Epilepsy

Question 1

What is epilepsy?

Answer 1

Condition characterised by unprovoked recurrent seizures

Question 2

What are the types of seizures?

Answer 2

Generalised

Focal/partial

Question 3

What are the types of generalised seizures?6

Answer 3

Tonic
Clonic
Tonic clonic
Atonic
Myoclonic
Absence

Question 4

What are focal or partial seizures?

Answer 4

Seizures that can be attributed to one area of the brain

Question 5

What are the types of focal seizure?

Answer 5

Simple- consciousness level normal

Complex- impaired conciousness

Question 6

What is the presentation of generalised seizures?

Answer 6

Classically no warning, aura or precipitating factors
Loss of conciousness
Injuries and incontinence common
Don't remember event
Post octal phase

Question 7

What is the presentation of absence seizures?

Answer 7

~10 seconds

Staring into space, eye blinking, lip smacking, fidgeting

Question 8

What happens in a post octal phase?

Answer 8

5-30 minutes
Decreased conciousness
Confusion
Tired
Headache

Question 9

What is the presentation of a focal seizures?

Answer 9

Often have aura
1-2 minutes
Deja vu, odd sensations, disorientation, speech changes, lip smacking, fiddling
Usually remember event

Question 10

What investigations are done for a first seizure emergently?

Answer 10

FBC, U&E, LFTs
BM
ECG

Question 11

What investigations are done for epilepsy?

Answer 11

EEG
CT/MRI esp in focal seizures
Video telemetry

Question 12

What is a general rule for management of epilepsy?

Answer 12

Generalised= sodium valproate
Partial= carbamazepine

Question 13

What are the 1st line choices for generalised seizures?

Answer 13

Sodium valproate- teratogenic
Lamotrigine
Levetiracetam

Question 14

What are the 2nd line options for generalised seizures?

Answer 14

Topiramate
Carbamazepine
Zonisamide

Question 15

What is the management of absence seizures?

Answer 15

Ethosuximide

Question 16

What is the 1st line management for focal seizures?

Answer 16

Carbamazepine

Lamotrigine

Question 17

What are some 2nd line options for focal seizures?4

Answer 17

Sodium valproate
Topiramate
Gabapentin
Pregabalin
More..

Question 18

What is the rule for driving with epilepsy?

Answer 18

Report to DVLA

Must be 6 months seizure free

Question 19

What is a complication of epilepsy?

Answer 19

Status epilepticus

Question 20

What is status epilepticus?

Answer 20

Prolonged or recurrent tonic clonic seizures for >30 mines with no recovery period between

Question 21

What are the management steps of status epilepticus?

Answer 21

1. IV lorazepam/buccal midazolam
2. IV lorazepam
3. IV phenytoin
4. Anaesthesia

Question 22

What is the prognosis for status epilepticus?

Answer 22

5-10% mortality

Question 23

What blood test can be used to differentiate seizures from pseudo seizures?

Answer 23

Prolactin- raised serum prolactin after true seizure