Epilepsy

Question 1

What are the causes of blackouts?

Answer 1

Vasovagal
Reflex syncope
Cardiogenic syncope
Epilepsy
Metabolic
Unkown

Question 2

What are the 3 categories of syncope?

Answer 2

Reflex (neurocardiogenic)- vagal tone increases
Orthostatic- BP related
Cardiogenic- CO falls

Question 3

What assessment is done for syncope?

Answer 3

Heart sounds
Pulse
Postural BPs
ECG- heart block, QT ratio

Question 4

What is a pseudo seizure?

Answer 4

Non epileptic attack

Question 5

What are provoked seizures?

Answer 5

Non epileptic:
- Alcohol/drug withdrawal
- Head injury
- Stroke
- Neurosugery

Question 6

What is epilepsy?

Answer 6

Tendency to recurrent seizures without provoking factors

Disruption of electrical activity in neurons causes seizures

Question 7

What are convulsions?

Answer 7

Motor signs of electrical discharges

Question 8

What is the classification of seizures?

Answer 8

Primary generalised
Focal/partial seizures

Question 9

What are generalised seizures?

Answer 9

Widespread electrical discharge with no localizing features referable to a single hemisphere

Question 10

What are the subtypes of generalised seizures?

Answer 10

Absences seizures
Tonic-clonic seizures
Myoclonic seizures
Atonic seizures
Infantile spasms

Question 11

What are the features of absence seizures?

Answer 11

Brief pauses (<10secs)
Presents in childhood

Question 12

What are the features of tonic-clonic seizures?

Answer 12

Loss of consciousness
Limbs stiffen (tonic) then jerk (clonic)
Post- ictal confusion and drowsiness

Question 13

What are the features of myoclonic seizures?

Answer 13

Sudden jerk of limb, face or trunk
May be thrown suddenly to ground or have a violently disobedient limb

Question 14

What are the features of atonic seizures?

Answer 14

Sudden loss of muscle tone causing fall
No loss of consciousness

Question 15

What are the elements of a seizure?

Answer 15

Prodrome
Aura (implies focal seizure)
Deja vu
Strange smells
Headache
Confusion
Myalgia

Question 16

What assessment is done for seizures?

Answer 16

Refer:
- MRI for focal lesion
- EEG
- Anti-epileptic drugs
- Refer to epilepsy nurse
- Inform DVLA

Question 17

What assessment is done for epilepsy?

Answer 17

EEG for primary generalised epilepsies
MRI if <50 with possible focal onset seizures
Video telemetry if uncertainty about diagnosis

Question 18

What is the treatment of generalised absence seizures?

Answer 18

First line: Sodium Valproate
Second line: Lamotrigine

Question 19

What is the treatment of generalised tonic clonic seizures?

Answer 19

First line: Sodium Valproate
Second line: Topiramate

Question 20

What is the treatment of generalised myoclonic seizures?

Answer 20

First line: Sodium Valproate
Second line: Topiramate

Question 21

What is the treatment of generalised atonic seizures?

Answer 21

Sodium Valproate or Lamotrigene

Question 22

What is the treatment of focal seizures?

Answer 22

First line: Lamotrigine
Second line: Sodium Valproate

Question 23

What are other interventions for epilepsy other than AEDs?

Answer 23

Psychological therapies- CBT
Surgical intervention- neurological resection, vagal nerve stimulation, deep brain stimulation (DBS)

Question 24

What is Status Epilepticus?

Answer 24

Generalised convulsive/non-convulsive seizures for 5 minutes or more

Question 25

What is the treatment of status epilepticus?

Answer 25

First line: Midazolam
Second line: Valproate
Third line: Anaesthesia