Epilepsy:

Question 1

What is epilepsy?

Answer 1

A recurrent tendency to spontaneous, intermittent, abnormal electrical activity of the brain, manifesting as seizures.

Question 2

What is a seizure?

Answer 2

It is the clinical manifestation of dysynchronus neuronal discharge - generalised/focal.

Question 3

What are primary generalised seizures?

Answer 3

(40%) Bilaterally symmetrical and synchronous discharge involving both hemispheres. No focal brain abnormality

Question 4

What are partial seizures?

Answer 4

One hemisphere involved at onset. New onset partial seizures represent a focal structural abnormality until proven otherwise.

Question 5

Give some causes/RF for epilepsy:

Answer 5

• Mostly idiopathic
• Genetic conditions (tuberous sclerosis)
• Cerebrovascular disease
• CNS infection

Question 6

What are the different types of generalised seizures?

Answer 6

(consciousness lost from start):

• Generalised tonic clonic
• Clonic seizures
• Tonic seizures
• Absence
• Myoclonic seizures
• Atonic seizures

Question 7

What is a generalised tonic clonic seizure?

Answer 7

Tonic phase (rigid and stiff) to clonic phase (generalised, bilateral, rhythmic jerking lasting seconds to minutes. often bite-tongue and incontinent of urine/faeces)

Question 8

What is a clonic seizure?

Answer 8

Rhythmic jerking movements

Question 9

What are tonic seizures?

Answer 9

Sudden sustained increased tone with a characteristic guttural cry/grunt

Question 10

What is an absence seizure?

Answer 10

Impaired consciousness with mild or no motor involvement. Normal activity resumes without awareness of seizure.

Question 11

What is a myoclonic seizure?

Answer 11

‘Shock like’ body jerks.

Question 12

What is a atonic seizure?

Answer 12

Sudden brief loss of tone may call falls

Question 13

What types of partial seizures are there?

Answer 13

• Simple partial seizures
• Complex partial seizures
• Partial seizures with secondary generalisation

Question 14

What are the features of simple partial seizures?

Answer 14

Awareness unimpaired - focal motor, sensory, autonomic or psychic symptoms.
No post-ictal symptoms

Question 15

What is a complex partial seizure?

Answer 15

Alteration of consciousness (LOC, automatisms, lip smacking, chewing, autonomic aura such as epigastric rising sensation)

Question 16

What characteristic appear based on the lobe affected?

Answer 16

Temporal lobe:

• Aura
• Deja-vu
• Auditory hallucinations

Frontal lobe:

• Motor features
• Jacksonian March (seizure marches up or down the motor homunculus)

Parietal lobe:
- Sensory disturbances (tingling/numbness)

Occipital lobe:
- Visual phenomena

Question 17

Give 3 DD for epilepsy:

Answer 17

• Syncope
• Cardiac arrhythmias
• TIA

Question 18

How is epilepsy diagnosed?

Answer 18

From history:

- need at least 2 unprovoked seizures occurring >24hrs apart to diagnose epilepsy

Question 19

What investigations are performed in epilepsy?

Answer 19

EEG - 3Hz wave seen in absence seizures

FBC, U&Es and LFTs to rule out metabolic causes.

MRI - identify structural abnormalities

Genetic testing (e.g. juvenile myoclonic epilepsy)

Question 20

What is the management for epilepsy?

Answer 20

Primary generalised - Valporate

Absence seizures - valporate

Partial seizures - carbamazepine

Question 21

What must patients do if they are diagnosed with epilepsy?

Answer 21

Inform DVLA. Cannot drive until they have been free of daytime seizures for at least one year

Question 22

What can be a severe complication of epilepsy?

Answer 22

Sudden unexpected death in epilepsy (SUDEP).

Question 23

What is status epilepticus?

Answer 23

Seizure lasting >30mins or reccurent seizures with no full recovery in between

Question 24

What is the management for status epilepticus?

Answer 24

• ABCDE (protect from injury, check glucose)
• Rectal diazepam - repeat x2
• Phenytoin loading
• If still fitting, anaesthetist involvement for anaesthetic and ventilation.