Epilepsy

Question 1

What are the risk factors for epilepsy?

Answer 1

Trauma at birth 
Past seizures (inc. febrile)
Head injury 
Family history 
Drugs & Alcohol

Question 2

What is the first line investigation in a patient with syncopal/seizure presentation?

Answer 2

ECG

Question 3

What presentations would provoke an urgent CT of the head?

Answer 3

Clinical or radiological skull fracture
Deteriorating GCS
Foca lsignhttps://www.facebook.com/?ref=tn_tnmns
Head injury with seizure
Failure to be GCS 15 4 hours after arrival

Question 4

How long after your 1st seizure can you not drive a car or HGV/PCV?

Answer 4

Car = 6 months 
HGV/PCV = 5 years

Question 5

How long do you have to be off epilepsy medication to drive a HGV/PCV?

Answer 5

10 years

Question 6

What are the potential triggers for a seizure?

Answer 6

Sleep deprivation
Stress/Anxiety 
Alcohol 
Recreational drugs 
Cough/cold
UTI/infections

Question 7

What factors lead to an increased risk of death in epileptics?

Answer 7

Learning disabilities
Nocturnal seizures
No bed partner
Non compliance with medication

Question 8

What are the types of epilepsy?

Answer 8

Focal
Generalised
Unclassified

Question 9

What are the 2 types of seizure in focal epilepsy?

Answer 9

Simple

Complex

Question 10

Describe a simple focal seizure

Answer 10

Aware - not unconscious

Question 11

Causes of simple focal seizures

Answer 11

Single site of injury (scar, tumour, stroke, encephaitis)

Question 12

Treatment of focal epilepsy

Answer 12

Carbemazepine

Lamotrigine

Question 13

Describe a complex focal seizure

Answer 13

Spreads to further part of hemisphere (mostly temporal)
Secondary generalised
Unconscious (unclear history)

Question 14

What is the first line treatment for generalised epilepsy in men?

Answer 14

Sodium valproate

Question 15

What is the first line treatment for generalised epilepsy in women?

Answer 15

Lamotrigine

But if lots of seizures levetiracetam as lamotrigine takes 10-12 weeks to work

Question 16

How is epilepsy diagnosed?

Answer 16

Eye witness account
MRI if focal tumour
EEG - classification ornon-convulsive status
Do ECG for long QT

Question 17

What is the biggest cause of death in epilepsy?

Answer 17

Suicide

Question 18

What is the first line management of status epilepticus?

Answer 18

Medazelam (buccal)

Lorazepa,

Question 19

Why should carbamazepine, phenobarbitol, phenytoin & primidone be prescribed carefully in women?

Answer 19

Induce hepatic enzymes - can alter efficacy of OCP & shouldn’t use progesterone only pill

Question 20

Side effects of sodium valproate

Answer 20

Weight gain
Teratogenic
Hair loss
Fatigue

Question 21

Side effects of topiramate

Answer 21

Sedation
Dysphagia
Weight loss

Question 22

What can precipitate status epilepticus?

Answer 22

Severe metabolic disorders 
Infection
Head trauma
Sub-arachnoid haemorrhage 
Abrupt withdrawal of anti-convulsants 
Treating absent seizures with CBZ

Question 23

Treatment of status lasting> 5 mins

Answer 23

Benzodiazepine
if continues for a further 10 mins - second dose of benzo
Within 30 mins of seizure started give sodium valporate - if continues should be sedated in ITU with CG monitoring

Question 24

What is a myotonic seizure?

Answer 24

Shock like jerks usually seen on both sides of the body at the same time