Epilepsy

Question 1

What is electroencephalography?

Answer 1

Electroencephalography is the recording of electrical activity along the scalp. EEG measures voltage fluctuations resulting from ionic current flows within the neurons of the brain.

Question 2

What is epilepsy?

Answer 2

 A paroxysmal dysfunction of brain neurophysiology (as seen on EEG)
 Accompanied by a paroxysmal dysfunction in brain action (cognitive, behavioural, sensory, experiential)
 Which has a tendency to recur
They affect different parts of the brain and this will affect how you react. They’re idiopathic.

Question 3

What is a simple partial seizure?

Answer 3

 If the area of the brain affected by the seizure is small, this is called a simple partial seizure (SPS). The person will be awake and aware during the seizure and will remember what happened to them.

Question 4

What is a complex partial seizure?

Answer 4

 If the area of the brain affected by the seizure is larger than that in the SPS, this causes a complex partial seizure (CPS). These seizures affect three things –
 the person’s awareness (they will be only partly conscious)
 their accessibility (they may not be able to respond to you)
 their memory (they may not remember the seizure).

Question 5

What’s a generalised seizure?

Answer 5

 In generalised seizures the seizure affects all the brain at once. Generalised seizures affect the persons consciousness. Because of this they will have no memory of the seizure.

Question 6

What’s a myoclonic seizure?

Answer 6

 ‘Myoclonic’ means ‘muscle jerk,’ which describes what happens during these seizures.
 Usually the arm or leg will briefly jerk, although it can be the head or trunk.
 These are similar to the jerks we all have just as we are falling asleep (Hypnagogic jerk), but they happen at other times during the day, often during the first few hours after waking–up. Usually, the person recovers quickly.

Question 7

What is a secondary generalised seizure?

Answer 7

 Sometimes a partial seizure can become a generalised seizure and is called secondarily generalised seizure (as it starts out as a partial seizure and becomes generalised in the second part of the seizure).
 As the seizure starts as a simple or complex partial seizure, the person might be aware that the seizure has started but as it becomes generalised, they will lose consciousness.

Question 8

What type of investigations can be done?

Answer 8

 EEG  MRI  Videotelemetry  CT scan  SPECT scan  PET scan

Question 9

What treatment can be given?

Answer 9

 Medication eg. Carbamazepine
 Surgery – e.g. lobectomy, vagus nerve stimulator
 Complementary therapies (but be careful - always consult a specialist first)

Question 10

What are the risk factors of SUDEP (sudden unexpected death in epilepsy)?

Answer 10

 Early onset  Male  20 – 40  Tonic-clonics  Nocturnal
 Living alone  Poor records  Poor seizure control
 Non-compliance
 Polytherapy
 Abrupt/frequent changes in AEDs
 alcohol
It’s relatively uncommon.

Question 11

What are the causes of epilepsy in the young?

Answer 11

 40% are idiopathic  40% developmental lesion  5% tumour  5% head injury

Question 12

What are the causes of epilepsy in the old?

Answer 12

 Cerebro-vascular

 Tumour  Head Injury  Alzheimers  Also remember medication as a cause

Question 13

What are the Psychiatric aspects of epilepsy?

Answer 13

 Psychoses : Ictal Peri-ictal
Inter-ictal  Mood disorders & anxiety
 Personality  Aggression  Non epileptic seizures