Epilepsy - 232

Question 1

What is a seizure?

Answer 1

Unregulated neuronal activity

Question 2

Name the sub-types of generalized seizures

Answer 2

Tonic-clonic
Absence
Myoclonic

Question 3

Name the sub-types of partial seizures

Answer 3

Complex, simple
Temporal
Frontal
Occipital

Question 4

Give 4 pointers suggestive of epileptic seizures

Answer 4

Lateral tongue biting
Shoulder dislocation
Cyanosis
Post-ictal confusion
Stereotyped and unprovoked

Question 5

How do temporal lobe seizures (complex partial) often present?

Answer 5

Auras - e.g. smells, tastes, sounds

Question 6

What investigations would you do in suspected epilepsy?

Answer 6

ECG, EEG, imaging

Question 7

What is the most common cause of epilepsy in each of these age groups?
Infants?
Children?
Young adult?
30-50?
50+?

Answer 7

Infants - developmental malformation, infections
Children - Idiopathic generalised epilepsy (IGE)
Young adult - IGE
30-50 - Brain tumors
50+ - Cerebrovascular disease

Question 8

Give an example of a syndrome of idiopathic generalised epilepsy.

Answer 8

JME (juvenile myoclonic epilepsy)

Question 9

What is IGE (Idiopathic generalised epilepsy)?

Answer 9

Mixture of generalised seizures, myoclonic jerks, absences. Usually starts in childhood or teens.

Question 10

In IGE (Idiopathic generalised epilepsy) what is imaging and EEG usually like?

Answer 10

Imaging - always normal

EEG - often abnormal

Question 11

What are seizures in IGE often triggered by?

Answer 11

Sleep deprivation and alcohol excess. Photo sensitivity is common

Question 12

Complicated febrile convulsions in childhood can cause what?

Answer 12

Hippocampal sclerosis

Question 13

Juvenile myoclonic epilepsy has a good response to what drug>

Answer 13

Sodium valproate

Question 14

What developmental malformation normally results in epilepsy with normal intelligence? What is it?

Answer 14

Heterotopic grey matter. Islands of grey matter that failed to migrate in the brain and intrude the ventricles

Question 15

What drug is the 1st line for focal/partial epilepsy?

Answer 15

Carbamazepine

Question 16

What drug is the 1st line for IGE (epliepsy)?

Answer 16

Sodium valproate

Question 17

What drug is the 1st line for IGE in femlales? Why is this used and not the other drug?

Answer 17

Lamotrigine or Leviteracetam - these are used as sodium valproate is teratogenic.

Question 18

Which AED (anti-epileptic) interacts with the OCP and warfarin?

Answer 18

Carbamazepine

Question 19

Name some side effects of sodium valproate

Answer 19

Weight gain, tremor, teratogenicity

Question 20

Which AED (anti-epileptic) can cause psychiatric problems?

Answer 20

Leviteracetam

Question 21

What drugs do you give if someone is it status epilepticus?

Answer 21

lorazepam early

IV phenytoin or valproate for established SE

Question 22

What must you check in the bloods of someone in status epliepticus?

Answer 22

Glucose and thiamine

Question 23

What are some potential causes for SUDEP?

Answer 23

Arrhythmias, hypoxia, postictal cerebral depression

Question 24

What is locked-in syndrome due to?

Answer 24

Pontine infarct

Question 25

In what circumstances can you NOT perform a neurological assessment of coma?

Answer 25

• Metabolically deranged
• Hypothermic
• Sedatives in circulation
• Endocrine disturbance

Question 26

What do roving eye movements suggest? (In a coma patient)

Answer 26

Intact brainstem

Question 27

What does the cornel response suggest in a coma patient?

Answer 27

Intact brainstem

Question 28

A coma patient’s pupils are unresponsive to light, which CN is damaged?

Answer 28

CN3