Epilepsy

Question 1

definition of seizure and epilepsy

Answer 1

Seizure: abnormal paroxysmal neuronal discharge of the brain

epilepsy: tendency to have seizures

Question 2

most common cause of epilepsy?

Answer 2

idiopathic (no clear cause)

genetics contribute to aetiology of epilepsy

Question 3

different types of epilepsy

Answer 3

Generalised: seizures start in and affect both sides of brain at once, happen w no warning

Focal: “” affect one part of brain
focal onset may spread to involve whole brain -> bilateral tonic clonic seizure (secondary generalisation)

Question 4

3 subtypes of generalised seizures?

Answer 4

tonic-clonic

Myoclonic

Absence seizure

Question 5

whats a tonic clonic seizure

Answer 5

tonic phase then
clonic phase: shaking of arm and legs
then post ictal period of sleepiness/drowsiness

Question 6

whats a myoclonic seizure?

Answer 6

jerky movements affecting both upper limbs w/out loss of consciousness

usually happens in morning

Question 7

whats an absence seixure?

Answer 7

childhood type of seizure, brief loss of contact with surroundings

Question 8

2 types of focal seizure?

Answer 8

focal aware seizure: consciousness not impaired

focal impaired awareness seizure: consciousness is impaired

Question 9

principle of management of epilepsy

main drug treatment?

Answer 9

anticonvulsants

e.g. carbamazepine, lamotrigine…

Question 10

how long is drug treatment required for?

Answer 10

2-3 years, sometimes lifelong

Question 11

how can compliance of drug treatment be increased?

Answer 11

patients must understand nature of treatment

most clinicians dont treat patients with a single seizure

Question 12

how will chosen drug treatment be introduced?

Answer 12

introduce at low dose, gradually increase to standard dose

Question 13

how to change drug treatment if seizures not controlled?

Answer 13

slowly inc to maximum tolerated before changing to another drug

Question 14

what type of therapy desired?

Answer 14

monotherapy.

combined only req in 10-15% patients w epilepsy

Question 15

surgical treatment for epilepsy

Answer 15

for drug-resistant patients

• temporal lobe resection (most common)
• extratemporal resection
• hemispherectomy
• corpus callosotomy
• vagus nerve stimulation

Question 16

implication of diagnosis of epilepsy on driving

Answer 16

not allowed unless seizure free for 1 years or had attacks during sleep for 3 years

large lorries and passenger vehicles: 10 years seizure free w/out taking AEDs

single seizure: wait 6 months

Question 17

implication of diagnosis of epilepsy on pregnancy and AED?

whats the main concern for any women taking AEDs?

Answer 17

baby with major congenital malformation such as neural tube defect

Question 18

whys sodium valproate contraindicated in preg?

Answer 18

can cause foetal valproate syndrome- dysmorphic features

AEDs stop in planning stages of preg if possible

Question 19

supplements: any woman on AEDs should take…?

Answer 19

5mg folic acid daily

Question 20

babies born to patients taking enzyme inducing AEDs (e.g. carbamazepine) should receive..?

Answer 20

1mg of Vit K IM at birth to reduce risk of haemorrhagic disease of newborn

Question 21

why should breatfeeding be encouraged (AEDs)?

Answer 21

amouont of AEDs excreted in breast milk too small to have significant problems to baby

Question 22

women on enzyme-inducing AEDs should avoid using what?

Answer 22

POP/COC containing less than 50mcg od oestrogen as Drug ineractions-> failure of the oral contraceptive

Question 23

whats (tonic clonic) status epilepticus?

Answer 23

Unremitting seizure: lasts >5 mins/
Recurrent seizures w/out regaining consciousness: >1 seizure within a 5 min period,

medical emergency that req prompt treatment to prevent any permanent/ long term cerebral damage

20% mortality rate

Question 24

how is status epilepticus managed?

Answer 24

emergency:
maintain airway, access breathing, give oxygen, maintain circulation, establish IV access

take blood for emerg. investigation (full blood count, gluc, renal, liver func tests, Ca level, AEDs level)

Question 25

drug management of status epilepticus?

Answer 25

dextrose (hyperglycaemia): thiamine (alcohol abuse)

Question 26

drug management of status epilepticus?

to stop seizures….

Answer 26

1. Lorazepam as IV bolus (or diazepam IV/rectally)
2. IV phenytoin infusion (valproate),(ECG, BP monitoring, pulse oximetry needed)
3. transfer to ICU if still …
   (propofol, thiopental, midazolam)