Epilepsy

Question 1

What is a seizure?

Answer 1

Transient neurological condition caused by abnormal electrical activity (excitatory > inhibitory neurones)

Question 2

3 features used to diagnose epilepsy?

Answer 2

1. 2 unprovoked seizures >24 hours apart
2. 1 unprovoked seizure with a high risk of recurrence
3. epilepsy syndrome features

Question 3

4 main stages of a seizure? What are the characteristic features of each stage?

Answer 3

1. prodromal - irritable, mood changes
2. early ictal (aura) - sensory, cognitive, behavioural changes, emotions
3. ictal - typically refers to Generalised tonic-clonic seizure
4. post-ictal - reduced consciousness, malaise, memory loss, confusion

Question 4

Typical features of the ictal period?

Answer 4

Refers to Generalised Tonic-Clonic seizures in lay-mans terms:

• urinary incontinence
• tongue biting
• stiffness (tonic) and rhythmic jerking (clonic)

Question 5

How long does the ictal period generally last for?

Answer 5

1-2 minutes

Question 6

3 main types of seizures?

Answer 6

1. focal
2. generalised
3. unclassified

Question 7

2 main types of focal/partial seizures?

Answer 7

1. aware (simple partial seizures)

2. unaware (complex partial seizures)

Question 8

Motor symptoms you can get with seizures?

Answer 8

tonic - increased tone/stiffness 
clonic - rhythmic jerking 
atonic - floppy 
myoclonic - "shock like" jerks 
spasms - sudden flexion and extension movements

Question 9

Types of generalised seizures?

Answer 9

1. absence
2. generalised tonic-clonic
3. atonic seizures
4. myoclonic seizures
5. tonic seizures

Question 10

Absence seizures classically appear in which type of patients?

Answer 10

Young children

Question 11

Investigations for epilepsy?

Answer 11

1. bedside - ECG
2. bloods - FBC, U&Es, LFTs, CRP, glucose, bone profile
3. imaging - MRI head (rule out causes)
4. EEG - confirm diagnosis (cannot be use to rule out)

Question 12

Management of epilepsy? (3)

Answer 12

1. 1st fit clinic (for investigations and AEDs if necessary)
2. education and lifestyle advice

Question 13

1st line AEDs used in focal epilepsy?

Answer 13

Lamotrigene (women of childbearing age) or Cabamezipine

Question 14

1st line AEDs used in generalised tonic-clonic epilepsy?

Answer 14

Sodium valproate (or Lamotrigine in women of childbearing age)

Question 15

AED typically used as 1st line in absence, atonic and myoclonic epilepsy?

Answer 15

Sodium valproate

Question 16

Why is sodium valproate not used in women of child bearing age?

Answer 16

Highly teratogenic

Question 17

Education and Lifestyle advice given in epilepsy?

Answer 17

1. Driving - inform DVLA and stop for 6 months for cars after 1st seizure and 1 year after epileptic seizure
2. water - take showers not baths, caution when swimming
3. fire and electrical hazards

Question 18

2 main complications of epilepsy?

Answer 18

1. Sudden Unexplained Death in Epilepsy (SUDEP)

2. Status Epilepticus

Question 19

What is status epilepticus?

Answer 19

When a seizure persists for more then 5 mins or 2 seizures occur without a period of recovery inbetween

Question 20

Initial management of Status?

Answer 20

1. A-E assessment

2. IV Lorazepam (rectal diazepam or buccal midazolam in the community)

Question 21

How long should you wait before giving another dose of IV Lorazepam to a patient with Status?

Answer 21

10 mins

Question 22

What should you give after giving 2 doses of benzodiazepine in a patient with Status? (3 options)

Answer 22

1. IV Phenytoin
2. IV Phenobarbital
3. IV Fosphenytoin

Question 23

Main risk factors for Sudden Unexplained Death in Epilepsy (SUDEP)?

Answer 23

1. nocturnal seizures

2. poorly controlled epilepsy