epilepsy

Question 1

what is a focal seizure?

Answer 1

a partial seizure

Question 2

what happens during a simple focal seizure?

Answer 2

-remain conscious
-affects small part of brain

Question 3

what happens during a complex focal seizure?

Answer 3

-impairment in consciousness
-start in 1 hemisphere of the brain

Question 4

what causes epilepsy?

Answer 4

excessive electrical discharges in the brain

Question 5

what is the difference between focal seizures and generalised seizures?

Answer 5

focal seizures affect part of the brain- presentation depends on part of brain affected and no loss of consciousness
generalised seizures affect the whole brain-whole body presentation seen and loss of consciousness

Question 6

what are the symptoms/signs of a generalised seizure?

Answer 6

-possible brief warning
-sudden loss of consciousness
-rigid-fall to ground
-cyanotic tonic phase (not breathing, blue, stiff)
-jerking movements (clonic phase)
-possible foaming of mouth and urinary incontinence
-flaccid body still unconscious
-after variable time- gain consciousness but may be confused

Question 7

what is an absence seizure?

Answer 7

commonly seen in children-blank stare and no movement

Question 8

how would you investigate epilepsy?

Answer 8

blood tests
brain imaging-mri
EEG- diagnostic tool

Question 9

what group of drugs are used to treat epilepsy?

what is the dental Side effect of phe?

Answer 9

anticonvulsants:
carbmazepine, levetiracetam, lamotrigine, zonisamide, gabapentin, pregabalin, topiramate, primidone

phenytoin- gingival hypertrophy

Question 10

how would you manage an acute seizure?

Answer 10

ABCDE approach
-make sure pt is not at risk of harm e.g move sharp objects
-high flow o2- 15l/min
-do not attempt to restrain convulsions
-after convulsions put pt in recovery position and check airways
-check for slow HR- may cause seizure
-reassure and sympathise with pt- as they may have post-ictal confusion-stay with them until completely subsides)
-send to hospital if injury, first seizure or abnormal seizure
-if convulsions last longer than 5min call 999= 10mg midazolam administered buccally

Question 11

what should you give a patient whose convulsions last longer than 5 mins?

Answer 11

10mg midazolam (5mg/ml=2ml) administered buccally

Question 12

what is the dose of midazolam for children

Answer 12

6-11 months = 2.5mg
1-4 years 5mg
5-9 years- 7.5mg
10-17- 10mg

Question 13

what should you ask a patient with known epilepsy before treatment?

Answer 13

is it well controlled? if not- postpone treatment