Epilepsy

Question 1

Epilepsy

Answer 1

• patients have recurrent epileptic seizures
• due to imbalance between excitatory and inhibitory neurosignalling

Question 2

Epilepsy risk factors

Answer 2

• head injury
• stroke
• space-occupying lesions
• neurodegenerative diseases
• lowered seizure threshold can be due to metabolic/electrolyte abnormalities, infections etc

Question 3

Seizure classification

Answer 3

• tonic-clonic - stiffening then jerking
• myoclonic - jerking movements
• atonic - sudden loss of tone
• absence - unresponsive but tone

Question 4

Seizure history

Answer 4

• prodrome e.g. sensory aura
• recent head trauma
• previous seizures
• activity at the time
• seizure - movements, tongue biting, incontinence, automatisms, abnormal speech, laughing or crying
• post-ictal confusion, weakness (Todd’s paresis)

Question 5

Seizure differentials

Answer 5

• functional neurological disorder
• vasovagal syncope/episode
• orthostatic syncope
• cardiac syncope

Question 6

Seizure investigations

Answer 6

• bedside - obs (hypoxia, ?unstable) and blood glucose
• bloods - FBC, U&Es, bone profile, VBG
• CT/MRI head to rule out other pathology
• electroencephalogram
• video-telemetry (video + EEG)

Question 7

Epilepsy diagnosis

Answer 7

• two or more unprovoked seizures more than 24 hours apart
• diagnosed with an epilepsy syndrome

Question 8

Tonic-clonic seizure management

Answer 8

• sodium valproate (men)
• lamotrigine or levetiracetam (women)

Question 9

Focal seizure management

Answer 9

lamotrigine or levetiracetam

Question 10

Myoclonic seizure management

Answer 10

• sodium valproate (men)
• levetiracetam

Question 11

Tonic/atonic seizure management

Answer 11

• sodium valproate (men)
• lamotrigine

Question 12

Absence seizure management

Answer 12

ethosuxamide

Question 13

Epilepsy lifestyle advice

Answer 13

• no driving until seizure-free for 1 year
• take showers, not baths
• caution with swimming, heights, traffic, dangerous equipment

Question 14

Sodium valproate side effects

Answer 14

• teratogenic (harmful in pregnancy)
• liver damage and hepatitis
• hair loss
• tremor
• reduce fertility

Question 15

Lamotrigine side effects

Answer 15

• rash - Stevens-Johnson syndrome (admit to hospital)
• headaches
• insomnia
• vivid dreams

Question 16

Status epilepticus management

Answer 16

• ABCDE approach
• benzo - buccal midazolam, rectal diazepam, IV lorazepam
• if fails - IV levetiracetam, phenytoin or sodium valproate
• if fails - phenobarbital, GA