Epilepsy

Question 1

Epilepsy?

Answer 1

Recurrent tendency to spontaneous, intermittent, abnormal electrical activity in the brain manifesting as seizures. Convulsions

Question 2

Elements of a seizure

Prodome

Aura

Post-ictally

Answer 2

Prodome
o Lasting hours/days of change in mood or behaviour.

Aura
o Implies focal seizure often from temporal lobe.
o Often a strange feeling in gut or strange smells or flashing lights.

Post-Ictally
o Headache, confusion, myalgia.
o Temporary weakness
o Temporary dysphasia often from focal seizure in temporal lobe

Question 3

Patients must be advised to stop what until diagnosis is confirmed?

Answer 3

Driving - can’t start again until seizure free for at least 1 year

Question 4

Most seizures only last?

Answer 4

a few minutes

Question 5

Diagnosis?

Answer 5

All patients with a seizure must be referred for specialist assessment and investigation within 2 weeks.

Question 6

Seizures - can either be focal (partial) or general?

Focal - can either be LOC or without LOC

or focal can develop into general in 2/3 of patients

Answer 6

o Without LOC – used to be termed ‘simple’ seizure, no post-ictal symptoms but focal motor, sensory symptoms.
o With LOC – used to be termed ‘complex’ seizure, awareness is impaired, commonly from temporal lobe, post-ictal confusion is a common feature.

Question 7

Seizures - can either be focal (partial) or general?

Different types of general seizures:

• absence seizures
• tonic clonic seizures
• myoclonic seizures
• atonic seizures

Answer 7

o Absence seizures – Brief (<10s) pauses, cut off mid-sentence then continue back to sentence, presents in childhood.

o Tonic-clonic seizures – LOC, limbs stiffen (tonic) then jerk (clonic). Post-ictal confusion and drowsiness.

o Myoclonic seizures – Sudden jerk of a limb, face or trunk. Patient may be thrown suddenly to ground or have a violently disobedient limb.

o Atonic seizures – Sudden loss of muscle tone causing a fall, no LOC.

Question 8

Ix?

Answer 8

Consider EEG – can’t exclude epilepsy and can be falsely +ve, so don’t do it if simple syncope is the likely diagnosis.

Question 9

if seizure marches from one part of body

Answer 9

jacksonian seizure

Question 10

Mx:

for partial seizure ?

tonic clonic seizure?

absence?

myoclonic seizure?

atonic and tonic seizure?

Answer 10

Partial Seizures - Carbamazepine or Lamotrigine

Tonic Clonic – Sodium Valproate / Lamotrigine

Absence – Ethosuximide or Sodium Valproate

Myoclonic – Sodium Valproate

Atonic & Tonic – Sodium Valproate

Question 11

Rules about withdrawing Antiepileptic drugs?

Answer 11

• If patient has been seizure free for >2 years,

- Dose must be decreased slowly over 2-3 months.

Question 12

Epilepsy and Pregnancy: Epilepsy carries 5% risk of fetal abnormalities.

• • Advise women of child-bearing age to take?
• • Strictly avoid?
• give what instead?

Answer 12

• folic acid 5mg/d.
• sodium valproate
• lamotrigine

Question 13

what is difference between

focal aware seizure

and

focal seizure with impaired awareness

Answer 13

Focal aware seizures would not involve conscious impairment, and would have rapid recovery without falling asleep

focal seizure with impaired awareness - involves emotional disturbance, automatism and followed by falling asleep