Epilepsy

Question 1

Define seizure

Answer 1

sudden irregular discharge of electrical activity in the brain causing a physical manifestation such as sensory disturbance, unconsciousness or convulsions

Question 2

Define convulsion

Answer 2

uncontrolled shaking movements of the body due to rapid and repeated contraction and relaxation of muscles

Question 3

Define aura

Answer 3

perceptual disturbance experienced by some prior to a seizure, e.g. strange light, unpleasant smell, confusing thoughts

Question 4

Define epilepsy

Answer 4

neurological disorder marked by sudden recurrent episodes of sensory disturbance, LOC or convulsions, associated with abnormal electrical activity in the brain

Question 5

How can seizures be classified?

Answer 5

Partial = simple (consious) or complex (unconsious)

Generalised = absence, myoclonic, tonic-clonic, tonic, atonic

Question 6

What is a partial seizure vs a generalised one?

Answer 6

Partial = part of the brain

Generalised = everywhere

Question 7

Describe partial seizures

Answer 7

Involves part of the brain

Simple = same consciousness

Complex = consciousness impaired

Most common = temporal lobe epilepsy

Question 8

Describe a tonic-clonic seizure

Answer 8

2 parts = 1st tonic (muscles tense), 2nd clonic (convulsions)

Question 9

Describe an absence seizure

Answer 9

Daydreaming

Unaware what has happened

Question 10

Describe a status epilepticus seizure

Answer 10

Seizures follow one after another without recovery of consciousness between

Medical emergency

Question 11

Describe a myoclonic seizure

Answer 11

Brief shock-like muscle jerks

Question 12

Describe an atonic seizure

Answer 12

Without tone – drop attack

Question 13

Describe a tonic seizure

Answer 13

Increased tone

Question 14

How are seizures investigated?

Answer 14

Clinical history

EEG = asses risk of recurrence, phonic stimulation may induce seizure

MRI

ECG

Question 15

Give a differential diagnosis for seizures

Answer 15

Vascular: Stroke, TIA

Infection: Abscess, Meningitis

Trauma: Intracerebral haemorrhage

Autoimmune: SLE

Metabolic: Hypoxia, Electrolyte imbalance, Hypoglycaemia, Thyroid dysfunction

Iatrogenic: Drugs, Alcohol Withdrawal

Neoplastic: Intracerebral mass

Question 16

Outline the initial management of seizures

Answer 16

ABCDE –

A – Airways: not blocked, patent

B – Breathing: listing to breath sounds check ox sats and circulation

C – Circulation: bp and heart rate, heart sounds

D – Disability: GCS, glucose levels

E – Exposure: look around and check for injuries

Lorazepam or midazolam