Epilepsy

Question 1

Causes of epilepsy

Answer 1

• Idiopathic
• Congenital
• Acquired
• Non-epileptic/provoked: Withdrawal, metabolic, raised ICP, infection

Question 2

Prodrome of a seizure

Answer 2

Change in mood or behaviour lasting hours/days

Not part of seizure

Question 3

Aura of a seizure

Answer 3

Simple partial seizure (usually temporal) which may precede other manifestations
Epigastric rising, Deja/Jamais vu, Automatisms, Smells, Lights etc

Question 4

Partial/Focal seizure

Answer 4

Only one hemisphere

Question 5

Primary generalised seizure

Answer 5

No aura/warning

Affects whole cortex not one hemisphere

Question 6

Simple seizure

Answer 6

Awareness unimpaired

Question 7

Complex seizure

Answer 7

Awareness impaired

Question 8

Secondary generalised seizure

Answer 8

Focal seizure –> generalised seizure

aura–>tonic-clonic

Question 9

Epilepsy history

Answer 9

Aura
Specific trigger (lights)
Lateral tongue biting
Tonic clonic movements
Cyanosis
Post-ictal phase

Question 10

Simple partial seizure features

Answer 10

Focal motor, sensory, autonomic or psychic symptoms

Question 11

Complex partial seizure features

Answer 11

Aura
Autonomic: change in skin colour, temp, palpitations
Awareness lost
Automatisms: lip smacking, fumbling, swallowing
Amnesia

Question 12

Absence seizure features

Answer 12

(Petit mal)
ABrupt onset/offset
Short <10s
Eyes glazed, blank stare
Normal intelligence, brain scan, examination
Clonus or automatisms
EEG 3Hz spike and wave
Stimulated by hyperventilation and photics

Question 13

Tonic Clonic seizure features

Answer 13

(Grand Mal)
LOC
Tonic: limbs stiffen
Clonic: rhythmic jerking
\+/- cyanosis, incontinence, tongue biting
Post ictal confusion and drowsiness

Question 14

Myoclonic seizure features

Answer 14

Sudden jerk of limbs, trunk or face

Question 15

Atonic seizure features

Answer 15

Sudden loss of muscle tone –> fall

No LOC

Question 16

West syndrome/infantile spasms

Answer 16

Head nodding and arm jerks

EEG hypsarrhythmia

Question 17

Temporal localising seizure features

Answer 17

Automatisms: lip smacking, chewing, fumbling
Deja/jamias vu
Delusional behaviour
Abdominal: rising, n/v
Emotional disturbance: terror, panic, anger, elation
Tastes, smells

Question 18

Frontal localising seizure features

Answer 18

Motor features

Question 19

Parietal localising seizure features

Answer 19

Sensory disturbance

Question 20

Occipital localising seizure features

Answer 20

Visual phenomena

Question 21

Diagnosis of epilepsy

Answer 21

Need more than 1 seizure
Bloods
Raised serum prolactin 10 min after fit
Urine toxicology
ECG
EEG
MRI

Question 22

Tonic Clonic seizure treatment

Answer 22

1) Valproate

2) Lamotrigine

Question 23

Absence seizure treatment

Answer 23

1) Valproate/ethosuximide

2) Lamotrigine

Question 24

Tonic, atonic, myoclonic seizure treatment

Answer 24

1) Valproate

2) Levetiracetam

Question 25

Focal +/- secondary generalised seizure treatment

Answer 25

1) Lamotrigine | 2) Carbamazepine

Question 26

Lamotrigine side effect

Answer 26

Skin rash (stephen johnson syndrome)

Question 27

Valproate side effects

Answer 27

``` Appetite ↑ → ↑wt. Liver failure: monitor LFTs over 1st 6mo Pancreatitis Reversible hair loss Oedema Ataxia Teratogenicity, Tremor, Thrombocytopaenia Encephalopathy: due to ↑ ammonia ```

Question 28

Carbamazepine side effects

Answer 28

Leukopenia Skin reactions Diplopia Syndrome of inappropriate ADH (SIADH) --> hyponatraemia

Question 29

Phenytoin side effects

Answer 29

``` Gingival hypertrophy Hirsutism Cerebellar syndromes: Ataxia, Nystagmus, Dysarthria Peripheral sensory neuropathy Diplopia Tremor ```

Question 30

Status epilepticus definition

Answer 30

Seizure > 30mins or repeated seizures without regain of conciousness

Question 31

Investigations for status epilepticus

Answer 31

BM Bloods ECG EEG

Question 32

Treatment of status epilepticus

Answer 32

1) Lorazepam: 2-4mg bolus over 30s, 2nd dose if don't respond in 2 mins 2) Phenytoin: 18mg/kg IV infusion 3) Diazepam infusion 4) Dexamethasone

Question 33

Pregnancy and epilepsy treatment

Answer 33

Don't give valproate | Give lamotrigine and folic acid