9. Epilepsy

Question 1

What is epilepsy?

Answer 1

Neurological condition characterised by recurrent and unpredictable SEIZURES - sudden irregular discharge of electrical activity (synchronous neuronal activity) in the brain causing a physical manifestation such as sensory disturbance, loss of consciousness or convulsions.

Can be:

1. primary - idiopathic
2. secondary - identifiable cause, e.g. head injury, hypoxia, tumour, stroke, infection, hypoglycaemia, drugs

Question 2

What are convulsions?

Answer 2

Rhythmic uncontrolled shaking movements of the body due to rapid and repeated contraction/relaxation of the body.

Question 3

What is an aura?

Answer 3

Perceptual disturbance experienced by some prior to a seizure (e.g. strange light, unpleasant smell, confusing thoughts).

Question 4

What are the 2 major types of seizures?

Answer 4

1. Partial/focal - involves 1 hemisphere or lobe

2. Generalised - both hemispheres affected

Question 5

What are the 2 main types of partial seizures?

Answer 5

1. Simple - normal consciousness, but may involve strange sensations or jerking movements in specific muscle groups depending on affected neurones
2. Generalised - impaired consciousness (loss of awareness and/or memory)

Question 6

Which area of the brain is affected in partial seizures presenting with auras (e.g. auditory hallucinations, rush of memories)? With abnormal movements?

Answer 6

1. Temporal lobe epilepsy can cause auras (most common, often onset in 1st-2nd decade).
2. Frontal lobe epilepsy can cause contralateral motor signs (2nd most common).

Question 7

P presents with seizure causing muscle stiffening (fell backwards). Type of seizure?

Answer 7

tonic

Question 8

P presents with seizure causing short muscle twitches. Type of seizure?

Answer 8

myoclonic

Question 9

P presents with seizure causing him to ‘space out’ for several secs. Type of seizure?

Answer 9

absence

Question 10

P presents with seizure causing violent and rhythmic body contractions. Type of seizure?

Answer 10

clonic

Question 11

P presents with seizure causing muscle relaxation (fell forwards). Type of seizure?

Answer 11

atonic

Question 12

P presents with seizure causing muscle stiffening followed by convulsions. Type of seizure?

Answer 12

tonic-clonic

Question 13

What is status epilepticus?

Answer 13

Epileptic seizures occurring continuously without consciousness recovery for over 5min. Usually caused by tonic-clonic seizures. Medical emergency.

Question 14

P presents with status epilepticus. How would you manage them?

Answer 14

i. ABCDE assessment
ii. Benzodiazepines: midozalam (5mg buccal) or lorazepam (4mg IV)
iii. Further dose if unresponsive after 5min
iv. IV phenytoin if still unresponsive after 10-15min

Question 15

Name 3 drugs you could use for long-term management of epilepsy.

Answer 15

1. SODIUM VALPROATE: 1st line for generalised seizures
2. CARBAMAZEPINE: 1st line for partial seizures
3. LAMOTRIGINE: partial or generalised seizures, least teratogenic