Epilepsy

Question 1

Status Epilepticus

Answer 1

Seizure lasting >30mins or recurrent seizures with no gain of consciousness in between

Question 2

Epilepsy

Answer 2

Tendency to have recurrent unprovoked seizures

Question 3

Seizure

Answer 3

Abnormal electrical discharges in the brain

Transient excessive electrical activity with motor, sensory or cognitive manifestations discernible to the patient or an observer

Question 4

Classification of seizures

Answer 4

Generalised - involve the whole brain from the start

Partial - involve a focal part of brain, at least initially

Question 5

Generalised seizures

Answer 5

Tonic-clonic (grand mal) - tonic phase initially with muscle rigidity followed by clonic phase with convulsive rhythmic muscular contractions

Absence (petite mal) - usually in children, loss of consciouness where child appears vacant and unresponsive for up to 30 secs

Atonic: loss of muscle tone where patient falls to the ground

Tonic - rigidity

Clonic - convulsive rhythmic muscular contractions

Myoclonic - extremely brief muscle contraction (

Question 6

Partial seizures

Answer 6

Classified as simple (unimpaired loss of consciousness) or complex (impaired loss of consciousness)
or
Classified according to area of brain affected
*temporal - deja vu, olfactory or auditory aura, epigastric discomfort
*frontal - motor
*parietal - sensory
*occipital - visual

Question 7

Treatment of Status Epilepticus

Answer 7

Treatment:

• lorazepam IV, diazepam, IV/PR or midazolam IV/BM
• repeated after 10 mins if there’s no improvement
• phenytoin infusion (15mg/kg at rate = 50mg/min
• diazepam infusion
• general anaesthesia (e.g. thiopentone)