Epilepsy

Question 1

What is epilepsy?

Answer 1

-A recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain
-Manifests as seizures
-Convulsions = motor signs of electrical discharges

Question 2

What causes epilepsy?

Answer 2

-2/3 are idiopathic
-STRUCTURAL - cortical scarring eg from head injury, developmental, space-occupying lesion, stroke, vascular malformations
-OTHER - SLE, sarcoidosis, tuberous sclerosis

Question 3

How does epilepsy present?

Answer 3

-PRODROME lasting hours/days experienced by some patients, change in mood / behaviour
-AURA may occur which implies a focal seizure
-POST-SEIZURE - headache, confusion, myalgia, temporary weakness, dysphasia

Question 4

How is epilepsy diagnosed?

Answer 4

-Thorough HISTORY including witness history, asking about tongue-biting and slow recovery
-Establish the TYPE OF SEIZURE ie focal or generalised (tonic-clonic, absence, myoclonic)
-RULE OUT provoking causes eg trauma, stroke, haemorrhage, alcohol / benzo withdrawal

Question 5

How would you investigate a patient with epilepsy?

Answer 5

-Look for provoking causes
-EEG
-MRI
-Drug levels of anti-epileptics
-Drugs screen
-LP if infection suspected

Question 6

How would you manage a patient with epilepsy?

Answer 6

-Counsel about dangers eg swimming, driving, heights until diagnosis is advised
-Contact DVLA and cannot drive until seizure-free
-Anti-epileptics (commenced by specialist) eg carbamazepine, lamotrigine, sodium valproate
-Psychological therapies eg CBT, relaxation
-SUDEP occurs most commonly in uncontrolled epilepsy related to nocturnal seizures