Epilepsy

Question 1

Absence seizures

Answer 1

Onset: 3-10 years
Duration: 10-20 s
EEG: 3 hz spike and wave
Fx: abrupt onset & offset, eyelid fluttering

Question 2

Complex partial seizure

Answer 2

Fx:

1. Aura- rising epigastric sensation, fear, smell, nausea
2. Autonomic symptoms: flushing, pupillary dilation, pallor
3. Dystonia: Contralateral
4. Automatisms: lip smacking, limb picking- ipsilateral usually

Question 3

Frontal lobe seizure

Answer 3

Onset: nocturnal
Duration: short
EEG: often normal
Fx: vocalization, bizarre bimanual/bipedal activity
Post-Ictal Weakness (Todd's Paresis)

Question 4

Juvenile Myoclonic Epilepsy

Answer 4

Onset: upon awakening
EEG: 4-6 Hz spike and wave
Fx: jerks, may be associated with tonic clonic seizures and absence seizure

Question 5

Generalized tonic-clonic seizures

Answer 5

Duration: 1-2 min
EEG: increased activity in all leads
Fx: sudden onset, increased HR/BP, no aura,
vocalization to tonic phase to clonic phase
post ictal confusion and fatigue

Question 6

Psychogenic seizures

Answer 6

Onset: middle age, post-emotional event, occur while awake
Duration; prolonged
Fx: CLOSED EYES, axial/trunk involvement

Question 7

Criteria for epilepsy

Answer 7

1. 2 unprovoked seizures more than 24 h apart
2. Diagnosed epilepsy syndrome
3. Unprovoked seizure with high probability of another one in next 10 y.

Question 8

Drug resistant epilepsy

Answer 8

Failure to achieve seizure freedom with appropriate trials of 2 or more medications

Question 9

Seizure

Answer 9

Abnormal electrical activity + hypersynchrony + behavioural changes

Question 10

Status Epilepticus

Answer 10

Seizures more than 5 min, or 2+ sequential seizures

Tx: stop seizures with IV benzo, phenytoin, stop cause

Question 11

First unprovoked seizure TX

Answer 11

Restrict driving for 3 months

Don’t need AED yet

Question 12

Second unprovoked seizure TX

Answer 12

Restrict driving for 6 months

Start AED

Question 13

Best AED for:

1. Absence
2. Focal
3. Generalized
4. Unsure

Answer 13

1. Absence: ethosuxamide
2. Focal: carbamazepine, clobezam
3. Generalized: Valproate
4. Unsure: keppra, lamotragine