Epilepsy

Question 1

What is epilepsy?

Answer 1

Tendency to recurrent seizures unprovoked by systemic or neurological insults

Question 2

What is a seizure?

Answer 2

A paroxysmal event in which changes of behaviour, sensation or cognitive processes are caused by excessive hyper synchronous neuronal discharges in the brain.

Question 3

What are the differential diagnoses of recurrent black outs?

Answer 3

• epilepsy
• syncope
• non-epileptic attach

Question 4

What are the triggers for syncope?

Answer 4

• stress
• fear
• prolonged standing
• heat
• venipuncture
• cough
• micturition

Question 5

What are the triggers for seizures?

Answer 5

• sleep deprivation
• flashing lights
• menstruation
• alcohol
• alcohol-withdrawal
• metabolic (e.g. hypoglycaemia, hyponatraemia, liver failure)

Question 6

What is the prodrome for syncope?

Answer 6

• light headed/feeling faint
• hot
• visual crowding
• pale

Question 7

What is the prodrome for an epileptic seizure?

Answer 7

• strange taste
• visual aura
• strange smell
• de ja vu

Question 8

How would you describe a syncopal attack?

Answer 8

• quick onset
• short (up to 1 minute)
• pale
• no convulsions (usually)
• no tongue biting
• no incontinence

Question 9

How would you describe an epileptic seizure? (tonic clonic)

Answer 9

• tonic (rigidity)
• clonic (rhythmic)
• lasts 2-3 minutes
• incontinence
• tongue biting

Question 10

How would you describe a non-epileptic attack?

Answer 10

• up to 30 mins :(
• non-neuroanatomically accurate convulsions
• wild shaking
• arms flexing and extending
• can just be still
• wax and wane
• pelvic thrusting
• eyes closed (resists opening)

Question 11

How do you recover after a syncopal attack?

Answer 11

• quick recovery

- little/no confusion

Question 12

What are the typical post-ictal features following an epileptic attack? (tonic clonic)

Answer 12

• confusion
• headache
• amnesia
• may not recognise family/friends
• can take several hours for recovery –> need to go sleep

Question 13

How do you recover after a non-epileptic attack?

Answer 13

• recovery is atypically quick for generalised prolonged fit

- can be upset

Question 14

What are the causes of syncope?

Answer 14

• neurogenic (vasovagal, situational, carotid sinus hypersensitivity (typically window cleaner)
• orthostatic (autonomic failure = can be secondary to diabetes or drugs)
• cardiac syncope (arrhythmias, valve stuff - typically aortic stenosis, or ischaemia)

Question 15

What in a patient’s history would indicate syncope?

Answer 15

• cardiac history (e.g. arrhythmias, valvular disease, previous MI)
• hypotensive meds
• FHx of sudden cardiac death

Question 16

What are the risk factors for seizures?

Answer 16

• febrile seizures
• head injury
• alcohol or drug use
• FHx

Question 17

What in the history would indicate non-epileptic attack?

Answer 17

• psychological co-morbidity
• functional illnesses (e.g. headaches, IBS)
• antidepressants
• domestic abuse
• asylum seekers
• family trauma

Question 18

What are some important differentials of blackouts?

Answer 18

• hypoglycaemia
• acute hydrocephalis/colloid cyst (a colloid cyst in ventricle which stops CSF leaving, however when they fall the cyst will be dis-lodged)

Question 19

What investigations should you do for someone who has transient loss of consciousness?

Answer 19

ECG - and check corrected QT interval
- blood tests (FBC CLASSIC ANAEMIA)
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