Epilepsy

Question 1

what is epilepsy?

Answer 1

tendency to recurrent seizure without provoking factors due to abnormal electrical activity

Question 2

what is the pathophysiology of epilepsy?

Answer 2

synchronous discharge in cortical neurones causes too much excitation or damaged neurones or too little inhibition

Question 3

how is a diagnosis of epilepsy made?

Answer 3

based on the characteristics of the seizure episodes

Question 4

what investigations would we do?

Answer 4

EEG= typical patterns in different forms of epilepsy and support the diagnosis
MRI brain= visualise structure of the brain to look for structural problems

Question 5

what are generalised tonic-clonic seizures?

Answer 5

loss of consciousness and tonic (muscle tensing) and clonic (muscle jerking) episodes- typically tonic phase before clonic and maybe tongue biting, incontinence and groaning –> generalised abnormality on EEG

Question 6

what happens after a tonic-clonic seizure?

Answer 6

prolonged post-ictal period where the person is confused, dross and feels irritable or depressed

Question 7

how are tonic-clonic seizures managed?

Answer 7

1st line= sodium valproate and 2nd line= lamotrigine or carbamazepine

Question 8

what are focal seizures?

Answer 8

start in the temporal lobe so affect hearing, speech, memory and emotions and can present as hallucinations, memory flashbacks, deja vu or doing strange things on autopilot –> seen as focal abnormality on EEG

Question 9

how are focal seizures treated?

Answer 9

1st line= carbamazepine or lamotrigine and 2nd line= sodium valproate or levetiracetam

Question 10

what are absence seizures?

Answer 10

patient becomes blank and stares into space and then abruptly returns to normal, unaware of surroundings and wont respond during the episode and typically lasts 10-20 seconds

Question 11

who normally has absence seizures?

Answer 11

children but tend to stop having them as they get older

Question 12

how are absence seizures treated?

Answer 12

sodium valproate or ethosuximide

Question 13

what are atonic seizures?

Answer 13

known as “drop attacks” and are characterised by brief relapses in muscle tone and don’t last more than 3 minutes, typically begin in childhood and may be indicative of Lennox-Gastaut syndrome

Question 14

how are atonic seizures treated?

Answer 14

1st line= sodium valproate and 2nd line= lamotrigine

Question 15

what are myoclonic seizures?

Answer 15

sudden brief muscle contractions= like a sudden “jump” and patient usually remains awake during the episode and they occur in various forms of epilepsy but typically happen in children as part of juvenile myoclonic epilepsy

Question 16

how are myoclonic seizures managed?

Answer 16

1st line= sodium valproate

Question 17

what are infantile spasms?

Answer 17

also known as west syndrome, rare disorder starting in infancy and is characterised by clusters of full body spasms

Question 18

how are infantile spasms treated?

Answer 18

prednisolone and vigabatrin

Question 19

how does sodium valproate work and what is it used for?

Answer 19

increases activity of GABA which has a relaxing effect on the brain and is used first line for most forms of epilepsy except focal seizures

Question 20

what are the side effects of sodium valproate?

Answer 20

teratogenic so patients need to be careful about contraception, liver damage and hepatitis, hair loss and tremor

Question 21

what are the possible side effects of carbamazepine and what is it used for?

Answer 21

first line for focal seizures and causes agranulocytosis, aplastic anaemia, induces the P450 system so there are may drug interactions

Question 22

what is status epilepticus?

Answer 22

medical emergency and defined as seizures lasting more than 5 minutes or more than 3 seizures in one hour

Question 23

what are the risk factors for status epilepticus?

Answer 23

non-adherence to treatment, chronic alcoholism, refractory epilepsy, toxic or metabolic causes, acute brain injury

Question 24

what are the medical treatments for status epilepticus in the community?

Answer 24

buccal midazolam and rectal diazepam

Question 25

how is status epilepticus treated in hospital?

Answer 25

ABCDE approach= secure airway, give high concentration oxygen, assess cardiac and respiratory function, check blood glucose levels, gain Iv access and IV lorazepam repeated after 10 minutes if seizure continues

Question 26

what is syncope?

Answer 26

transient loss of consciousness provoked by cerebral hypoxia and can cause myoclonic jerks, verbalisations and eye movements which can mimic seizures

Question 27

what are the 3 categories of syncope?

Answer 27

reflex, orthostatic and cardiogenic

Question 28

what is reflex syncope?

Answer 28

stressful situation= increased vagal tone= decreased HR and BP= syncope

Question 29

what is orthostatic syncope?

Answer 29

normally BP related to Shen changing postions so when standing up fell faint and pass out - endocrine and ANS diseases, dehydration and antihypertensive medications increase risk

Question 30

what is cardiogenic syncope?

Answer 30

fall in cardiac output eg arrhythmia, aortic stenosis

Question 31

what are pseudo seizure/non-epileptic attack?

Answer 31

seizures not due to abnormal electrical activity and tend to be in people who have experienced trauma or have a chronic underlying illness