Epilepsy

Question 1

What is epilepsy

Answer 1

neurological disorder characterised by recurrent seizures

Question 2

What are seizures

Answer 2

A seizure is defined as a paroxysmal alteration of neurological function as a result of excessive, hypersynchronous discharge of neurons within the brain

Question 3

What causes a seizure

Answer 3

imbalance between excitation and inhibition within the neurons of the brain.

Question 4

What is the imbalance between

Answer 4

• GABA -VE
• GLUTAMATE +VE

Question 5

Inherited risk factors of epilepsy

Answer 5

• premature birth
• brain development malformation
• fx
• av malformation

Question 6

Acquired risk factors

Answer 6

• febrile convulsions
• brain tumor
• traumatic brain injury

Question 7

What can trigger a seizure

Answer 7

• Non-adherence with anti-epileptic -drugs (AEDs)
• Fatigue
• Stress
• Alcohol or recreational drugs
• Flashing lights

Question 8

How are seizures classified

Answer 8

1-Where the seizures began
2-Level of awareness during the seizure
3-Other features of the seizure e.g. motor

Question 9

Pre - ictal phase features ?

Answer 9

• triggers such as alcohol
• aura - subjective feeling of warning pre- seizure
• mood changes
• anxiety
• difficulty sleeping
• feeling that your gonna have a seizure b4 you have it not everyone has it

Question 10

what to investigate during the Ictal stage ? 6

Answer 10

• length of seizure
• appearance
• progression
• consciousness
• injury
• urinary incontinence

Question 11

What would jerking suggest

Answer 11

tonic clonic

Question 12

What occurs in a tonic clonic seizure

Answer 12

• no aura
• rigidity, fall to floor
• clonic phase , jerking phase
• eyes open
• incontinence
• tongue biting

Question 13

What is myoclonic

Answer 13

Some or all of the body suddenly twitches. Usually lasts less than a second

Muscle twitching and spasming

Question 14

What is a behavioural arrest seizure and what does it suggest?

Answer 14

A type of focal non-motor seizure characterized by an arrest or pause of activities, freezing, or immobilization as the predominant semiological feature throughout the seizure

Arrest seizure? IDK Maryam’s retarded

Question 15

What is atonic

Answer 15

Sudden loss of muscle strength. Can cause a person to drop to the ground

Question 16

What occurs during an abscence seizure

Answer 16

• childhood moments of staring blankly into space
• 3hz spike on ecg

Question 17

what to investigate in the post - ictal symptoms 5

Answer 17

post ictal symptoms:

• drowsiness
• headaches
• amnesia
• dysphagia
• sore tongue

Question 18

Where can seizures originate?

Answer 18

• Focal: originates within one side of the brain
• Generalised: involve both hemispheres of the brain at onset
• Focal to bilateral: previously termed ‘secondary generalised’, the seizure starts on one side of the brain and spreads to both sides
• Unknown: difficult to determine in some cases

Question 19

What is the most common location of focal seizures

Answer 19

temporal lobe

Question 20

Temporal lobe focal seizure features

Answer 20

• oral automatis , lip smacking, chewing
• manual automatism - picking, fumbling
• auras - deja vu, unpleasant smells

Question 21

frontal lobe features of a focal seizure

Answer 21

• sexual automatism
• predominantly motor symptoms
• bizarre behavior

Question 22

occipital focal seizure features

Answer 22

• vision loss

Question 23

Initial investigations

Answer 23

Bedside

• Urinalysis: nitrites or leucocytes would suggest infection
• Capillary blood glucose: to exclude hypoglycaemia
• ECG: to exclude differentials such as cardiogenic syncope

Bloods

• FBC
• Inflammatory markers
• U&E,bone profile , mg2+

Question 24

Imaging for a seizure

Answer 24

ct head - to exclude intracranial causes such as haemorrhage

Question 25

Diagnosis for epilepsy must involve?

Answer 25

must have had 2 or more seizures withins 24hr periodq

Question 26

Conservative management

Answer 26

• education
• stop driving

Question 27

medical management ?

Answer 27

• anti epileptic drugs
  
  • sodium valproate for general epilepsy
  • carbamezepine for focal seizures

Question 28

who cant have sodium valproate

Answer 28

except females of child bearing age

Question 29

mechanism of sodium valproate

Answer 29

• increases conc of GABA

Question 30

Acute complications

Answer 30

• Injury
• Tongue biting
• Shoulder dislocation: usually posterior
• Status epilepticus: state of prolonged seizure activity >5 minutes

Question 31

Three types of focal seizures

Answer 31

• Complex- with impairment of consciousness
• Simple- no impairment of consciousness
• Secondary generalised - focal to bilateral

Question 32

first line tx for focal seizures

Answer 32

Lamatrogine or levetiracetam
1st line for tonic clonic focal

Question 33

What seizures have sodium valproate as first line tx

Answer 33

Abscence

Generalised - tonic-clonic

myoclonic

Question 34

Complications of epilepsy

Answer 34

• Status epilepticus - >5 minutes of continuous seizures
• Depression
• Suicide
• Sudden unexpected death in epilepsy (SUDEP)

Question 35

what medication may worsen myoclonic seizures

Answer 35

carbamezepine

Question 36

asynchronous limb movements, trunk movements and eyes being closed would suggest ?

Answer 36

dissociative seizure

Question 37

Side effects of lamotrigine

Answer 37

• blurred vision
• agitation
• diplodopia
• rash
• tremor

Question 38

’ crazy movements’ sudden jerking of a limb , trunk or face with preserved consciousness would indicate

Answer 38

Myoclonic seizure

Question 39

jacksonian march ?

Answer 39

Seizure starts in one group but can then move to another
Classic to focal motor seizures