Epilepsy

Question 1

Type of seziure that involves muscle tensing and muscle jerking associated with a complete loss of consciousness? and treatment?

Answer 1

Generalised tonic- clonic seizures/grand mal seizures

Patients may also experience an aura before

May be:
* Tongue biting
* Incontinence
* Groaning
* Irregular breathing
* Post ictal period after seizure where patient is confused, tired, irritable

Treatment:
Males- sodium valporate- increases GABA
Females- lamotrigine or levetiracetam

Question 2

Seizure where patients may remain awake but it affects their hearing, speeech, memory and emotions? Treatment?

Answer 2

Partial seizure/focal seizures

Often occur in the temporal lobes

Symptoms:
* Deja vu
* Strange smells and tastes
* Rising epigastric sensation
* Unusual emotios
* lip smacking, grabbing, head jerks

Treatment:
* 1st line- lamotrigine or levetiracetam
* 2nd line- carbamazepine, oxcarbazepine or zonisamide

Question 3

Patient presents with sudden, brief muscle contractions like an abrupt jump or jolt. They remain awake. What seizure is this? Treatment?

Answer 3

Myoclonic seizure

Treatment:
* Males- sodium valporate
* Females- levetiracetam

Question 4

Patient is standinf and suddenly their whoel body stiffens usually causinf them to fall backwards lasting a few seconds. Type of seizure? Treatment?

Answer 4

Tonic seizure

Treatment:
* Males- sodium valporate
* Females- lamotrigine

Question 5

Patient suffers from drop attacks where they suddenly fall to the floor- happened since childhood. Type of seizure? Treatment?

Answer 5

Atonic seizure- sudden loss of muscle tone can be indicative of Lennon-Gastaut syndrome

Treatment:
* Male- sodium valporate
* Females- lamotrigine

Question 6

Child becomes blank, stares into space and then abruptly returns to normal lasting 10-20 seconds. Type of seizure?

Answer 6

Absence seizures

Treatment:
* 1st line- ethosuximide
* 2nd line- male- sodium valporate female- lamotrigine/levetiracetam

Question 7

What are infantile spasms?

Answer 7

Also known as west syndrome

Starts at about 6 months of age- presnets with a cluster of full body spasms

EEG-hypsarrhythmia

Associated with dveelopmental regression and a poor prognosis

Treatment- ACTH and vigabatrin

Question 8

What are febrile convulsions?

Answer 8

Tonic-clonic seizures that occur in children during a high fever
Do not cause lasting damage

Question 9

Define status epilepticus and its mangement?

Answer 9

Aseizure lasting more than 5 mins or multiple seizures without regaining consciousness

ABCDE:
* secure airway
* Give o2
* check blodo glucose
* gain IV access

Medication:
* 1st line- Benzodiazepine repeat after 5 mins
* options- Buccal midazolam (10mg), recatl diazepam (10mg) or IV lorazepam (4mg)
* 2nd line- after 2 doses of benzodiazepine- IV levetiracetam, phenytoin or sodium valporate
* 3rd line- phenobarbital or general anaesthesia

Question 10

Where in the brain are focal seizures localised compared to generalised?

Answer 10

Focal- within one hemisphere
Generalised- both hemisphere

Question 11

Before starting lamotrigine what risks need to be discussed with the patient?

Answer 11

• Need for regular dosing
• Requirement for long term therapy
• Risk of hypersensitivity rash

Question 12

Non-epileptic attack features?

Answer 12

• Prolonged period >10mins
• Back arching
• Asynchronus limb movement
• Eyes tightly closed

Question 13

Vaso vagal attack?

Answer 13

Fainting
Will appear clammy, dizziness etc but will be well orientated on recovery