Epilepsy

Question 1

When does epilepsy most commonly start?

Answer 1

Childhood or >60 years

Question 2

What is the ILEA definition of epilepsy?

3

Answer 2

One of the following:
Two unprovoked seizures >24 hours apart

One unprovoked seizure & probability of further seizures

Diagnosis of an epilepsy syndrome

Question 3

What is a seizure?

Answer 3

Neurons synchronously active when they aren’t supposed to be

Question 4

What are the two types of focal seizure?

Answer 4

Without impaired awareness (e.g. strange sensations, jerking movements)

With impaired awareness

Question 5

Generalised seizures, define:
Tonic
Atonic
Clonic

Answer 5

Tonic: muscles become stiff & flexed

Atonic: suddenly relax

Clonic: violent muscle contractions (convulsions)

Question 6

Generalised seizures, define:
Tonic-clonic
Myoclonic
Absence

Answer 6

Tonic clonic: muscles first stiff & flexed, followed by convulsions

Myoclonic: short muscle twitches

Absence: ‘blank out’

Question 7

What is status epilepticus?

How is it managed?

Answer 7

Seizure lasting >30 minutes, but treat after 5 minutes

Management: benzodiazapine

Question 8

What are the 3 options for managing status epilepticus?

Answer 8

Midazolam 10mg buccal

Lorazepam 4mg IV

Diazepam 10mg

REPEAT DOSE AFTER 10 MINUTES IF THERE IS NO RESPONSE

Question 9

Explain epilepsy to a patient

Answer 9

Signals in the brain travel via neurons to make you do something (think like electricity travelling along a wire). In epilepsy, neurons fire when they shouldn’t be

Question 10

What are some possible triggers?

Answer 10

Sleep deprivation
Stress
Light
Alcohol

Question 11

Give 3 non-modifiable risk factors

Answer 11

Family history
Low birth weight
Cerebral palsy

Question 12

How is epilepsy diagnosed?

Answer 12

BY A SPECIALIST, SO REFER ANY SUSPECTED CASES

Question 13

Who can start a patient on anti-epileptics?

Answer 13

A specialist

Question 14

What AED is first line for focal epilepsy?

Answer 14

Lamotrigine

Question 15

Give two alternatives for treating focal epilepsy

Answer 15

Carabamazepine

Levetiracetam

Question 16

What is first line for generalised seizures?

Answer 16

Sodium valproate

Question 17

What is first line for women of child-bearing age?

Answer 17

Levetiracetam

Question 18

Why does sodium valproate interact with lots of drugs?

Answer 18

CYP450-metabolised

Question 19

Is sodium valproate safe in pregnancy?

Answer 19

NO!!!!!

Question 20

What are some SEs of sodium valproate?

Answer 20

GI upset, Neuro & psych SEs, thrombocytopenia

Question 21

What are some SEs of leveteracitam?

Answer 21

Blocked nose, drowsiness, headaches, GI upset, aggression

Question 22

What 4 things should be a discussed in a follow-up consultation?

Answer 22

Assess seizure control (severity & frequency, effect on QOL)

Adverse effects & compliance

In controlled patients: warn about risk of osteoporosis

Women of child-bearing age: up to date on contraception, risk of anti-epileptics in pregnancy

Question 23

Give 4 differentials of epilepsy in children

Answer 23

Febrile seizure
Breath-holding attacks
Night terrors
Ritualistic behaviour (especially in learning difficulties)

Question 24

Febrile seizure or epilepsy?

Answer 24

Febrile seizures:

Child has a fever
Most common between 6 months & 3 years
Usually <5 minutes
May wet or soil themselves
May be sleepy for <1 hour after

Question 25

What is a complex febrile seizure?

Answer 25

Lasting longer than 15 minutes

Question 26

Do children who have a history of febrile seizures have an increased risk of epilepsy?

Answer 26

Yes, but important to stress that this risk is very small

Question 27

What is the risk of febrile seizures –> epilepsy?

Answer 27

1 in 50
Complex febrile: 1 in 20
No febrile: 1 in 100

Question 28

What is it important to do ASAP in a prolonged seizure?

think ABCDE

Answer 28

Secure the airway