Epilepsy

Question 1

What visible things are important to note in a patient with a fall?

Answer 1

Pallor, breathing
posturing of limbs
Head turning

Question 2

What are the different types of movements?

Answer 2

Tonic phase
Clonic movements
Corpopedal spasms
Rigor

Question 3

What type of seizure is this: In bed, staring at onset of attack, unresponsive, had movements of upper limbs, some kicking of lower limbs

Answer 3

Generalised tonic-clonic seizure

Question 4

What are important questions to ask regarding epilepsy?

Answer 4

Birth and development
Past seizures icluding febrile C
Head injuries
FHx, drugs, alcohol

Question 5

What should always be taken with a first seizure?

Answer 5

ECG - look for abnormality such as Prolonged QT syndrome

Question 6

Who gets an acute CT scan?

Answer 6

Clinical/Radiological skull fracture
Deteriorating GCS
Focal signs
Head injury with seizure
Suggestion of other pathology
Failure to be GCS 15/15 4 hours after arrival

Question 7

How long can’t you drive for if you’ve had a first seizure?

Answer 7

Car = 6 months
HGV/PCV = 5 years

Question 8

How long can’t you drive for if you are diagnosed with epilepsy?

Answer 8

Car = 1 year/3 years during sleep
HGV/PCV = 10 years off all medication

Question 9

Do most epilepsies have a genetic predisposition about them?

Answer 9

Yes

Question 10

What is seen with epilepsy on an EEG?

Answer 10

Generalsied spike-wave abnormalities, usually in a child or adolescence

Question 11

When does primary generalized epilepsy present?

Answer 11

Childhood or teens

Question 12

What is the treatment of choice for primary generalized epilepsy?

Answer 12

Sodium Valporate or Lamitrigine

Question 13

Give and describe an example of a primary generalized epilepsy

Answer 13

Juvenile Myoclonic Epilepsy - early morning jerks
generalized seizures
Risk factors include sleep deprivation and flashing lights

Question 14

When can focal onset epilepsy present?

Answer 14

Any age

Question 15

What are possible treatments for focal onset epilepsy?

Answer 15

1st line = Carbamazepine or Lamotrigine

2nd line = Sodium valporate

Question 16

Give 3 examples of old anticonvulsants?

Answer 16

Phenytoin - enzyme inducer, acute management
Sodium Valporate - many side effects
Carbamazepine = focal onset seizures, can worsen primary generalzied epilepsies worse

Question 17

Give some examples of new anticonvulsants

Answer 17

Lamotrigine - generalized and focal epilepsies
Levetiracetam - can cause mood swings
Topiramate - Sedation and dysphasia are caused
Gabapentin/Pregabalin - more for neuropathic pain

Question 18

What should women on anti-convulsants be warned about?

Answer 18

Alter the efficacy of combined oral contraceptive pill

Should use progesterone only pill

Question 19

What isn’t effective if on Enzyme Inducing AEDs?

Answer 19

Morning after pill

Question 20

What is non-convulsive status?

Answer 20

Conscious but in altered state

Question 21

What is Epilepsia partialis continua?

Answer 21

Continual focal seizures, consciousness preserved

Question 22

What are other causes of a seizure?

Answer 22

Severe metabolic disorders - hyponatraemia, pyridoxine deficiency
Infection
Head trauma
Sub-arachnoid haemorrhage
Abrupt withdrawl of anti-convulsants

Question 23

How long does syncope take to recover?

Answer 23

Seconds

Question 24

How long does a seizure take to recover?

Answer 24

Minutes to hours

Question 25

What seizures can a focal epilepsy cause?

Answer 25

Focal or generalised seizures

Question 26

What seizures can generalised epilepsy cause?

Answer 26

Generalised seizure

Question 27

How does an epilepsy be generalised?

Answer 27

The electrical signals hit a pathway and spread to a different part of the brain affecting that as well

Question 28

What is sudden death caused by epilepsy called?

Answer 28

SUDEP