Epilepsy

Question 1

What is epilepsy?

Answer 1

The tendency to have recurrent seizures

Question 2

What is a seizure?

Answer 2

Transient episodes of abnormal electrical activity in the brain.

Question 3

How do tonic-clonic seizures present?

Answer 3

Tongue biting 
Muscle jerking 
Incontinence 
Foaming at the mouth 
Loss of consciousness

Question 4

What does the patient experience after the seizure?

Answer 4

Post ictal period

Question 5

What is the post ictal period?

Answer 5

Person is confused, drowsy and feels irritable or low for about 15 minutes after the seizure

Question 6

What is the first line management of tonic clonic seizures?

Answer 6

Sodium valporate

Question 7

Who is sodium valporate not recommended for use in?

Answer 7

Girls

Question 8

Why is sodium valporate not recommended in girls?

Answer 8

It is teratogenic

Question 9

What is an alternative to sodium valporate?

Answer 9

Lamotrigine

Question 10

Where do focal seizures start in the brain?

Answer 10

In the temporal lobe

Question 11

What do focal seizures affect?

Answer 11

Hearing
Speech
Memory
Emotions

Question 12

How do focal seizures present?

Answer 12

• Hallucinations
• Memory flashbacks
• Déjà vu
• Doing strange things on autopilot

Question 13

What is the first line management for focal seizures?

Answer 13

Carbamazepine

Question 14

Who do absence seizures mainly affect?

Answer 14

Children

Question 15

How does a child having an absence seizure present?

Answer 15

The patient becomes blank, stares into space and then abruptly returns to normal

Question 16

How long do absence seizures normally last?

Answer 16

About 10 to 20 seconds

Question 17

What is the main management of absence seizures?

Answer 17

Ethosuximide

Question 18

What are atonic seizures also known as?

Answer 18

Drop attacks

Question 19

What are atonic seizures characterised by?

Answer 19

Brief lapses in muscle tone.

Question 20

How long do atonic seizures last?

Answer 20

Less than 3 minutes

Question 21

When do atonic seizures typically start?

Answer 21

In childhood

Question 22

What is the main management of an atonic seixure?

Answer 22

Sodium valproate

Question 23

How does a myoclonic seizure normally present?

Answer 23

Sudden brief muscle contractions, like a sudden “jump”.

Question 24

What is the main management of myoclonic seizures?

Answer 24

Sodium valproate

Question 25

What are infantile spasms also referred to as?

Answer 25

West syndrome

Question 26

When do infantile spasms/ west syndrome occur?

Answer 26

About 6 months of age

Question 27

How are infantile spasms/west syndrome characterised?

Answer 27

Clusters of full body spasms.

Question 28

What is the prognosis of West syndrome/infantile spasm?

Answer 28

Poor prognosis: 1/3 die by age 25,

Question 29

What is the problem with infantile spasms/ west syndrome?

Answer 29

Difficult to treat

Question 30

What is the management of infantile spasms/west syndrome?

Answer 30

• Prednisolone

* Vigabatrin

Question 31

What is the key to diagnosing epilepsy?

Answer 31

A good history

Question 32

What imaging investigations can you do for Epilepsy?

Answer 32

EEG

MRI

Question 33

What general advice can you give to a parent with an epileptic child?

Answer 33

• Take showers rather than baths
• Be very cautious with swimming unless seizures are well controlled and they are closely supervised
• Be cautious with heights
• Be cautious with traffic
• Be cautious with any heavy, hot or electrical equipment
Older teenagers with epilepsy will need to avoid driving unless they meet specific criteria regarding control of their epilepsy

Question 34

What would you find on EEG if the child had West syndrome?

Answer 34

Hypsarrhythmia

Question 35

What is West syndrome characterised by?

Answer 35

Flexion of the head and limbs, extension of the arms