Epilepsy

Question 1

What specific aspects are important in a patient who has fallen?

Answer 1

Before, during and after events

Eye witness account- phone if necessary

Question 2

Risk factors for epilepsy?

Answer 2

Birth
Developmental
Previous seizure (inc. febrile)
Head injury (incl LOC)
FH
Drugs
Alcohol

Question 3

What role does examination play in 1st seizure clinics?

Answer 3

Little to no role, history most important

Question 4

What should be performed in a diagnosis of syncope?

Answer 4

Full cardio exam including L + S Blood pressure

Question 5

Which investigations are useful in the fallen patient?

Answer 5

ECG compulsary

CT or MRI brain

Question 6

Which patients get a CT scan acutely?

Answer 6

Clin or radiological skull fracture
Deteriorating GCS
Focal signs
Head injury w/ seizure
Not GCS 15 after 4 hrs
Suggestion of other pathology eg SAH

Question 7

What are the rules of driving after a seizure

Answer 7

1st seizure - 6 months car, 5 years HGV

Epilepsy - 1 year or 3 years during sleep, 10 years off meds for HGV

Question 8

Features of primary generalised seizure?

Answer 8

Often childhood or teens

Early morning jerks
Generalised sizure
Often sleep depiravtion or flashing lights

Question 9

Treatment for primary generalised seizure

Answer 9

Sodium Valproate (Teratogenic)

Lamotrigine as alternative

Question 10

Features of focal onset epilepsy

Answer 10

Underlying structural cause
Focal onset at any age

Frequent complex partial seizures with hippocampal sclerosis

Question 11

Treatment of focal onset epilepsy

Answer 11

Carbamazepine or lamotrigine (Not sodium valproate because S/E)

Question 12

Side effects of sodium valproate?

Answer 12

Weight gain

Teratogenic

Hair loss

Fatigue

Question 13

What effect does carbamazepine have on generalised epilepsy?

Answer 13

It makes primary generalised epilepsies worse

Question 14

Disadvantage of Lamotrigine

Answer 14

Takes a long time to titrate dose up

Question 15

Side effect of Levetiracetam

Answer 15

Can cause mood swings

Question 16

Side effects of Topiramate?

Answer 16

Sedation

Dysphagia

Weight loss

Question 17

What is the method of interaction between anti convulsants and the contraceptive pill?

Answer 17

They can induce hepatic enzymes which alter the efficacy of the OCP

Question 18

What is status epilepticus

Answer 18

Recurrent epileptic seizures without full recovery of conciousness, can last more than 30 mins

Question 19

What are the 3 types of status epilepticus?

Answer 19

Generalised convulsive status epilepticus

Non convulsive (Concious but in altered state)

Epilepsia partialis continua (Continual focal seizures, conciousness preserved)

Question 20

Precipitants of status epilepticus

Answer 20

Hyponatraemia, pyridoxine deficiency

Infection

Head trauma

SAH

Abrupt withdrawal of anti convulsants

Treating absence seizures with CBZ

Question 21

What is a convulsive status?

Answer 21

Generalised convulsions without cessation

Excess cerebral energy demand and poor substrate delivery causes lasting damage

Question 22

Complications of convulsive status?

Answer 22

Resp insufficiency and hypoxia

Hypotension

Hyperthermia

Rhabdomyolysis

Question 23

Which Anti convulsants in acute setting

Answer 23

Phenytoin
Keppra
Valproate
Benzodiazepenes