20

Most anti-epileptic medicine is given
BD

LIST 4 that are given OD

Answer 20

1. Lamotrigine
2. Phenytoin
3. Phenobarbital
4. Perampanel

ON (due to long half-life)

Question 21

What is the aim of treating epilepsy

Answer 21

Prevent seizures by maintaining an effective dose of 1 or more anti-epileptic drugs