epilepsy

Question 1

presentation of typical temporal lobe focal seizure

Answer 1

may occur with or without impairment of consciousness or awareness
aura occurs in most patients
seizures last about a minute
lip smacking

Question 2

typical presentation of frontal lobe focal seizure

Answer 2

head/leg movements, posturing, post ictal weakness, jacksonian march (clonic movements travelling proximally)

Question 3

typical presentation of parietal lobe focal seizure

Answer 3

sensory
paraesthesia

Question 4

typical presentation of occipital lobe focal seizure

Answer 4

visual
floaters/flashes

Question 5

investigations for epilepsy

Answer 5

EEG
MRI

Question 6

DVLA guidelines

Answer 6

patient can’t drive 6 months post seizure
if diagnosed with epilepsy patient must be seizure free for 12 months

Question 7

drug treatment of generalised tonic-clonic seizures

Answer 7

males: sodium valproate
females: lamotrigine or levetiracetam

Question 8

drug treatment of focal seizures

Answer 8

first line: lamotrigine or levetiracetam
second line: carbamazepine, oxcarbazepine or zonisamide

Question 9

drug treatment in absence seizures

Answer 9

first line: ethosuximide
second line: sodium valproate (males), lamotrigine or levetiracetam (females)

Question 10

drug treatment for myoclonic seizures

Answer 10

males: sodium valproate
females: levetiracetam

Question 11

drug treatment for tonic or atonic seizures

Answer 11

males: sodium valproate
females: lamotrigine

Question 12

definition of status epilepticus

Answer 12

single seizure lasting > 5 mins
> = 2 seizures within 5 mintues

Question 13

initial assessment and investigation in status epilepticus

Answer 13

ABC:
- rule out hypoxia and hypoglycaemia

Question 14

management of status epilepticus

Answer 14

benzodiazepines
- PR or buccal in prehospital
IV lorazepam in hospital (repeat once after 5-10mins)
if ongoing: levetiracetam, phenytoin, sodium valproate