Epilepsy

Question 1

Main queries of patient account on episodes of collapse?2

Answer 1

history leading up to event (context/timing/posture)
history of event itself (warning/level of awareness)
after event (first recollection and seizure markers)

Question 2

Main queries of witness account on episodes of collapse?

Answer 2

how were they before

description of episode (eyes/abnormal movements, pallor, breathing, duration and recovery time)

Question 3

3 types of Syncope

Answer 3

Reflex
Orthostatic
Cardiogenic

Question 4

what is Reflex syncope?

Answer 4

change in vagal tone

taking blood, cough and micturition

Question 5

what is orthostatic syncope?

Answer 5

change in BP

dehydration, endocrine, medication related, ANS

Question 6

what is cariogenic syncope?

Answer 6

heart rhythm changes and CO changes

arrhythmia, aortic stenosis

Question 7

how is an episode of syncope often described?

Answer 7

pale, floppy and falling to the ground

brief jerking is common in syncope

Question 8

what may there not be in cardiogenic syncope?

Answer 8

pulse

breathing

Question 9

assessment of syncope?

Answer 9

examination - heart sounds, pulse and postural BPs

ECG (look for heart block and QT ratio)

Question 10

2 basic classifications of seizure?

Answer 10

generalised

focal

Question 11

generalised seizures? (5)

Answer 11

absence seizures
generalised tonic-clonic seizures
myoclonic seizures
juvenile myoclonic epilepsy
atonic seizures

Question 12

focal seizures? (3)

Answer 12

simple partial seizures
complex partial seizures
secondary generalised

Question 13

what is an EEG?

Answer 13

electroencephalogram

Question 14

primary generalised seizure?

Answer 14

<25
no warning
may have history of absences and jerks/GTCs
EEG shows generalised abnormality
FH possible

Question 15

Focal/partial seizure?

Answer 15

any age
may get an aura
simple/complex partial
focal abnormality on EEG
MRI may show cause

Question 16

Key points about generalised tonic clonic seizures?

patient account

Answer 16

unpredictable & cluster
PMH usually includes complications at birth, feb conv, trauma, meningitis
tongue biting/incontinence and first recollection ambulance

Question 17

Key points about generalised tonic clonic seizures?

witness account

Answer 17

groaning sound with rigid phase before generalised jerking in all limbs with eyes open
possible foaming at mouth
groggy afterwards

Question 18

absence seizures?

Answer 18

often in children whom are unaware
can have absence and GTC seizures
often having early morning myoclonus

Question 19

Complex partial seizure?

temporal lobe seizure

Answer 19

patient has rise of feeling in stomach, funny smell/taste
no recollection and briefly disorientated

witness say sudden arrest of activity, staring into space with automatism (lip smacking) and may be disorientated afterwards

Question 20

clinical assessment in seizures?

Answer 20

refer to first seizure clinic

ECG and routine bloods with CT scan potentially

Question 21

first line treatment for primary generalised epilepsy?

Answer 21

sodium valporate

Lamotrigine

Question 22

first line treatment for focal and secondary generalised seizures?

Answer 22

Lamotrigine

Carbamazepine

Question 23

absence seizure treatment?

Answer 23

Ethosuximide

Question 24

Acute treatment for seizures?

Answer 24

lorazepam

midazolam (diazepam)

Question 25

what is status epilepticus?

Answer 25

prolonged or recurrent tonic-clonic seizures persisting for more than 30 minutes with no recovery time between seizures

Question 26

Treatment for status epilepticus?

Answer 26

Valproate or phenytoin anaesthesia if must