Epilepsy

Question 1

what are focal and generalised seizures?

Answer 1

focal = one part of the brain

generalised = larger part of the brain

Question 2

who tends to suffer from focal and generalised seizures?

Answer 2

focal more common in 50s

generalised more common <30 as tend to be genetic

Question 3

what are provoked seizures?

Answer 3

alcohol

sleep deprivation

hypoglycaemia

Question 4

are provoked seizures classed as epilepsy?

Answer 4

no

Question 5

what is important to ask about to determine epileptic seizure vs faint?

Answer 5

what happens before/after

eye witness

Question 6

how would you describe an epileptic event?

Answer 6

lose awarness and go stiff

Question 7

what exam must be carried out if investigating syncope?

Answer 7

cardiovascular exam

Question 8

what is used to investigate epilepsy?

Answer 8

ECG

cerbral hypoperfusion and hypotension (watch for prolonged QT syndrome)

Question 9

is an EEG manatory when investigating epilepsy?

Answer 9

no- 1 in 5 will show abnormal activity but not have epilepsy, likewise people will have nromal result when they do have epilepsy

Question 10

when will an EEG be used?

Answer 10

in those <30 to differentiate between focal/generalised

Question 11

how would an epileptic seizure affect someones ability to drive?

Answer 11

first seizure: car 6 months, HGV 5yrs

epilepsy: car 1yr, HGV 10yrs

Question 12

how does focal epilepsy affect the brain?

Answer 12

one part of brain is structurally abnormal which predisposes to seizures i.e. sensory cortex gives sensory seizure

Question 13

how can seizures propagate through the brain?

Answer 13

cortical networks

Question 14

if a focal epilepsy results in a generalised siezure by propagating through brain what is this then termed?

Answer 14

secondary generalised seizure

Question 15

what part of the brain is affected in generalised epilepsy?

Answer 15

abnormality already in cortical network so will always get generalised seizures

Question 16

what are the kinds of generallised seizure people can experience?

Answer 16

absence

myoclonic

atonic

tonic

tonic clonic

Question 17

what drug can be given to treat focal epilepsy?

Answer 17

carbamazepine

lamotrogine

Question 18

what is side effect of carbamazepine?

Answer 18

lessens effects of other drugs i.e. COCP, chemo

wgt gain

hair loss

fatigue

Question 19

what is used to treat genrealised epilepsy?

Answer 19

sodium valproate

Question 20

what do you need to consider when prescribign sodium valproate?

Answer 20

teratogenic so muct be given contraception if child bearing age

Question 21

lamotrogine can cause which syndrome if given too quickly?

Answer 21

steven-johnson syndrome

Question 22

how long should it take to titrate up lamotrogine?

Answer 22

3 months

Question 23

what drug should never be given to treat generalised epilepsy?

Answer 23

carbamazepine

Question 24

can phenytoin be used to treat epilepsy?

Answer 24

used acutely- 6months to 1 year

Question 25

what other anti-epileptic can be used as few drug interaction but can cause mood swings?

Answer 25

levetiracetam

Question 26

carbamazepine, oxcarbazepine, phenobarbital, phenytoin, primidone and topiramate are all what kind of anti-epileptic drug?

Answer 26

enzyme inducing AEDs

Question 27

what is status epilepticus?

Answer 27

recurrent epileptic seizures without full recovery of consciousness \>30mins

Question 28

status epilepticus can last \>30mins, at what point is it treated?

Answer 28

10 mins as chances of self-terminating after then are near 0

Question 29

what is generalised convulsive status?

Answer 29

generalised convulsions without cessation

Question 30

what can cause generalised convulsive status?

Answer 30

severe metabolic disease withdrawal of anti-convulsant head trauma sub-arachnoid haemorrhage

Question 31

what is the management of generalised convulsive state?

Answer 31

stabalise patient- ABS and identify cause anticonvulsant: benzo, phenytoin, sodium valproate if possible hypo give glucose/if alcohol give thiamine

Question 32

what is the max dose of benzodiazepine that can be given when suffering seizure?

Answer 32

max 2 doses

Question 33

what is teh name given to continous focal seizures with consciousness preserved?

Answer 33

epilepsia partialis continua

Question 34

what is an absence seizure?

Answer 34

interrupts activity with pause i.e. makes you stop what youre doing then start again

Question 35

what will be seen in frontal lobe seizure?

Answer 35

motor signs i.e. stiffness, twitching or spasm

Question 36

what will be seen in parietal lobe seizure?

Answer 36

sensory manifestations i.e. tingling, numbness, pain

Question 37

what will be seen seizures in occipital lobe seizures?

Answer 37

visual phenomena such as flashing lights, colours or hallucinations

Question 38

what will be seen in temporal lobe seizure?

Answer 38

change in mood or behaviour rising epigastric sensation is common manifestation

Question 39

hippocampal sclerosis is the most common cause of temporal lobe epilepsy typically assoc w what type of seizure?

Answer 39

complex partial seizures | (focal)

Question 40

what is a complex partial seizure?

Answer 40

arises in one lobe of the brain rather than whole brain itself

Question 41

what are the three components seen in complex partial seizures?

Answer 41

aura absence automatism

Question 42

what is classically seen on EEG in absence seizure?

Answer 42

3Hz generalised spike-wave

Question 43

clonic seizures are most frequent in which age groups?

Answer 43

neonates and young children

Question 44

what imaging is helpful in those who develop epilepsy before the age of 2?

Answer 44

MRI

Question 45

what is teh MoA of carbamazepine and phenytoin?

Answer 45

Na⁺ channel inactivation

Question 46

what is the MoA of lamotrogine?

Answer 46

blocks voltage-gated Na⁺ channels

Question 47

what is the MoA of sodium valproate?

Answer 47

Na⁺ channel inactivation with increase GABA concentration

Question 48

what is first line treatment in community and in hospital for status epilepticus?

Answer 48

community: buccal or rectal midazolam hospital: IV lorazepam IV phenobarbital or phenytoin if sezures persist

Question 49

describe absence seizures?

Answer 49

brief, sudden lapse in consciousness

Question 50

describe myoclonic seizures?

Answer 50

sudden, jerking spasms of teh muscle/ muscle groups

Question 51

describe atonic seizures?

Answer 51

aka 'drop seizure' partial or compelte loss of muscle tone

Question 52

describe a tonic seizure?

Answer 52

sudden stiffness in muscles of arms/ legs/ trunk uncoordinated, can last 20 secs

Question 53

describe a tonic clonic seizure?

Answer 53

loss of consciousness stiffening of muscles followed by jerking movements (muscles relaxing: stiff/relax/stiff/relax)