Epilepsy

Question 1

what is epilepsy

Answer 1

the continuing tendency to have seizures

Question 2

what is a seizure

Answer 2

a convulsion or a transient abnormal event caused by a paroxysmal discharge of cerebral neurones

Question 3

classification of seizures

Answer 3

partial or generalised

Question 4

partial seizures

Answer 4

involve only a portion of the brain at their onset (e.g. temporal lobe) - may later become generalised
are simple or complex (do or don’t affect consciousness or memory)
symptoms depend on the area of the brain where the seizure starts

Question 5

generalised tonic clonic seizures

Answer 5

grand mal
sudden onset of rigid tonic phase followed by convulsion clonic phase in which muscles jerk rhythmically
lasts seconds/minutes
incontinence
followed by coma / drowsiness

Question 6

typical absence seizures

Answer 6

petit mal
disease of childhood
child stares and pales for a few seconds
3Hz spike on EEG
often develop t-c seizures

Question 7

myoclonic, tonic and akinetic seizures

Answer 7

isolated muscle jerking (myoclonic)
intense stiffening of the body (tonic)
falling & loss of consciousness (akinetic)

Question 8

Jackonian (motor) seizures

Answer 8

type of partial seizure
originate in the motor cortex
typically result in jerking movements opposite side
no impairment of consciousness - simple
paralysis may follow

Question 9

temporal lobe seizures

Answer 9

olfactory & visual hallucinations
blank staring
feelings of unreality or undue familiarity with the surroundings

Question 10

generalised seizures

Answer 10

bilateral

abnormal electrical activity with bilateral motor manifestations and impaired consciousness

Question 11

egs generalised seizures

Answer 11

absence seizures (petit mal)
generalised tonic-clonic seizures (grand mal)
myoclonic seizures 
tonic seizures
akinetic seizures

Question 12

partial seizures egs

Answer 12

simple - no impaired awareness e.g. jacksonian

complex - impaired awareness

Question 13

aetiology seizures

Answer 13

less than a third = found a cause
flashing lights
cereberovascular disease, cerebral tumours, alcohol, metabolic disturbances

Question 14

emergency management seizure

Answer 14

ensure little harm done and airway patent
prolonged seizure (>3min) or repeated = treated w rectal or iv diazepam or lorazepam

Question 15

status epilepticus

Answer 15

medical emergency
continuous seizures without recovery of consciousness
risk of cardioresp failure
>5min
>30m = medical emergency

Question 16

rx status epilepticus in and out of hosp

Answer 16

out of hosp - rectal diazepam or buccal midazolam
in hosp - thiamine if nutrition poor / alcohol
urgent: blood gluc, serum electrlytes incl calcium and magnesium, drug screen, anticonvulsant levels - give anticonvulsants e.g. phenytoin

Question 17

why give thiamine before glucose drip?

Answer 17

thiamine used in glycolytic pathway so need to give it first otherwise more is used up and pt dies

Question 18

first line rx generalised t-c seizure

Answer 18

sodium valproate

Question 19

first line rx petit mal

Answer 19

sodium valproate

Question 20

first line rx focal seizures

Answer 20

lamotrigine carbamazepine

Question 21

surgery for epilepsy

Answer 21

amputation of the anterior temporal lobe cures in 50%