Epilepsy

Question 1

define absence (petit mal) seizures

Answer 1

brief episodes (3-20s) of staring with impairment of awareness and responsiveness

Question 2

characteristics of petit mal seizures

Answer 2

sudden onset and end 
no warning prior 
immediate alertness and attention following
occur 4-14yrs and resolve by 18yrs  
provoked by hyperventilation

Question 3

characteristic of petit mal seizures lasting >10s

Answer 3

eye blinks
brief automatic mouth of hand movements
changes in muscle tone

Question 4

EEG appearance of petit mal seizures

Answer 4

generalised 3Hz spike-wake discharge

Question 5

characteristics of atypical absence seizures

Answer 5

last 5-30s 
begin before 6yrs 
not provoked by rapid breathing 
incomplete reduction in responsiveness 
eye blinking 
lip twitching

Question 6

EEG appearance of atypical absence seizures

Answer 6

generalised ‘slow spike waves’ of < 2.5Hz

Question 7

define tonic-clonic seizures (grand-mal or convulsive)

Answer 7

seizures that cause a loss of consciousness associated with an initial tonic phase of stiffening, falling or a cry

Question 8

characteristics of grand-mal seizures

Answer 8

extension of lower limbs 
extension/flexion of upper limbs 
jerking of extremities - increases in amplitude then decreases in frequency
drooling or foaming 
biting of mouth 
bladder or bowel incontinence 
post lethargy and confusion

Question 9

EEG characteristics of a grand-mal seizure

Answer 9

generalised polyspikes

Question 10

management of seizures

Answer 10

anti-epileptics such as lamotrigine, levetiracetam and valproate can be used in all seizure types

Question 11

anti-epileptics used for treatment of focal seizures

Answer 11

carbamazepine
gabapentin
phenytoin

Question 12

anti-epileptics used in absence seizures

Answer 12

ethosuximide

Question 13

management of epilepsy in women

Answer 13

lamotrigine should be used in women of child bearing age - AVOID valproate

Question 14

characteristics of complex epileptic seizures

Answer 14

patient loses consciousness after an aura or at seizure onset
post-ictal symptoms

Question 15

characteristics of simple epileptic seizures

Answer 15

no loss of consciousness
only experience focal symptoms
no post-ictal symptoms

Question 16

characteristics of secondary generalised seizures

Answer 16

focal seizure developing into a generalised seizure (tonic-clonic)

Question 17

features of temporal lobe focal seizure

Answer 17

lip-smacking
deja vu or jamais vu
emotional disturbance
olfactory or auditory hallucinations

Question 18

features of frontal lobe focal seizures

Answer 18

Jacksonian features
dysphasia
Todd’s Palsy

Question 19

features of parietal lobe focal seizures

Answer 19

tingling and numbness

motor symptoms

Question 20

potential triggers of seizures

Answer 20

poor sleep
alcohol and drugs 
stroke 
intracranial haemorrhage 
space-occupying lesions 
metabolic disturbance

Question 21

management of absence seizures

Answer 21

sodium valproate

ethosuximide

Question 22

management of tonic-clonic seizures

Answer 22

sodium valproate

lamotrigine

Question 23

management of myoclonic seizures

Answer 23

sodium valproate
topiramate
levetiracetam

Question 24

management of atonic seizures

Answer 24

sodium valproate

lamotrigine

Question 25

characteristics of myoclonic seizures

Answer 25

sudden jerking motion of limbs, trunk or face

Question 26

characteristics of atonic seizures

Answer 26

sudden loss of muscle tone causing fall

retain consciousness

Question 27

side effects of topiramate

Answer 27

abdominal pain
cognitive behavioural change/impairment
weight loss
bowel habit change

Question 28

side effects of lamotrigine

Answer 28

blurred vision 
ataxia 
diarrhoea 
headache 
rash

Question 29

side effects of carbamazepine

Answer 29

skin problems
oedema
fatigue
blood disorder

Question 30

side effects of sodium valproate

Answer 30

weight gain
headache
transient hair loss
anaemia