Epilepsy

Question 1

what questions should you ask a patient who has presented with a seizure?

Answer 1

what happened before/during/after

how did they feel

what were they doing

Question 2

what is a vital part of a history of a seizure?

Answer 2

eye witness account

Question 3

what investigation is mandatory following a seizure?

Answer 3

ECG

Question 4

what imaging can be done to look for a possible cause of a seizure?

Answer 4

MRI or CT

Question 5

what are the indications for EEG following a seizure?

Answer 5

classification of epilepsy
confirming non-epileptic attacks
surgical evaluation

Question 6

how long must you be seizure free after your first seizure before you can drive a car?

Answer 6

six months

Question 7

how long must you be seizure free after your first seizure before you can drive a HGV/PCV?

Answer 7

five years

Question 8

how long must you be seizure free if you have epilepsy before you can drive a car?

Answer 8

1 year

3 years if during sleep

Question 9

how long must you be seizure free if you have epilepsy before you can drive a HGC/PCV?

Answer 9

10 years off of medication

Question 10

what is epilepsy?

Answer 10

a tendency to recurrent, usually spontaneous, epileptic seizures

Question 11

what are epileptic seizures?

Answer 11

abnormal synchronisations of neuronal activity

Question 12

what does focal interruption of brain activity result in?

Answer 12

a focal seizure

Question 13

what does generalised interruption of normal brain activity result in?

Answer 13

a generalised seizure

Question 14

how long do seizures tend to last?

Answer 14

seconds to minutes

Question 15

when is epilepsy most common?

Answer 15

infancy to old age

Question 16

what are the two main types of epilepsy?

Answer 16

focal

general

Question 17

what is the seizure focus?

Answer 17

the part of the brain that is structurally abnormal in epilepsy

Question 18

how does structural abnormality result in an epileptic seizure?

Answer 18

the seizure focus irritates the surrounding brain, resulting in a seizure

Question 19

what part of the brain is irritated in focal epilepsy?

Answer 19

just the area around the seizure focus

Question 20

what is another name for focal epilepsy?

Answer 20

partial epilepsy

Question 21

what are the possible types of seizures seen in focal epilepsy?

Answer 21

tonic

tonic clonic

Question 22

what are the two types of focal epilepsy?

Answer 22

simple

complex/dyscognitive

Question 23

what is simple focal epilepsy?

Answer 23

without impaired consciousness

Question 24

what is complex focal epilepsy?

Answer 24

with impaired consciousness

Question 25

what motor symptoms can be seen in focal epilepsy?

Answer 25

rhythmic jerking posturing head and eye deviation vocalisation

Question 26

what psychiatric symptoms can be seen in focal epilepsy?

Answer 26

deja vu depersonalisation aphasia complex visual hallucinations

Question 27

what is it called when focal epilepsy becomes generalised?

Answer 27

second degree generalisation

Question 28

when can focal epilepsy come on?

Answer 28

any age

Question 28

what is the management for focal epilepsy?

Answer 28

carbamazepine or lamotrigine

Question 28

what is the pathophysiology behind general epilepsy?

Answer 28

irritation from the seizure focus spreads throughout the brain, irritating other areas

Question 28

what seizure types can be seen in general epilepsy?

Answer 28

``` absence myoclonic atonic tonic tonic clonic ```

Question 28

what is primary generalised epilepsy?

Answer 28

general epilepsy with tonic clonic seizures

Question 28

when does general epilepsy often present?

Answer 28

childhood or teenage years

Question 28

what is the treatment of choice for general epilepsy?

Answer 28

sodium valproate

Question 28

what is the alternative management of general epilepsy and when is this given?

Answer 28

lamotrigine pregnancy - sodium valproate is teratogenic

Question 28

how is general epilepsy with absence seizures managed?

Answer 28

sodium valproate | ethosuximide

Question 28

how is general epilepsy with myoclonic seizures managed?

Answer 28

sodium valproate levetiracetam clonazepam

Question 28

name four anticonvulsant drugs

Answer 28

phenytoin sodium valproate carbamazepine lamotrigine

Question 28

what drug can be given for acute management of a seizure?

Answer 28

phenytoin

Question 28

name some possible side effects of sodium valproate

Answer 28

weight gain teratogenic hair loss fatigue

Question 28

what is a possible serious side effect of lamotrigine?

Answer 28

stevens johnson syndrome

Question 29

what is status epilepticus?

Answer 29

recurrent epileptic seizures without full recovery of consciousness continuous seizure activity for >30 minutes

Question 30

what are the three types of status epilepticus?

Answer 30

generalised convulsive status non convulsive status epilepsia partíalis continua

Question 31

what happens in generalised convulsive status?

Answer 31

generalised convulsions without cessation

Question 32

what can generalised convulsive status cause?

Answer 32

respiratory insufficiency hypotension hyperthermia rhabdomyolysis

Question 33

how does non-convulsive status present?

Answer 33

conscious, but in an altered state

Question 34

how does epilepsy partialis continua present?

Answer 34

continual focal seizures preserved consciousness

Question 35

what are some possible precipitants of status epilepticus?

Answer 35

``` metabolic disorders infection head trauma abrupt withdrawal of anti-convulsants subarachnoid haemorrhage ```

Question 36

how is status epilepticus managed?

Answer 36

anti-convulsants = phenytoin, valproate benzodiazepines

Question 37

what should be give if a patient in status epilepticus is hypoglycaemic?

Answer 37

50ml 50% glucose

Question 38

what should be given if there is indications that a patient with status epilepticus is an alcoholic or has impaired nutritional status?

Answer 38

thiamine

Question 39

what should be done if status epilepticus persists?

Answer 39

transfer to ITU general anaesthesia monitor with full EEGs