506. Epilepsy

Question 1

What are the causes of a seizure?

Answer 1

Epilepsy

Idiotpathic

Cortical scarring

Space occupying lesion

Stroke

vascular malformation

TS, Sarcoid, PAN, antibodies of voltage gated potassium channels

Question 2

What are some good questions to ask in seizure history?

Answer 2

Tongue biting and slow recovery

Funny turns/odd behaviour

Deja vu and odd episodic feelings of fear

Question 3

What may provoke a seizure?

Answer 3

Trauma, stroke, heamorrhage, raosed ICP

Alcohol of benxo withdrawl

Metabolic distrubance- Hypoxia, hypo/hypernatraemia, hypocalcaemia, low/high glucose, ureamia, liver disease

Infection- meningitis, encephalitis

Tricylclics, cocaine

Question 4

What are the different types of focal seizures?

Answer 4

Impaired awareness- usually temporal lobe

Focal awareness- no change in awareness, change in vody. no post ictal

evolving bilateral convulsive- starts focally, spreads wide

Question 5

What are the different types of generalised seizures?

Answer 5

Tonic clonic- Limbs stiffen, then jerk

Myoclonic- spasm of one limb

Absence seizures- ~10s

Infantile spasms-

Question 6

What are the symptoms of a temporal lobe epilepsy

Answer 6

Lip smcaking, chewing

Dysphagia

Deja-vu

Emotional disturbance

Hallucinations

Delusional behavious

Question 7

What are the symptoms of a frontal lobe epilepsy

Answer 7

Motor feautres

Jacksonian march

Motor arrest

Dysphagia or speech arrest

Post ictal Todd’s palsy

Question 8

What are the symtpoms of a parietal lobe epilepsy

Answer 8

Sensory disturbances

Motor symptoms

Question 9

What are the symptoms of an occipital lobe epilepsy?

Answer 9

Visual phenomenon

Question 10

What is the first line drug tresatment for focal sizures

Answer 10

Carbamazepine or lamotrageine

Question 11

First line treatment for tonic clonic seizures is what

Answer 11

Sodium valproate or lamotrigine

Question 12

A patient has an absentm tonic/atoniuc or myoclonic seizure. What is first line?

Answer 12

Sodium valproate

Question 13

What is the process of stopping antiepileptic medication

Answer 13

Can consider if seizure free for 2 years

Assess risks and benefits

Decrease slowly over 2/3 months

Question 14

What side effects are assoicated with carbamazepine

Answer 14

Leucopenia

Diplopia

Blurred vison

SIADH

Question 15

Lamotragine risks the incurrence of which side effects?

Answer 15

maculopapular rash- may lead to steven johnsons syndrome)

Diplopia, tremor

Aplatic anaemia

Question 16

the drug Levetiracetam can cause which side effects

Answer 16

Psychaitric side effects- depression/agitation.

D&V, drowsiness

bloody dyscriasis- marrow failure

Question 17

Sodium valproate seems to be the go to drug but what are the side effects

Answer 17

Watch LFT’s

Nausea

Curly hair

Pancreatitis

Question 18

The side effects that phenytoin posseses are what

Answer 18

High toxcity levels (nystagmus, diplopia, tremor, dysarthria)

Decreased intellect, depression, gum hypertrophy

Coarse facial features

Question 19

Which anti-epileptic drugs are liver enzyme INDUCING?

Answer 19

Carbamazepine, phenytoin and barbituates

Question 20

What is the chat withepilepsy and pregnancy?

Answer 20

5% risk of fetal abnormalities

Take folic acid 5mg

Avoid sodium valproate

Carbamazepine and valpraote are not present in breastmilk. Lamotrigine not harmful.

Question 21

How do anti-epileptics affect contraception?

Answer 21

Make progesterone only unreliabel

Oestrogen containing lower lamotrgine levels