Epilepsy

Question 1

What is a seizure?

Answer 1

An abnormal discharge of electrical activity in the brain

Question 2

What is epilepsy?

Answer 2

A tendency to recurrent, usually spontaneous, epileptic seizures

Question 3

What are some factors that can contribute to epilepsy?

Answer 3

Genetic factors
Acquired brain conditions
Metabolic factors
Toxic factors
Environmental factors

Question 4

Describe the aetiology of generalised epilepsy

Answer 4

Childhood - Adolescence
Usually have a genetic predisposition

Question 5

What is an epileptic seizure?

Answer 5

An abnormal synchronisation of neuronal activity, usually excitatory with high frequency action potentials but can sometimes be predominantly inhibitory

Question 6

What are some changes that occur in seizure?

Answer 6

• Cell numbers/types
• Connectivity
• Synaptic function
• Voltage-gated ion channel function

Question 7

What us the usual length of a seizure?

Answer 7

Seconds to minutes

Question 8

What are some ways in which seizures can be classified?

Answer 8

Location of onset
Awareness of seizure
Symptoms of seizure

Question 9

How are seizures classified by location of onset?

Answer 9

Focal
Generalised

Question 10

How are seizures classified by awareness?

Answer 10

Aware
Impaired

Question 11

How are seizures classified by symptoms?

Answer 11

Motor
Sensory
Psychic

Question 12

Describe the pathophysiology of focal seizure

Answer 12

1 area of the brain is structurally normal
This causes production of a seizure which stays in this area

Question 13

How can a focal seizure generalise

Answer 13

The area of electrical activity may pass onto a pathway that runs throughout the brain, causing spread to other parts of the brain

Question 14

What are the 3 main forms of focal seizure

Answer 14

Motor
Sensory
Psychic

Question 15

What are the 5 main types of generalised seizure?

Answer 15

Absence
Myoclonic
Atonic
Tonic
Tonic-Clonic

Question 16

Describe the pathophysiology of a generalised seizure

Answer 16

An abnormality occurs of a pathway that runs through the brain (Not an abnormality that spreads through the pathway), causing problems in many regions of the brain

Question 17

Presentation - Absence seizure

Answer 17

Goes blank and unresponsive for a few seconds

Question 18

Presentation - Myoclonic seizure

Answer 18

Sudden muscle jerks

Question 19

Presentation - Atonic

Answer 19

Muscles suddenly relax and the person will fall over

Question 20

Presentation - Tonic

Answer 20

Muscles go stiff and the person will fall

Question 21

Presentation - tonic-clonic

Answer 21

Muscles stuffed and tighten rhythmically

Question 22

What type of epilepsy is associated with hippocampal sclerosis

Answer 22

Temporal lobe epilepsy

Question 23

What are some risk factors for juvenile myoclonic epilepsy?

Answer 23

Sleep deprivation
Flashing lights

Question 24

How will juvenile myoclonic epilepsy present?

Answer 24

Early morning jerks
Generalised myoclonic (rhythmic muscle jerks) seizures

Question 25

What are some symptoms of motor focal epilepsy?

Answer 25

Rhythmic jerking, posturing, head and eye deviation, other movements (eg cycling), automatisms (eg plucking), vocalisation

Question 26

What are some symptoms of sensory focal epilepsy?

Answer 26

Somatosensory, olfactory, gustatory, visual, auditory dysfunction

Question 27

What are some symptoms of psychic focal epilepsy?

Answer 27

Memories, déjà vu, jamais vu, depersonalisation, aphasia, complex visual hallucinations etc

Question 28

What are some important history points in epilepsy?

Answer 28

What were they doing before, during and after the event, what did they look like (Ask witnesses), what type of movements were there

Question 29

What test is always performed in suspected seizure?

Answer 29

ECG - Rule of prolonged QT syndrome

Question 30

What are the uses of EEG in epilepsy?

Answer 30

Distinguish between non-convulsive status and encephalopathy Otherwise very unreliable

Question 31

What are some uses of CTb or MRIb in epilepsy?

Answer 31

Indicated in acute cases to rule out skull fracture, in cases of deteriorating GCS or head injury

Question 32

What anti-E drugs are good for most seizure types?

Answer 32

Lamotrigine Levetiracetam Valproate

Question 33

What are some anti-E medications used in focal seizures?

Answer 33

Carbamazepine Gabapentin Phenytoin

Question 34

What anti-E drug may worsen myoclonic seizures

Answer 34

Carbamazepine

Question 35

Drug - Absence seizures

Answer 35

Ethosuxamide Sodium valproate

Question 36

Drug - Myoclonic seizures

Answer 36

- Sodium valproate - Levetiracetam - Clonazepam

Question 37

Drug - Tonic, atonic, generalised tonic-clonic

Answer 37

- Sodium valproate (1st line) - Levetiracitam - Lamotrigine

Question 38

Describe the car driving rules for seizures (Non-epilepsy)

Answer 38

1st seizure = 6 months no car-driving

Question 39

Describe the HGV driving rules for seizures (Non-epilepsy)

Answer 39

1st seizure = 5 years no HGV-driving

Question 40

Describe the car driving rules for epilepsy

Answer 40

1 year no car-driving following last seizure

Question 41

Describe the HVG driving rules for epilepsy?

Answer 41

10 years no HGV-driving following last seizure and no medication

Question 42

What are some of the pre-synaptic targets for anti-epileptic drugs?

Answer 42

Voltage-gated Na+ channels (drives APs) Voltage-gated K+ channels (Lowers neuronal excitation) SV2A (Neurotransmitter release) Voltage-gated Ca2+ channels (influx drives neurotransmitter release)

Question 43

What anti-E medications target voltage-gated Na+ channels to reduce APs in the pre-synaptic neurones

Answer 43

Carbamazepine Lamotrigine Phenytoin

Question 44

What anti-E medication targets voltage-gated K+ channels to reduce pre-synaptic neuronal excitation?

Answer 44

Retigabine

Question 45

What anti-E medications target SV2A channels to reduce neurotransmitter release?

Answer 45

Levetiracetam

Question 46

What anti-E medications target voltage-gated Ca2+ channels to reduce neurotransmitter release?

Answer 46

Pregabalin Gabapentin Ethosuxamide

Question 47

What are some targets for anti-E medication in the GABA system?

Answer 47

GABA synthesis GABA transporter (Removes GABA from synapse) GABA transaminase (Degrades GABA) GABA receptor (Reduces neuronal excitability)

Question 48

What anti-E medication increases GABA synthesis?

Answer 48

Sodium valproate

Question 49

What anti-E medication inhibits the GABA transporter?

Answer 49

Tiagabine

Question 50

What anti-E medications inhibit GABA transaminase?

Answer 50

Vigabatrin

Question 51

What anti-E medications increase GABA receptor presentation?

Answer 51

Benzodiazepines Barbituates Falbamate Topiramate

Question 52

Side effects of phenytoin

Answer 52

Gum hyperplasia Hair growth

Question 53

Side effects of sodium valproate

Answer 53

Weight gain !!!!!!!!!!!!!!! Teratogenic !!!!!!!!!!!!!!!!!!!!!!! Hair loss Fatigue

Question 54

Side effects of levetiracetam

Answer 54

Mood swings

Question 55

Side effects of topiramate

Answer 55

Sedation Dysphasia Weight loss

Question 56

What anti-E medications can alter the efficacy of morning-after pill

Answer 56

- Carbamazepine - Oxycarbazepine - Phenobarbitol - Phenytoin - Primidone - Topiramate