Epilepsy

Question 1

How are seizures classified?

Answer 1

Focal onset
- Aware vs Impaired aware
- Motor onset vs nonmotor onset

Generalised onset
- Motor vs nonmotor (absence)

Unknown onset
- Motor vs nonmotor

Question 2

Young pt sleep deprived due to exams. Has GT seizure. Has generalized spike and wave pattern when drowsy on EEG. Dx?

Answer 2

Genetic generalized epilepsy
- can make Dx of epilepsy based on only 1 seizure because other presentation fits (ie young, sleep deprivation, typical EEG pattern)

Question 3

GLUT 1 deficiency manifestations? Treatement?

Answer 3

GLUT 1 def in infants can cause epilepsy
GLUT 1 def in adults can cause paroxysmal exersise induced dystonia +/- epilepsy +/- haemolytic anaemia

Due to inability to get glucose in CNS
Therefore treat with ketogenic diet

Question 4

What is tuberous sclerosis? Pathophys and treatment?

Answer 4

This is a rare AD inherited multisystem disorder that causes non cancerous tumers to grow in the brain and other organs
- many have epilepsy due to brain tumours

Due to mutations in TSC1 and TSC2 genes that lead to aberrent signalling in the mTOR pathway

Treated with mTOR inhibitors (everolimus)

Question 5

What is the HLA type assoicated with antiepileptics (aromatic such as carbamazapine) assoicated SJS/TEN?

Answer 5

HLA B1502
- han chinese

Question 6

What is the HLA type assoicated with antiepileptics (aromatic such as carbamazapine) assoicated DRESS?

Answer 6

HLA A 3101

Question 7

Slower background rhythm (6Hz) with Biphasic waves on EEG. What condition?

Answer 7

diffuse encephalopathy, mild

Question 8

Much slower (ie 4Hz) background waves. What condition?

Answer 8

moderate to severe diffuse encephalopathy

Question 9

Pt with epilepsy, found to have focal slowing on his non-seziure EEG? what does this indicated?

Answer 9

Focal slowing indicates a focal abnoramlity in the brain, could indicate structural cause of epilepsy

Question 10

What is a sharp wave discharge on EEG?

Answer 10

sharp wave followed by some slow waves is an epileptiform discharge

Question 11

What is spike a wave pattern on EEG?

Answer 11

This is analogous to the sharp wave discharge but generalized

Ie spike and wave pattern = generalized epileptiform discharge

Question 12

Pt has periodic lateralised epileptiform dischaerges (PLEDs). What condition?

Answer 12

Herpes simplex encephalitis

Looks like rhythmic period high amplitude spikes that occur more so on one side (ie lateralised to the left)

Question 13

Pt has generalised periodic epileptiform dischaerges (PLEDs). What condition?

Answer 13

Hypoxic brain injury

Question 14

What test to look as structure? and what test to look at funciton of brain in epilepsy?

Answer 14

MRI
PET / SPECT

Question 15

What are 2 common forms of focal epilepsy?
What is the most common cause?

Answer 15

Mesiotemporal lobe epilepsy
Frontal lobe epilepsy

Question 16

What is mesiotemporal lobe epilepsy. What type of seizure? What is the underlying pathology? Managment?

Answer 16

Mesiotemporal lobe epilepsy
- Common form of focal epilepsy
- Usually focal aware seizure -> focal imparied aware -> generalised tonic clonic
- Most common cause is hippocampal sclerosis characterized by neuronal loss and atrophy in the hipocampus (MRI), and PET decreased funcitoning

Cause is unknown

Management
- medicaitons
- Lifestyle modification (avoid etoh and stress)
- Psychological care

Question 17

First line medicatiosn for focal seizures (ie mesiotemporal lobe epilsepsy)?

Answer 17

Sodium channel blocker
- carbamazapine (ETG says this)
- lamotrogine (less enzyme inducing activity)
- Oxcarbazapine

Question 18

What is frontal lobe epilepsy. What type of seizure?

Answer 18

Frontal lobe epilepsy
- common form of focal onset seizure
- Form of seizure related to area affected. Can have sleep related hypermotor / hyperkinetic seizures
- Often short duration seizures, short post ictal period
- Caused by unilateral frontal lobe hypofunction (PET), nil structural change (MRI normal)

One form of frontal lobe epilepsy is called sleep related hyper motor epilepsy
- this is an autosomal dominant condition

Question 19

What is the most common form of generalized epilepsy?

Answer 19

Idiopathic generalised epilepsy is most common
- Juvelinile myoclonic epilepsic is a type of idiopathic generalized epilepsy

Question 20

What is juvenile myoclinic epilepsy? what are the features? managment?

Answer 20

• MRI normal
• PET normal

Presentation with classic triad of symptoms:
- Myoclonic jerks often in the morning. Often recalled as clumbsiness or dropping things in the morning
- generalised tonic clinic seizures, very symetrical
- Absence seizures occur in some pts

Seizures often happen when walking
Triggers:
- sleep deprivation
- stress
- alcohol in excess

managment:
- valproate in men (avoid in women because preg)
- Avoid carbamazapine, oxcarbazamine because and worsen abscense seizures
- Lifestyle care (triggers)
- psychosocial care

Question 21

Common form of autoimmune epilepsy? General treatment?

Answer 21

faciobrachial seizures (classically associated with Lgi1-encephalitis )
- AED + immunotherapy

Question 22

Treatment for abscence seizures in isolation?

Answer 22

Ethosuxamide

Question 23

What are 4x enzyme inducing antiepileptics?
What are 1x enzyme inhibiting antiepileptics?

Answer 23

phenytoin
Phenibarbitone
carbamazapine/oxcarbazine
primidone

Valproate

Question 24

1x example of anticonvulsant synergism?

Answer 24

valproate and lamotrogine

Question 25

First line med in generalised epilepsy?

Answer 25

VPA

Question 26

What are two new antiepileptics?

Answer 26

Perampanel
Lacosamide
Brivaracetam (new version of leviteracitam but with less neuropsychiatric side effects)

Question 27

Pt on multiple other medications, which antiuepileptic to avoid?

Answer 27

carbamazapine (enzyme inducer)

Question 28

Best drugs in preg for epi?

Answer 28

Lamotrogine and leviteracitam

Question 29

When does SUDEP occur most commonly in the preg?

Answer 29

thrid tri
post partum period

Question 30

Highest RF for SUDEP?

Answer 30

seizures from sleep