Epilepsy

Question 1

What is the presentation of a generalised tonic-clinic seizure?

Answer 1

Loss of consciousness
Patients might experience aura before the seizure
May be tongue biting, incontinence,groaning and irregular breathing

Tonic = muscle tensing
Clinic = muscle jerking

Question 2

What is a post ictal period? After what type of seizure is it usually seen?

Answer 2

Person is confused, tired, irritable, low
Tonic clinic

Question 3

Where do partial seizures most often occur?

Answer 3

Temporal lobe

Question 4

Partial seizure in temporal lobe. How might it present?

Answer 4

Affects hearing, speech, memory and emotion
Awake

Question 5

What is the difference between simple and complex partial seizures?

Answer 5

Simple = remain aware
Complex = lose awareness

Question 6

What is a myoclonic seizure?

Answer 6

Sudden, brief muscle contractions e.g. abrupt jump or jolt
Awake

Question 7

What type of epilepsy are myoclonic seizures apart of?

Answer 7

Juvenile myoclonic epilepsy in children

Question 8

What are tonic seizures?

Answer 8

Tonic seizures involve a sudden onset of increased muscle tone, where the entire body stiffens. This results in a fall if the patient is standing, usually backwards. They last only a few seconds, or at most a few minutes.

Question 9

What are atonic seizures?

Answer 9

Loss of muscle tone resulting in a fall
<3mins
Aware

Question 10

What may atonic seizures indicate?

Answer 10

Lennox-Gastaut syndrome

Question 11

What are absence seizures?

Answer 11

Patient becomes blank, stares in to space and then returns to normal
Unaware of surroundings
10-20s

Question 12

What is west syndrome?

Answer 12

Infantile spasms
Starts at around 6months of age
Clusters of foul body spasms
Associated with developmental regression

Question 13

What is the characteristic eeg finding in west syndrome?

Answer 13

Hypsarrhythmia

Question 14

What is treatment of west syndrome with? (2)

Answer 14

ACTH
Vigabatrin

Question 15

What are febrile convulsions?

Answer 15

Febrile convulsions are tonic-clonic seizures that occur in children during a high fever. They are not caused by epilepsy or other pathology (e.g., meningitis or tumours). Febrile convulsions occur in children aged between 6 months and 5 years. Febrile convulsions do not usually cause any lasting damage. One in three will have another febrile convulsion. They slightly increase the risk of developing epilepsy.

Question 16

Which types of epilepsy are more common in children? (3)

Answer 16

Absence seizures
Infantile spasms
Febrile convulsion

Question 17

What safety precautions are put in place with people experiencing seizures? (3)

Answer 17

• The DVLA will remove their driving licence until specific criteria are met (e.g., being seizure-free for one year)
• Taking showers rather than baths (drowning is a major risk in epilepsy)
• Particular caution with swimming, heights, traffic and dangerous equipment

Question 18

What is the management of generalised tonic clinic seizures in:
Men/women who can’t have children?
Women who can have children?

Answer 18

Men/women who can’t = sodium valproate
Women who can = lamotrigine or levetiracetam

Question 19

What is the management of partial seizures for:
Men/women who can’t have children?
Women who can have children?

Answer 19

Both = lamotrigine or levetiracetam

Question 20

What is the management of myoclonic seizures for:
Men/ women who can’t have children?
Women who can have children?

Answer 20

Men/women who can’t = sodium valproate
Women who can = levetiracetam

Question 21

What is the management of tonic and atonic seizures for:
Men/women who can’t have children?
Women who can have children?

Answer 21

Men/women who can’t = sodium valproate
Women who can = lamotrigine

Question 22

What is the management of absence seizures?

Answer 22

Ethosuximide

Question 23

What is a main side effect of lamotrigine?

Answer 23

Steven Johnson syndrome

Question 24

What are some side effects of ethosuximide? (2)

Answer 24

Night terrors
Rash

Question 25

What is carbamazepine the first line management for?

Answer 25

Trigeminal neuralgia

Question 26

What is a side effect of carbamazepine?

Answer 26

Aplastic anaemia

Question 27

What is a side effect of phenytoin?

Answer 27

Folate and vit d reduction .: osteomalacia

Question 28

What is the action of sodium valproate?

Answer 28

Increases activity of gaba .: has a calming effect on the brain

Question 29

What are some side effects of sodium valproate? (5)

Answer 29

• Teratogenic (harmful in pregnancy)
• Liver damage and hepatitis
• Hair loss
• Tremor
• Reduce fertility

Question 30

What is status epilepticus defined as? (3)

Answer 30

• A seizure lasting more than 5 minutes
• Multiple seizures without regaining consciousness in the interim
more than 3 seizures in 1 hour

Question 31

What is the first line treatment of status epilepticus?

Answer 31

A benzodiazepine first-line, repeated after 5-10 minutes if the seizure continues
□ Buccal midazolam (10mg)
□ Rectal diazepam (10mg)
□ Intravenous lorazepam (4mg)

Question 32

Person is in status epilepticus and has already been given 2 doses of first line treatment. What is next option?

Answer 32

§ Second-line options (after two doses of benzodiazepine) are IV levetiracetam, phenytoin or sodium valproate

Question 33

What is the third line options in status epilepticus?

Answer 33

§ Third-line options are phenobarbital or general anaesthesia

Question 34

What types of benzodiazepines are used for status epilepticus in the community? (2)

Answer 34

□ Buccal midazolam (10mg)
□ Rectal diazepam (10mg)

Question 35

What is the option for benzodiazepines for status epilepticus in the hospital?

Answer 35

Intravenous lorazepam (4mg)