Epilepsy

Question 1

Give 7 risk factors for epilepsy.

Answer 1

birth, development, previous seizure (including febrile fits), alcohol, drugs, FH

Question 2

What in social history is particularly relevant?

Answer 2

driving

occupation

Question 3

Would you examine in 1st seizure clinics?

Answer 3

no

Question 4

What is important in diagnosis of syncope?

Answer 4

cardiovascular examination and BP important

Question 5

What is an absolute mandatory investigation for the fallen?

Answer 5

ECG

Question 6

When would you do a CT scan acutely?

Answer 6

focal signs
skull fracture
not returned to 15/15 GCS 4 hrs after injury
head injury with seizure

Question 7

How long post seizure should you not drive?

Answer 7

1st seizure – car = 6 months, 5 years for HGV/PCV

Question 8

How long if epileptic should you not drive?

Answer 8

1 year or 3years during sleep, 10 years

off medication for HGV/PCV

Question 9

IS generalized epilepsy likely to be genetic?

Answer 9

yes

Question 10

Treatment for primary generalized epilepsy?

Answer 10

Sodium valproate treatment of choice, but

teratogenic. Lamotrigine as alternative.

Question 11

Describe the symptoms of primary generalized epilepsy e.g. juvenile myoclonic epilepsy.

Answer 11

– Early morning jerks
– Generalized seizures
– Risk factors: sleep deprivation, “flashing light

Question 12

What may be helpful in identifying subtype of epilepsy?

Answer 12

EEG

Question 13

Age of onset of primary generalized epilepsy?

Answer 13

childhood/teens

Question 14

Age of onset of focal onset epilepsy?

Answer 14

any age

Question 15

What is treatment for focal onset epilepsy?

Answer 15

Carbamazepine or lamotrigine

Question 16

Why is sodium valproate not first line for focal onset epilepsy?

Answer 16

side effects (stomach irritation, unsteadiness, tremor, weight gain)

Question 17

Are focal onset seizures frequent?

Answer 17

yes

Question 18

What type of seizures occur with focal onset epilepsy?

Answer 18

complex partial seizures with

hippocampal sclerosis

Question 19

Is lamotrigine well tolerated?

Answer 19

yes

Question 20

An issue with Lamotrigine?

Answer 20

Takes a long time to titrate up

Question 21

Issue with levatiracetum?

Answer 21

can cause mood swings

Question 22

Side effects of topiramate?

Answer 22

Sedation, dysphasia, weight loss

Question 23

Gabapentin, Pregabalin are used less as anticonvulsants and more for what?

Answer 23

neuropathic pain

Question 24

Do anticonvulsants induce hepatic enzymes?

Answer 24

some do yes

Question 25

What can anticonvulsants affect in women?

Answer 25

efficacy of OCP
- do not use progesterone only pill/implant
depot needs to be more frequent
morning after pill not effective

Question 26

Symptoms of primary generalized epilepsy?

Answer 26

bit clumsy and jerky in the

mornings recently, e.g. dropping hairbrush or coffee cup.

Question 27

What is status epilepticus?

Answer 27

Recurrent epileptic seizures without full recovery of
consciousness
Continuous seizure activity lasting more than 30
minutes

Question 28

3 types of status epilepticus?

Answer 28

1. Generalized convulsive status epilepticus
2. Non convulsive status (conscious but in “altered state”)3.Epilepsia partialis continua (continual focal seizures, consciousness preserved)

Question 29

What 4 things can convulsive state cause?

Answer 29

• respiratory insufficiency and hypoxia
  – hypotension
  – hyperthermia
  – rhabdomyolysis