Epilepsy

Question 1

What is epilepsy?

Answer 1

A recurrent tendency to spontaneous, intermittent, abnormal electrical activity in the brain

Question 2

What does this abnormal activity do?

Answer 2

It causes disturbance in consciousness, behaviour, emotion, motor function and sensation

Question 3

What is the cause? (10)

Answer 3

2/3 are idiopathic, Cerebrovascular disease, head injury, Cranial surgery, CNS infections, Neurodegenerative diseases, Autoimmune, Brain neoplasm, Drugs, Metabolic

Question 4

What are the main types of Focal Epilepsy? (3)

Answer 4

1. Simple Focal (no loss of consciousness)
2. Focal dyscognitive (lose consciousness half way through)
3. Focal seizure evolving to Generalised Tonic Clonic

Question 5

What are the main types of Generalised Epilepsy? (7)

Answer 5

1. Absence/Petit Mal
2. Myoclonic
3. Clonic
4. Tonic
5. Tonic Clonic
6. Atonic
7. Unclassified

Question 6

Do seizures have any warning symptoms?

Answer 6

Yes, people usually experience a ‘prodrome’ e.g smell, hallucination, sound etc

Question 7

Do people go back to normal straight away?

Answer 7

No, there is usually a Post-ictal phase

Question 8

Is epilepsy common?

Answer 8

5-10 cases per 1000 people

Question 9

Who does it affect?

Answer 9

It is most common in children or people above the age of 60

Question 10

Is there any genetic link?

Answer 10

Unsure of the genes, but 30% of sufferers have a 1st degree relative with the condition

Question 11

Signs and Symptoms (13)

Answer 11

Sudden falls, involuntary jerky movements, blank spells, unexplained urinary incontinence, odd events in sleep, confused behaviour, epigastric fullness sensation, deja vu, premonition, loss of memory, disorientation, sensory hallucinations, unremarkable examination

Question 12

Differentials (7)

Answer 12

Syncope, cardiac arrhythmias, TIA, migraine, Hypoglycaemia, Sleep Disorders, Panic Attacks

Question 13

What bloods would you do? (4)

Answer 13

Glucose, U&E, Calcium, LFT

Question 14

Other investigations (7)

Answer 14

Urinalysis, ECG, EEG, MRI, Video of the event, Neurophysiological assessment, Genetic testing

Question 15

Drug Treatment (3)

Answer 15

Generalised= Sodium Valproate or Lamotrigine, Absence= Sodium Valproate, Partial & Secondary= Carbemazepine

Question 16

Other treatment (3)

Answer 16

Educate the patient about the condition and its triggers, Vagus nerve and deep brain stimulation, resection of affected brain

Question 17

Complications (8)

Answer 17

Status Epilepticus, Sudden Death, Social stigma, occupational issues, anxiety, depression, suicide, accidents resulting from seizures

Question 18

Is there a good prognosis? (3)

Answer 18

Remission is less likely with longer persistence of seizures, focal dyscognitive and tonic/clonic seizures have poorer prognosis, premature death under 55 years old is more likely