Epilepsy

Question 1

How can epilepsy be studied

Answer 1

Home videos EEG

Careful history taking

Question 2

What are he two main types of seizure

Answer 2

Generalised and focal

Question 3

What types of generalised seizure exist

Answer 3

Typical absence
Myoclonus
Tonic-Clonic
Also atypical absence, tonic and atonic

Question 4

What is an absence seizure

Answer 4

Childhood onset
Frequent and bread attack lasting 1-30secomds
Sudden loss and return to consciousness 
No aura
No post ictal state 
some involuntary movements

Question 5

What is a myoclonus seizure

Answer 5

Sudden brief shock like muscle contractions
Often ark jerks
Worse in the morning and precipitated by sleep deprivation and alcohol

Question 6

What is a tonic clinic seizure

Answer 6

Sudden onset, gasp and fall
Tonic phase with cyanosis, tense and rigid, seconds long
Clobic phase- rapid muscle contractions, eye rolling, tongue damage, strong jaw contractions
Post- ictal state- tongue bitten and incontinence, noisy breathing, headache and muscle pain

Question 7

What happens in an atonic seizure

Answer 7

Brief lapse in muscle tone- head drop
15 seconds
Begin in childhood

Question 8

What’s types of focal seizures are there

Answer 8

Simple partial ( awareness present only and aura)
complex partial ( awareness lost)
Secondary generalised ( evolves to TV)

Question 9

What characterises a temporal lobe seizure

Answer 9

Aura 
Epigastric rising sensation 
Olfactory and gustatory 
Strong déjà vu
Complex partial seizure - oral automatisms 
Nose wiping
Unresponsive post- ictal state

Question 10

What characterises a frontal lobe seizure

Answer 10

Movement because frontal = motor planning
Slows towards end
Quick recovery

Question 11

What is the neuronal activity in epileptic seizures

Answer 11

Burst firing behaviour

Synconrised firing is huge networks

Question 12

What is seen on an EEG of someone with focal epilepsy

Answer 12

Interictal spikes = sudden synchronous firing in a strongly connected network of neurons

Question 13

Describe the evolution of a seizure

Answer 13

Initiation- high frequency oscillations, inhibition overcome
Synchronisation-synaptic and non-synaptic
Termination -synaptic inhibition
Depolarisation block
Hyper polarisation

Question 14

What are the neuromodulators of epilepsy

Answer 14

Adenosine
Opioids
Endocannabinoids

Question 15

Describe the action and give examples of a sodium channel inhibitor for epilepsy

Answer 15

Prolong inactivated state of channel and reduces burst firing ( voltage and frequency dependant so doesn’t affect normal firing)
Phenytoin
Carbamazepine
Lamotrigine

Question 16

What drugs promote inhibition

Answer 16

Enhance cl- current at GABA receptors
Benzodiazepines
Barbiturates
Topiramate

Question 17

How do Vigabatrun and Tigabine work (epilepsy)

Answer 17

Reduce GABA degradation/reuptake

Question 18

What are some causes of epilepsy

Answer 18

Cortical malformations
Cerebral palsy 
Genetic and metabolic disorders
Hippocampal sclerosis 
Trauma and infection
Tumours
Stroke

Question 19

What are the initial treatment options for generalised and focal epilepsy

Answer 19

Generalised -sodium valproate and lamotrigine

Focal- lamotrigine

Question 20

What is carbamazepine and when is it used

Answer 20

Na channel blocker
Used for partial and generalised
Not helpful for myoclonus and absences

Question 21

When is valproate used

Answer 21

Myoclonus
Absences
Photosensitive

Question 22

When is phenytoin used

Answer 22

Not helpful for myoclonus and absences

Used in emergencies

Question 23

What two AEDs and broad spectrum

Answer 23

Levetiracetam

Topiramate

Question 24

What is a seizure

Answer 24

The clinical manifestation of a disordered and synchronised discharge in a network of cerebral neurons