Epilepsy

Question 1

what is epilepsy

Answer 1

tendency to have recurrent unprovoked seizures

Question 2

how many seizures must someone have had to be diagnosed with epilepsy

Answer 2

2 or more seizures

Question 3

what is a seizure

Answer 3

paroxysmal synchronised cortical electrical discharges

Question 4

what are the types of seizures

Answer 4

FOCAL SEIZURES (localised to specific cortical regions e.g temporal lobe seizure)

• Complex (consciousness affected)
• simple (consciousness not affected)

GENERALISED SEIZURES (affects the whole brain AND consciousness)

• tonic-clonic
• absence
• myoclonic
• atonic
• tonic

Question 5

aetiology/ causes of epilepsy

Answer 5

primary epilepsy syndromes are IDIOPATHIC

secondary epilepsy syndromes are secondary to a tumour, trauma, infection, drugs, vascular, inflammation etc.

Question 6

what common presentations may be mistaken for a seizure

Answer 6

syncope, migraines and dissociative disorder (Non epileptic seizures)

Question 7

what is the pathophysiology of seizures

Answer 7

Result from an imbalance in the inhibitory and excitatory currents or neurotransmission in the brain

Precipitants include anything that promotes excitation of the cerebral cortex

Often it is unclear why the precipitants cause seizures

Question 8

in between seizures is the patient normal

Answer 8

yes

Question 9

what type of history may be key in an epileptic patient

Answer 9

collateral history

Question 10

what types of things to ask and explore in history

Answer 10

Rapidity of onset

Duration of episode

Any alteration in consciousness?

Any tongue-biting or incontinence?

Any rhythmic synchronous limb jerking?

Any post-ictal abnormalities (e.g. exhaustion, confusion)?

Drug history (alcohol, recreational drugs)

Question 11

presentation of focal seizures

Answer 11

can be frontal (motor convulsions) or temporal lobe (hallucinations, aura - psychic symptoms)

Question 12

investigations for epilepsy

Answer 12

bloods (ruling out other causes or seeing infection/ inflammation)

EEG

CT/ MRI (to see structural, vascular or space occupying lesions)

Question 13

treatment of epilepsy

Answer 13

anticonvulsants (e.g. lamotrigine, levetiracetam, gabapentin, diazepam)

Question 14

prognosis of epilepsy

Answer 14

Nearly two-thirds of patients with focal seizures achieve adequate seizure control with anticonvulsant drugs, either monotherapy or polytherapy. Most patients are treated with anticonvulsants for at least 2 years