Epilepsy

Question 1

Epilepsy

Answer 1

Chronic neurological disorder manifesting by repeated epileptic seizures, which result from paroxysmal uncontrolled discharge of neurone within CNS
Clinical manifestations range from major motor convulsion to brief period of lack of awareness

Question 2

Pathogenesis

Answer 2

Animal models of focal epilepsy suggest central role for excitatory NT glutamate (inc in epilepsy) and inhibitory gamma am ion acid butyric acid (dec)

Question 3

Epidemiology and course

Answer 3

Any age
5% of population
0.5-1% have recurrent
70% well controlled with drugs
30% partially resistant to drug treatment= intractable epilepsy

Question 4

Classification

Answer 4

Based upon nature of seizure rather than presence of absence of an underlying cause
Focal seizures- account for 80% of adult epilepsies
Simple partial seizures
Complex partial seizures
Generalised seizures

Question 5

Partial seizure types

Answer 5

Focal
Jacksonia (focal motor seizures)
Temporal lobe

Question 6

Focal seizures

Answer 6

Specific area of brain has generated abnormal electrical activity
Clinical features depend on area
Characterised by aura

Question 7

Jacksonia

Answer 7

Simple motor seizure which originates in motor cortex
Jerking movements (angle of mouth –> limbs)
Weakness may persist for several hours- Todds’ paralysis

Question 8

Temporal lobe seizures

Answer 8

Partial seizures characterised by feeling of reality (jamais vu) or familiarity (deja vu)
Absence attacks
Vertigo
Hallucinations

Question 9

Generalised seizures

Answer 9

Tonic/clonic (grad mal seizures, generalised major convulsion)

Question 10

DDX

Answer 10

Syncope attacks
Cardiac arrhythmias
Migraine
Hypoglycaemia
Panic attack

Question 11

Investigation

Answer 11

Concern of clinician is that epilepsy may be symptomatic of a treatable cerebral lesion
Routine- haematology, biochemistry (electrolytes, urea, calcium), x-ray
Specialised neurophysiological investigations- sleep deprived EEG, video EEG monitoring
Advanced investigations- neuropsychology, semi-invasive EEG recording, MR spectroscopy, PET scan

Question 12

Treatment

Answer 12

Anticonvulsant drugs
Surgery may be necessary
Treatment target is seizure freedom and improvement of QOL
Most common drugs- sodium valproate, lamotrigine (1st line), toprimate (2nd), start slow and simple, mono therapy and careful monitoring over time