Epilepsy

Question 1

what is part of the seizure which may be a strange feeling, deja vu, strange smells, flashing lights

Answer 1

aura- implies focal/partial seizure

Question 2

what symptoms can you get post ictally

Answer 2

headache, confusion, myalgia, sore tongue, temporary weakness (focal seizure in motor cortex), dysphasia (impairment of communication)(if in temporal lobe)

Question 3

what makes up 2/3 of seizures

Answer 3

idiopathic

Question 4

structural causes of seizures

Answer 4

cortical scarring, developmental, space occupying lesions, stroke, hippocampal sclerosis, vascular malformation

Question 5

other causes of seizures

Answer 5

tuberous sclerosis, sarcoidosis, SLE, PAN

Question 6

non epileptic causes of seizures

Answer 6

trauma, stroke, haemorrhage, incr ICP, alcohol, benzodiazepine withdrawal

Question 7

metabolic disturbances causes of seizures

Answer 7

hypoxia, changes in Na, calcium decr, glucose incr, uraemia, liver disease, infection, temperature, drugs, pseudoseizures

Question 8

investigations

Answer 8

24h admission for bloods, drug screen, LP, EEG, CT/MRI

Question 9

what are focal seizures

Answer 9

focal onset with features referable to a part of one hemisphere. often seen with underlying structural disease

Question 10

what happens in a simple partial seizure

Answer 10

awareness unimpaired, focal motor sensory autonomic or psychic symptoms. no post ictal symptoms

Question 11

what happens in a complex partial seizure

Answer 11

awareness impaired. may have simple partial onset - aura or impaired awareness at onset. commonly arise from temporal lobe. recovery rapid after seizures in frontal love, confusion common if temporal lobe

Question 12

what happens in a partial seizure with secondary generalisation

Answer 12

in 2/3 patients with partial seizures, electrical disturbance spreads widely causing secondary generalised seizure- convulsive

Question 13

what is a primary generalised seizure

Answer 13

simultaneous onset of electrical discharge throughout the cortex with no localising features referable to only one hemisphere

Question 14

what types of seizures are primary generalised seizures

Answer 14

absence, tonic-clonic, myoclonic, atonic (akinetic), infantile spasms

Question 15

what happens in an absence seizure

Answer 15

brief pauses. presents in childhood

Question 16

what happens in tonic-clonic seizures

Answer 16

loss of consciousness. limbs stiffen (tonic), then jerk (clonic). can have one without the other. post ictal confusion and drowsiness

Question 17

what happens in myoclonic seizures

Answer 17

sudden jerk of limb, face or trunk. may be thrown suddenly to the ground or violently disobedient limb

Question 18

what happens in atonic seizures

Answer 18

sudden loss of muscle tone causing a fall no loss of conciousness

Question 19

what are infantile spasms commonly associated with

Answer 19

tuberous sclerosis

Question 20

what are localising features of focal seizures in the frontal lobe

Answer 20

motor features, motor arrest, behavioural differences, dysphasia or speech arrest, post ictal Todds palsy

Question 21

what are localising features of focal seizures in the parietal lobe

Answer 21

sensory disturbances- tingling, numbness, pain. motor symptoms

Question 22

what are localising features of focal seizures in the occipital lobe

Answer 22

visual phenomena- spots, lines, flashes

Question 23

what are localising features of focal seizures in the temporal lobe

Answer 23

automatisms (complex motor- impaired awareness and no recollection after); abdominal rising sensation or pain; dysphasia; memory phenomena; emotional disturbance (hippocampal involvement); hallucinations; delusional behaviour

Question 24

what is the first line of treatment for generalised tonic clonic seizures

Answer 24

sodium valproate or lamotrigine is 1st line. carbamazepine or topiramate.

Question 25

drugs used in absence seizures

Answer 25

sodium valproate, lamotrigine, ethosuximide

Question 26

what drugs may worsen seizures in tonic, atonic and myoclonic seizures

Answer 26

carbamazepine, oxcarbazepine

Question 27

if drugs don’t work what can be done

Answer 27

neurosurgical resection (70% improvement); vagal stimulation (33% improvement)

Question 28

what is sudden unexpected death in epilepsy associated with

Answer 28

nocturnal seizure associated apnoea or asystole

Question 29

doses and side effects carbamazepine

Answer 29

100mg/12h incr by 200mg/d every 2 weeks up to max 1000mg/12. SE: leucopenia, diplopia, blurred vision, impaired balance, dwosy, erythematous rash, SIADH

Question 30

doses and side effects lamotrigine

Answer 30

monotherapy- 25mg/day, incr by 50mg every 2 weeks to max 250mg/12h. SE- maculopapular rash, diplopia, blurred vision, photosensitivity, tremor, agitation, vomiting, aplastic anaemia

Question 31

doses and side effects phenytoin

Answer 31

no longer first line due to toxicity. SEs- depression, coarse facial features, acne, gum hypertrophy, hypertrophy.

Question 32

doses and side effects sodium valproate

Answer 32

300mg/12h incr by 100mg every 3 days. nausea very common. SEs- VALPROATE- Valproate, Appetite incr, Liver failure, Pancreatitis, Reversible hair loss, Oedema, Ataxia, Teratogenicity Tremor Thrombocytopenia, Encephalopathy

Question 33

what feature is important of anti epileptic drugs for pregnant women

Answer 33

teratogenicity. take folic acid 5mg/d. valproate in particular should be avoided