Epilepsy

Question 1

What is epilepsy?

Answer 1

Tendency to have seizures due to abnormal electrical activity in the brain

Question 2

What are the features of tonic-clonic seizures?

Answer 2

Loss of consciousness
Muscle jerking (clonic)
Muscle tensing (tonic)
Tongue biting
Incontinence

Question 3

Which phase usually comes first in a tonic-clonic seizure?

Answer 3

Tonic phase

Question 4

What is the first line treatment of tonic-clonic seizures?

Answer 4

Sodium valproate for males
Lamotrigine or levetiracetam for females

Question 5

What is the second line treatment of tonic-clonic seizures?

Answer 5

Lamotrigine or carbamezapine

Question 6

How does an absence seizure present?

Answer 6

Usually children
Stare into space for a few seconds
Abruptly returns to normal
Lasts around 20 seconds

Question 7

What is the first line management of absence seizures?

Answer 7

Ethosuximide

Question 8

When is sodium valproate contraindicated?

Answer 8

In females of fertile age

Question 9

What are the side effects of sodium valproate?

Answer 9

Teratogenic
Liver damage
Hair loss
Tremor
Weight gain
Oedema
Ataxia

Question 10

What is the first line medication for focal seizures?

Answer 10

Lamotrigine or leveteracitam

Question 11

What is the second line medication for focal seizures?

Answer 11

Carbamezapine

Question 12

What are the features of a frontal focal seizure?

Answer 12

Jacksonian features - numbness of tingling starts isolated, and then moves to the other limbs on the same side of the body
Dysphasia
Todd’s paresis

Question 13

What is Todd’s paresis?

Answer 13

When a seizure is followed by a brief period of paralysis

Question 14

What are the features of a temporal lobe focal seizure?

Answer 14

Deja vu
Lip smacking
Emotional disturbance - sudden onset of fear
Hallucinations - auditory, gustatory or olfactory

Question 15

What are the features of a parietal lobe focal seizure?

Answer 15

Sensory symptoms - tingling and numbness
Motor symptoms - from spread of seizure into pre-frontal gyrus where motor cortex is

Question 16

What are the features of an occipital focal seizure?

Answer 16

Visual symptoms - dots and lines in the vision

Question 17

What are the features of a myoclonic seizure?

Answer 17

Sudden jerking of the limbs, face or trunk

Question 18

What is the first line medication for a myoclonic seizure?

Answer 18

Sodium valproate for males
Levetiracetam for females

Question 19

What drug worsens myoclonic seizures?

Answer 19

Carbamezapine

Question 20

What is the first line medication in hospital for status?

Answer 20

IV lorazepam

Question 21

What is status epilepticus?

Answer 21

5 or more minutes of continuous seizure

Question 22

What is the driving guidance for patients with epilepsy?

Answer 22

1 seizure - 6 months seizure free
More than 1 seizure - one year seizure free

Question 23

What are the features of an atonic seizure?

Answer 23

Sudden loss of muscle tone, which leads to a fall
No loss of consciousness

Question 24

What is the first line management of status epilepticus in the community?

Answer 24

Buccal medazolam or rectal diazepam
Repeat 15 minutes later

Question 25

What medication can worsen absence seizures?

Answer 25

Carbamezapine

Question 26

What investigations are performed to diagnose epilepsy?

Answer 26

EEG (after 2 seizures) MRI brain ECG Electrolytes Blood glucose Blood cultures, urine cultures Lumbar puncture

Question 27

What is juvenile myoclonic epilepsy?

Answer 27

An epilepsy syndrome characteristed by infrequent generalised seizures (often in the morning), absence seizures and sudden shock like myoclonic jerks

Question 28

When is the typical onset of juvenile myoclonic epilepsy?

Answer 28

In teenage years

Question 29

Who is juvenile myoclonic epilepsy more common in?

Answer 29

Girls

Question 30

What is benign rolandic epilepsy?

Answer 30

An epileptic syndrome characterised by either tonic-clonic seizures, or focal seizures with abnormal sensation in the face - These seizures typically occur during sleep

Question 31

When can medication be started for seizures?

Answer 31

After a patient has had 2 seizures, and has been investigated with an EEG

Question 32

What are the fetal complications of antiepileptics in pregnancy?

Answer 32

Orofacial defects Haemorrhagic disease of the newborn Congenital heart defects Spina bifida

Question 33

What are the complications of sudden withdrawal of antiepileptics?

Answer 33

Status epilepticus Suddent unexpected death in epilepsy

Question 34

Do antiepileptic levels increase or decrease in pregnancy?

Answer 34

Decreased due to increased hepatic metabolism and increased renal clearance

Question 35

Can breastfeeding women take antiepileptics?

Answer 35

Yes

Question 36

What investigation can be used to distinguish between a true seizure and a pseudoseizure?

Answer 36

Prolactin - prolactin will be raised in a true eplipetic seizure

Question 37

What is the definition of a seizure?

Answer 37

A transient episode of abnormal electrical activity in the brain

Question 38

What general advice should be offered to parents of children with epilepsy?

Answer 38

Take caution when swimming Take caution with heights Shower rather than have a bath Record any further episodes Call 999 if a seizure lasts more than 5 minutes, or more than 2 minutes with LOC

Question 39

What is West syndrome?

Answer 39

A type of childhood epilepsy

Question 40

When does West syndrome typically present?

Answer 40

Between 4 and 8 months

Question 41

What are the features of West syndrome?

Answer 41

Salaam attacks - flexion of head trunk and arms, followed by extension of the arms

Question 42

What is the first line therapy for West syndrome?

Answer 42

Vigabatrin

Question 43

What features favour a pseudoseizure?

Answer 43

Pelvic thrusting Family member with epilepsy Crying after seizure Don't occur when alone Gradual onset