Epilepsy

Question 1

Definition of epilepsy

Answer 1

Seizures occurring as a result of spontaneous abnormal electrical discharge in brain

Question 2

Prodrome vs aura

Answer 2

Prodrome - precedes fit, usually behavioural changes

Aura - part of seizure that precedes other manifestations eg odd sensations

Question 3

Investigations for epilepsy

Answer 3

EEG, drugs screen, CT/MRI/LP if thinking structural or infective

Bloods + ECG

Question 4

What is a partial seizure?

Answer 4

Limited to one area of brain

Simple = no impairment of consciousness

Complex = consciousness impaired

Question 5

What is a generalised seizure?

Answer 5

Whole brain involved

6 types:

tonic-clonic, absence, myoclonic, tonic, clonic + atonic

Question 6

What is an absence seizure, what would the EEG show + what are the triggers?

Answer 6

Brief staring spell, usually in children

EEG shows 3 second spike-wave pattern

Triggers = hyperventilation + flashing lights

Question 7

What is a tonic-clonic seizure + what does EEG show?

Answer 7

Losing consciousness + falling to ground T

onic phase = stiffening, 10-20s

Clonic phase = jerking 30-40s

Causes cyanosis, excessive salivation, tongue biting + incontinence

Bilateral, slow wave, subcortical seizures

Question 8

What is a tonic seizure?

Answer 8

Sudden onset of maintained increase in tone in extensor muscle - will usually fall

Question 9

What is a clonic seizure?

Answer 9

LOC and sudden loss of muscle tone followed by limb jerking

Question 10

What is an atonic seizure?

Answer 10

Drop attack - loss of muscle tone causing person to fall to ground

Question 11

What are the signs of temporal lobe seizures?

Answer 11

Aura

Automatisms = oral movements like lip smacking, plucking at clothing

Abdominal rising sensation of pain +- vomiting

Dysphasia

Memory phenomena eg deja vu

Delusional behaviour/ bizarre stories

Question 12

What are the signs of a frontal lobe seizure?

Answer 12

Motor features = posturing, versive movements

Jacksonian march

Motor arrest

Behavioural disturbances

Dysphasia

Todd’s palsy (post ictal)

Question 13

What are the signs of a parietal lobe seizure?

Answer 13

Sensory disturbances = tingling, numbness, pain

Visual phenomenon eg spots, lines, flashes

Contralateral

Question 14

What is Todd’s palsy?

Answer 14

Focal CNS signs eg hemiplegia

Follows an epileptic seizure

Question 15

General post-ictal features

Answer 15

Headache, confusion, myalgia, sore tongue, temporary weakness, dysphasia

Question 16

Management post first seizure

Answer 16

Urgent assessment (2 weeks) by neurologist

Screen for depression

Question 17

Non pharmacological management of epilepsy

Answer 17

Annual GP review Education

Question 18

Driving + epilepsy

Answer 18

Stop driving + notify DVLA

For first fit: 6 months off driving (group 1), group 2 = 5 years off driving

For diagnosed epilsepy: licensed revoked for 1 year after last attack.

For group 2, license revoked for 20 years

Question 19

When to give drugs for epilepsy

Answer 19

Drug treatment after 2nd seizure

Consider withdrawal if fit free for 2-3 years

Question 20

Management of absence seizures

Answer 20

Sodium valproate

Lamotrigine

Question 21

Management of myoclonic seizures

Answer 21

Sodium valproate

Clonazepam

Question 22

Management of tonic clonic seizures

Answer 22

Sodium valproate

Carbamazepine

Lamotrigine

Question 23

What other treatments are available for epilepsy?

Answer 23

Surgery = for intractable partial seizures

Vagus nerve stimulation = useful for those refractory to meds

Ketogenic diet = used for refractory epilepsy

Question 24

What is SUDEP?

Answer 24

Sudden unexplained death in epilepsy

Usually due to respiratory arrest during seizure