EPILEPSY

Question 1

What is epilepsy?

Answer 1

ongoing susceptibility to recurrent epileptic seizures

Question 2

What are epileptic seizures?

Answer 2

sudden synchronised discharge of cerebral neurones causing symptoms or signs that are clear to patient or observes

Question 3

What are primary causes?

Answer 3

• epilepsy syndromes, usually genetic causes
• neurodegenerative e.g. parkinsons

Question 4

What are acquired causes?

Answer 4

• excitatory/inhibitory receptors can be effected by infection/tumours/injury

Question 5

What are electrolyte causes?

Answer 5

drugs can reduce seizure threshold
alcohol has inhibitory effect in the brain as it up regulates excitatory neurotransmitters

Question 6

What drugs can reduce seizure threshold

Answer 6

• antimicrobials e.g. beta-lactams, chloroquine
• antipsychotics - clozapine
• antidepressants - trycilic antidepressants (in overdose)

Question 6

How do beta lactams reduce threshold?

Answer 6

• mainly in high doses for infections in CNS
• penicillin

Question 7

How does anti-tuberculosis reduce threshold?

Answer 7

• inhibits formation of GABA
• increased excitatory neurotransmission

Question 8

What is generalised seizures?

Answer 8

whole brain

Question 9

What does antipsychotics need to be coprescribed with and why?

Answer 9

• anti-epileptics because the risk of stopping antipsychotics are too high

Question 10

What is focal (partial) seizure?

Answer 10

focus of electrical activity in one hemisphere or one lobe

Question 11

What are the different focal seizures and describe them

Answer 11

simple: dont lose consciousness
complex: lose consciousness

Question 12

what is secondary generalisation

Answer 12

when focal seizures develop onto general seizures

Question 13

What are the different types of generalised seizures?

Answer 13

tonic-clonic: alternating stiffening
tonic: stiffening
myoclonic: muscle contractions, often rhythmic, involuntary
Atonic: drop seizures
abscence seizures: involves both sides of brain, begins in childhood - loss of awareness for under 10yo

Question 14

What is Jacksonian march?

Answer 14

starts in one place and spreads throughout the limb

Question 15

What is Todd’s paralysis?

Answer 15

temporary paralysis of the limb

Question 16

What are the characteristics of tonic phase in tonic-clonic seizures?

Answer 16

Tonic(10-20s) - funny feeling
- tonic stiffening which can cause patient to dall
- larynx contracting
- cyanosis (bluish/purple skin) due to respiratory impairment
- tonic contractions of jaw leading to tongue biting
- increases sympathetic activity (tachycardia + hypertension)

Question 17

What are the characteristics of the clonic phase in tonic-clonic seizures?

Answer 17

• 1 min
  -convulsions (discharges in brain are being disrupted by small periods of relaxation)
• eyes open/tongue biting
• urine/faecal incontinence

Question 18

What is the post-ictal?

Answer 18

• lasts 1-2 hrs
• flaccid unresponsiveness
• drowsiness &confusion

Question 19

What is status epileptics?

Answer 19

continuous seizure longer than 5 mins
- failed to terminate

Question 20

What are the investigations for epilepsy

Answer 20

blood tests, MRI, EEG, safety advice: avoid swimming or baths or working at heights
stop driving

Question 21

What is syncope

Answer 21

describes loss of consciousness for a short period of time

Question 22

What is the difference between seizure and syncope

Answer 22

in syncope there is no tongue biting, pallor, prolonged standing and rapid recovery
whereas in seizure there is post-ictal confusion, longer recover, during there is tongue biting and cyonosis

Question 23

Why is it difficult to withdraw epileptic treatment?

Answer 23

50% chance of recurrence

Question 24

What is refractory epilepsy?

Answer 24

when anti epileptics are no longer controlling the seizures

Question 25

When is surgery necessary

Answer 25

if there is a focus of epilepsy e.g. tumour

Question 26

When do you consider to remove antiepileptic drugs?

Answer 26

if seizure free for over 3 years

Question 27

Why is it dangerous to take anti-epileptics for pregnant women?

Answer 27

they can be teratogenic - causes fatal abnormalities

lamotrigine is the safest