Epilepsy

Question 1

What causes seizures?

Answer 1

Imbalance in inhibitory/excitatory currents/neurotransmission in the brain

Question 2

Precipitants (5)

Answer 2

Flashing lights
drugs
sleep deprivation
metabolic
cryptogenic

Question 3

Key features from history

Answer 3

Before- what was happening? Prodrome?
During- aura, onset, duration, loss, of consciousness, tongue biting, incontinence
After- recovery, any residual weakness

Question 4

Main classification of seizures (2)

Answer 4

Partial (focal onset) or generalised (throughout cortex)

Question 5

What proportion of partial/focal seizures go on to become generalised?

Answer 5

Around 2/3rds

Question 6

Brief pauses of around 10 seconds, present in childhood

Answer 6

Absence seizures

Question 7

Loss of consciousness, limbs stiffen and then jerk

Answer 7

Tonic-clonic seizures

Question 8

Todd’s palsy

Answer 8

Post-ictal flaccid weakness seen in focal frontal lobe seizures

Question 9

Investigations in epilepsy (3)

Answer 9

CT (if fracture, head injury, deteriorating GCS, focal signs)
ECG
EEG

Question 10

Atonic seizure

Answer 10

Sudden loss of muscle tone, causing fall, with no LOC

Question 11

How long must a patient be seizure-free in order to drive?

Answer 11

At least one year

Question 12

Definition of status epilepticus

Answer 12

Seizures lasting for more than 30 mins, or repeated seizures without intervening consciousness

Question 13

Status usually occurs in…

Answer 13

Known epileptics

Question 14

Management of status (3)

Answer 14

Manage ABC (DEFG)
Rectal diazepam (10mg adult dose)
2nd line- phenytoin, valproate

Question 15

What type of drug is lorazepam and how does it work?

Answer 15

Long-acting Benzodiazepene

Works by enhancing GABA binding to its receptor, causing a widespread depression of synaptic transmission

Question 16

Why would thiamine be considered in treatment of status?

Answer 16

Alcoholics and malnourished are often thiamine-deficient

Question 17

When should anti-epileptic therapy be commenced?

Answer 17

After a second seizure

Question 18

Treatment of choice in generalised juvenile epilepsy

Answer 18

Sodium valproate

Question 19

Treatment of choice in partial epilepsy?

Answer 19

Carbamazepine

Question 20

Side effects of sodium valproate (4)

Answer 20

Teratogenicity
Hair loss
Weight gain
Fatigue

Question 21

First-line in generalised tonic-clonic epilepsy (2)

Answer 21

Sodium valproate or lamotrigine

Question 22

What can be the issues for women of child-bearing age taking AEDs? (2)

Answer 22

Can alter effectiveness of the oral contraceptive pill and morning after pill
Teratogenicity

Question 23

Possible severe side effect of lamotrigine

Answer 23

Stevens Johnson syndrome

Question 24

Difference between simple and complex partial seizures

Answer 24

In complex, awareness is impaired and there is more likely to be post-ictal symptoms e.g. confusion

Question 25

In a history of a first seizure what should be enquired?

Answer 25

Whether there has ever been any similar “funny turns”

Question 26

When can anti-epileptic drugs be stopped?

Answer 26

Two years seizure-free, drugs stopped over 2-3 months under supervision of a specialist

Question 27

DDx of seizure? (5)

Answer 27

Epilepsy
Isolated due to brain insult e.g. infection, trauma, metabolic
Febrile convulsions
Alcohol withdrawal
Psychogenic non epileptic seizures

Question 28

What characterises a generalised seizure?

Answer 28

Immediate loss of consciousness

Question 29

Treatment of absence seizures?

Answer 29

Sodium valproate or ethosuximide