Epilepsy

Question 1

Define seizure.

Answer 1

A single episode of neuronal hyperactivity

Question 2

Define epilepsy.

Answer 2

At least 2 unprovoked episodes of seizure

OR

A single unprovoked episode of seizure with a high risk of recurrence

Question 3

What are the 2 types of seizure?

Answer 3

Focal/partial seizures

Generalised seizures

Question 4

Define focal/partial seizures.

Answer 4

Seizures that originate in one specific area of the brain, though neuronal hyperactivity may spread throughout the whole brain

Question 5

What are focal/partial seizures caused by? (2)

Answer 5

Infection

Trauma

Question 6

Describe the clinical features of focal seizures. (3)

Answer 6

Focal aura (sensory/motor effects)

Simple motor seizures:

• Convulsive movements of one limb
• Jacksonian march (spread of convulsions from thumb to hand to face)

Complex focal seizures:

• Hallucinations (in any sensory modality)
• Paroxysmal memory disorders
• Automatism
• Amnesia after the episode

Question 7

Which parts of the brain is affected by complex partial seizures?

Answer 7

Temporal and parietal lobes

Question 8

Define a generalised seizure.

Answer 8

Seizures that affect the whole brain; usually appearing as generalised tonic-clonic seizures

Question 9

What causes generalised seizures?

Answer 9

Genetic defects

Question 10

Describe the clinical features of tonic-clonic (generalised) seizures.

Answer 10

TONIC PHASE:
Lack of movement
-May involve respiratory muscles (cyanosis)
Loss of consciousness
Version (head turning)

CLONIC PHASE:
Convulsive movements of whole body
Tongue biting (usually lateral)
Urinary incontinence

Question 11

What would you think if a tonic-clonic seizure involved version (head turning)?

Answer 11

Frontal lobe origin

Question 12

Describe the usual resolution of tonic-clonic seizures. (4)

Answer 12

Patient enters a deep sleep
May be very aggressive when roused
Memory loss
Gradual recovery

Question 13

Describe the clinical features of absence (generalised) seizures. (3)

Answer 13

Brief spells of unconsciousness (few seconds)
Fluttering eyelids
Finger/mouth twitching

Question 14

Describe the pathophysiology of generalised epilepsy. (2)

Answer 14

1. Defects in glutamine and GABA cause rapid transmission of electrical activity through brain
2. Electrical activity originates all over the brain

Question 15

List 4 diagnostic features of focal epilepsy.

Answer 15

Focal aura (e.g. hallucinations, motor convulsions)
Post-attack confusion/drowsiness
Automatism
Nocturnal events

Question 16

List 4 diagnostic features of generalised epilepsy.

Answer 16

Photosensitivity
Myoclonus
Lack of aura
Abnormal EEG

Question 17

What investigations would you do for epilepsy? (3)

Answer 17

ECG
-Excludes other conditions

EEG

• Ambulatory EEG
• Video telemetry (records video of seizure)

Systemic provocations
-Tests for seizure triggers

Question 18

List the differential diagnosis for a seizure. (7)

Answer 18

Syncope
Non-epileptic attack disorder
Migraine
Narcolepsy
Cataplexy
Transient global amnesia
Panic attacks

Question 19

How would you treat someone having a seizure? (1)

When would you encourage hospital admission? (3)

Answer 19

Recovery position

Hospital admission when:

• Movements do not stop after 5 minutes
• ABCs are impaired
• New neurological deficit

Question 20

How would you treat long term focal epilepsy? (3)

How would you treat long term generalised epilepsy? (3)

Answer 20

FOCAL EPILEPSY:
Lamotrigine
Carbamazepine
Levetiracetam

GENERALISED EPILEPSY:
Sodium valproate
Levetiracetam
Lamotrigine

Question 21

Define status epilepticus.

Answer 21

Occurrence of repeated (at least 2) epileptic seizures without any recovery of consciousness between them

OR

Continuous seizure activity for more than 30 minutes

Question 22

Describe the consequences of status epilepticus. (3)

Answer 22

Increased mortality
Profound systemic damage/disability
Profound neuronal damage

Question 23

Which anti-epileptic would you use to treat status epilepticus?

Answer 23

Phenytoin