Epilepsy

Question 1

What is epilepsy?

Answer 1

A disease characterised by: an enduring predisposition to generate epileptic seizures and by the neurobiological, cognitive, psychological and social consequences of this condition

Question 2

Name 5 areas of the brain?

Answer 2

Frontal
Parietal
Temporal
Occipital
Cerebelllum

Question 3

What is a seizure?

Answer 3

A transient occurrence of signs and symptoms due to abnormal excessive or synchronous neuronal activity in the brain

Question 4

What is the risk of a single seizure?

Answer 4

9%

Question 5

What is the risk of epilepsy?

Answer 5

1%

Question 6

What is a generalised seizure?

Answer 6

Originates within and rapidly engages neuronal networks in both hemispheres

Question 7

What is a focal seizure?

Answer 7

Arise within an area confined to one hemisphere. They can spread within the same hemisphere and or to areas in the contralateral hemisphere and then evolve into a generalised convulsive seizure

Question 8

What is the cause of epilepsy?

Answer 8

Genetic (75%)
Autoimmune
Stroke
trauma 
tumour 
infection
congenital lesions
birth anoxia
excess alcohol

Question 9

How do we diagnose epilepsy?

Answer 9

Very easy to mis-diagnose - could be syncope, psychogenic, hypoglycaemia
Need to get witness account
Take a long time to recover after a seizure vs eg syncope

Question 10

What investigations can be done after the 1st seizure?

Answer 10

1) EEG (electro encephalogy) (30% +ve)- 20 minute brain recording to look at electrical activity, brain rhythms, waveform
(can do sleep deprived EEG, prolonged EEG (48hrs), repeated EEG, cant do it after a blackout)
2) IMAGING - MRI or CT (10% +ve) - not needed if complete and rapid response to antiepileptic drugs,
3) ECG - not always accurate, after seizure you get arrythmias or atrial fibrilation. Seizures due to cardiac causes are very bad
4) BLOODS

Question 11

What are the driving regulations for epilepsy?

Answer 11

Legal responsibility to tell the DVLA
After 1st seizure = 6 month restriction on driving
After 2nd seizure/ eilepsy diagnosis = 12 month restriction

Question 12

What treatment is there for epilepsy?

Answer 12

DIET
DRUGS -
1st line drugs :
lamotrigine
carbamazepine (can make generalised seizure worse)
levatiracetam
valproate (ot for pregnant women)
phenobarbitol - not given after 1st seizure
SURGERY - not easy as cant always work out where epilepsy coming from so use grids on brain surface or stereo EEG to know location to operate
NEUROMODULATORS - deep vein stimulators - go into thalamic part of brain and disrupt seizure generation or vagal nerve stimulator goes into neck and a signal is sent up to the brain to disrupt seizure generation

Question 13

What are the complication associated with epilepsy?

Answer 13

Accidents / suicide
Status epilepticus when brain doesnt stop seizures and causes irreversible damage after 30 mins - give lorazepam, diazepam, then phenytoin, sodium valproate
SUDEP - brain inhibits seizure too strongly and brain is shut down. 0.1%/yr. Risk factors - young males, long duration of epilepsy, poor drug compliance, lack of supervision post seizure

Question 14

What is the mechanism of SUDEP?

Answer 14

Cardiac arrythmias
Apnoea
Cerebral electrical shutdown

Question 15

What co morbidities are associated with epilepsy?

Answer 15

SOCIAL PROBLEMS
no driving
unemployment
depression
anxiety
suicide
mental health disorders

Question 16

What are the outcomes after the first seizure?

Answer 16

No meds as 50% chance or reoccurence
If EEG and MRI fine then 30% reoccurrence
If EEG and MRI abnormal then 70% reoccurrence
If no reoccurrence in 3 months 15% risk/year