Epilepsy

Question 1

Define epilepsy

Answer 1

Tendency to have recurrent, unprovoked seizures

Question 2

Define seizure

Answer 2

Transient excessive electrical activity with motor, sensory, cognitive manifestations discernible to patient or observer

Question 3

What are the two groups of seizures?

Answer 3

Generalised
Partial
Depends on if the abnormal electrical activity is whole brain or focal

Question 4

What are the different types of generalised seizures?

Answer 4

Tonic-clonic 
Absence
Atonic
Tonic
Clonic
Myclonic

Question 5

What are the features of tonic-clonic seizures?

Answer 5

‘Grand Mal’
Patients are initially rigid - tonic
Convulse with rhythmical muscular contractions - clonic

Question 6

What are the features of absence seizures?

Answer 6

Children
Loss consciousness
Appears vacant
Up to 30 seconds

Question 7

What are the features of an atonic seizure?

Answer 7

Brief loss of muscle tone

Patient falls to the ground

Question 8

What are the features of a tonic seizure?

Answer 8

Rigidity

Question 9

What are the features of a clonic seizures?

Answer 9

Convulsions

Rhythmical muscular contractions

Question 10

What are the features myoclonic seizures?

Answer 10

An extremely briefly contraction
<0.1 seconds
Jerky movement

Question 11

What are the two types of partial seizures?

Answer 11

Impaired consciousness
Unimpaired consciousness

Also classified re area of brain affected

Question 12

Using what investigations is epilepsy diagnosed?

Answer 12

Electroencephalogram

MRI

Question 13

What are some RFs for generalised seizures?

Answer 13

FH
Prev CNS infection
Head trauma
Prior seizure events

Question 14

What other investigations should be done for suspected epilepsy?

Answer 14

Blood glucose (extreme hyper/hypo can provoke GTCS)
FBC (signs of infection)
Electrolyte panel
Toxicology panel
Head CT (structural lesion)

Question 15

What anti-convulsant drugs are used to treat GTCS?

Answer 15

First line: Valproate - 10-15mg/kg/day

Lamotrigine - specialist needed for dosing

Levetiracetam - 500mg orally 2x a day increase gradually

Phenytoin - 15-20mg/kg orally

Gabapentin - 300mg 3x a day increase gradually

Question 16

What anti-convulsants are used in absence seizures in children?

Answer 16

Valproate

Lamotrigine

Question 17

What are some diagnostic features of focal seizures?

Answer 17

Movement on one side of the body or specific part
Premonitory sensation e.g. fear, epigastric sensation, jamais vu, deja vu
(temporal lobe)
Temporary aphasia
Staring and becoming unaware of surroundings

Question 18

What are the features of non-epileptic seizures?

Answer 18

Present with epileptic-like seizures
No characteristic electrical discharges
Mental Health history

Question 19

What anti-convulsant is first line for focal seizures?

Answer 19

Carbamazepine

Question 20

For how long can you not drive following a seizure?

Answer 20

6 months

If epilepsy has been established they must be 12 months fit free

Question 21

What need to be considered with valproate?

Answer 21

Teratogenic

Question 22

What is the mechanism of action of sodium valproate?

Answer 22

Increases GABA activity

Question 23

What is the mechanism of action of carbamazepine?

Answer 23

Binds to sodium channels increasing refractory period

Question 24

What is the mechanism of action of lamotrigine?

Answer 24

Sodium channel blocker

Question 25

What is the mechanism of cation of phenytoin?

Answer 25

Binds to sodium channels increasing their refractory period

Question 26

What medication can be used as ‘rescue’ for acute management of seizures?

Answer 26

Benzodiazepine

Intranasal or sublingual

Question 27

What factors favour true epileptic seizures over psychogenic?

Answer 27

Tongue biting

Raised serum prolactin

Question 28

What favours psychogenic seizures?

Answer 28

pelvic thrusting
family member with epilepsy
much more common in females
crying after seizure
don't occur when alone
gradual onset