Epilepsy

Question 1

What are the risk factors for epilepsy?

Answer 1

prematurity; global developmental delay; seizures in the past (incl. febrile fits); head injury; family history; drugs; alcohol

Question 2

What investigation is mandatory in all those who have fallen/had fit?

Answer 2

ECG

Question 3

When is a CT scan done acutley?

Answer 3

clinical/radiological skull #; decreasing GCS; focal neuro signs; head injury with seizure; GCS 12; auggestion of other pathology- eg SAH

Question 4

What is the ban of driving length after a first seizure for a car?

Answer 4

6 months

Question 5

What is the ban on driving an HGV/ PCV after the first seizure?

Answer 5

5 years

Question 6

What is the driving rules for epilptics and HGV/PCV?

Answer 6

been 10 years off medication

Question 7

What is generalised epilepsy?

Answer 7

most genetically prediposed which present in childhood and adolescence, affect both hemispheres and lose consciousness

Question 8

What is seen on EEG with generalised epilepsy?

Answer 8

generalised spike-wave abnormalities on EEG

Question 9

What is the treatment of choice generally for primary generalised epilpsy?

Answer 9

sodium valproate

Question 10

What is an example of a type of priamry generalised epilepsy?

Answer 10

juvenile myoclonic epilepsy

Question 11

What are the problems with sodium valproate?

Answer 11

teratogenic- not suitable for women of child-bearing age; lots of side effects

Question 12

What are the SE with sodium valproate?

Answer 12

weight gain; pancreatitis; hepatitis; oedema; hair loss; ataxia; fatiue; nausea; encephalopathy

Question 13

What are the risk factors for juvenile myoclonic epilepsy?

Answer 13

sleep deprivation and flashing lights

Question 14

What causes focal onset epilepsy?

Answer 14

underlying structural cause- commonly hippocampal sclerosis

Question 15

What typically causes hippocampal sclerosis?

Answer 15

hx of febrile convulsions

Question 16

What is teh treatmetn for focal epilepsy?

Answer 16

carbamazepine or lamotrigine

Question 17

What is phenytoin used for?

Answer 17

acute managment only

Question 18

What is a main problem with carbamazepine?

Answer 18

can make primary generalised epilepsies worse

Question 19

What is the problem with carbamazepine with females?

Answer 19

alters the efficacy of the OCP adn morning after pill

Question 20

What is status epilepticus?

Answer 20

recurrent epilpetic seizures without full recovery of consiousness; lasting more than 30 mins

Question 21

What are the types of status epilepticus?

Answer 21

generalised convulsive status epilepticus; non convulsive status (consiouc but in altered state); epilepsiea partialis continua- continual focal seizures- consioucenss preserved

Question 22

What are the causes of status?

Answer 22

severe metabolic disorders- hyponatraemia; hypoglycaemia; infection; head trauma; SAH; abrupt withdrawal of anti-convulsants; treating absence seizures with CBZ

Question 23

What can convulsive status result in?

Answer 23

respiratory insufficiency and hypoxia; hypotension; hyperthermia and rhabdomyolysis

Question 24

What drugs can precipitate epileptic seizures?

Answer 24

theophylline; tramadol; anti-emetics; opioids; antibiotics eg penicillins; cephalosproins and quinolones

Question 25

What is the MOA of carbamazepine and lamotrigine?

Answer 25

inhibit the actiivity of voltage-gated sodium channels; reducing pre-synaptic excitability and abilityo f APS to spread

Question 26

What is MOA of pregabalin and gabapentin?

Answer 26

inhibt voltage-gated calcium cannels with drives neurotrasmitter release