Epilepsy

Question 1

What is the most important part of investigating epilepsy?

Answer 1

THE HISTORY

Question 2

What is a key thing to ask about and what would it indicate?

Answer 2

head turning - frontal lobe

drug history - many precipitate an epileptic seizure

Question 3

What investigations must be done in somebody presenting with a seizure?

Answer 3

ECG - MUST RULE OUT PROLONGED QT SYNDROME
MRI brain (CT if contraindicated) - look for lesions/tumours
if syncope - do CVS exam and lying/sitting BP

Question 4

When would you do a CT scan acutely?

Answer 4

if clinical or radiological skull fracture
deteriorating GCS
focal signs - stroke/bleed
head injury with seizure
failure to be GCS 15/15 4hrs after arrival
suggestion of other pathology

Question 5

What other investigation is sometimes done?

Answer 5

EEG - can be misleading but can show electrical problems within the brain and classify the epilepsy

Question 6

What are the driving rules for after your first seizure - IMPORTANT?

Answer 6

cant drive for 6 months

cant drive an HGV/PCV for 5 years

Question 7

What are the driving rules for epilepsy - IMPORTANT?

Answer 7

can drive 1 year after last seizure or 3 years if nocturnal seizures
can drive HGV/PCV after 10 years off medication

Question 8

What is epilepsy?

Answer 8

tendancy to have seizures that are recurrent and spontaneous due to abnormal synchronisation of neuronal activity
there is an abnormal discharge in the brain leading to high frequency action potentials

Question 9

What is the pathophysiology behind epilepsy?

Answer 9

due to either too little or too much excitation or changes in cell numbers/types, connectivity, synaptic function or changes in voltage gated channels

Question 10

What is Sudden Unexplained Death in Epilepsy (SUDE)?

Answer 10

due to cardiac arrest or massive seizure telling brainwaves to stop

Question 11

What are the two types of epilepsy?

Answer 11

focal

generalised

Question 12

What is focal epilepsy?

Answer 12

part of the brain is abnormal due to stroke, haemorrhage, demyelination etc, this causes abnormal discharge of electricity
focal pathways can hit other pathways and become generalised

Question 13

What is the presentation of focal epilepsy?

Answer 13

rhythmic jerking
head and eye deviation
plucking and cycling movements 
vocalisation 
(DEPENDS on where the lesion is in the brain)

Question 14

At what age does focal epilepsy present?

Answer 14

any age

Question 15

What is the treatment for focal epilepsy?

Answer 15

carbamazepine or lamotrigine

sodium valporate but bad side effects

Question 16

What are the side effects of carbamazepine?

Answer 16

impairs other drugs - esps contraceptive medication

Question 17

What is generalised epilepsy?

Answer 17

most people are predisposed due to genetics

can start from any point in the brain and engages in bilateral networks

Question 18

How do generalised seizures present?

Answer 18

different types:
absent 
myoclonic
atonic
tonic
tonic clonic

Question 19

At what age do generalised seizures come on?

Answer 19

childhood or teens

juvenile myoclonic epilepsy - freshers

Question 20

What treatment should be given for generalised seizures?

Answer 20

sodium valporate (makes you fat and bald and is tetragenic)
lamotrigine - not good if you have lots of fits
levetiracetam
topiramte - reduces effects of oral contraceptives