Epilepsy

Question 1

Definition of a seizure

Answer 1

A convulsion caused by paroxysmal discharge of cerebral neurones

Question 2

Definition of epilepsy

Answer 2

Neurological disorder characterized by recurrent sudden onset seizures

Question 3

Types of focal seizures

Answer 3

Focal aware (simple)
Focal impaired awareness (complex)

Question 4

Focal to bilateral tonic-clonic seizure is where

Answer 4

Seizure begins in an area in one hemisphere of the brain but spreads to involve both hemispheres

Question 5

Tonic seizure

Answer 5

All muscles become stiff

May lose balance and fall (usually back)

Question 6

Clonic seizure

Answer 6

Body jerks (more regular & sustained than myoclonic)
Usually lasts a few minutes
May lose consciousness

Question 7

Patient usually falls backwards in this type of seizure

Answer 7

clonic

Question 8

Patient usually falls forwards in this type of seizure

Answer 8

atonic

Question 9

Myoclonic seizure

Answer 9

Some/all of body suddenly jerks and twitches like you’ve had an electric shock

Question 10

Atonic seizure

Answer 10

All your muscles relax (loss of tone) suddenly
May fall (usually forwards)

Question 11

Causes of epilepsy

Answer 11

2/3 idiopathic
Other causes:
Head injury
Disease - tumour, infection 
Stroke
Ischemia during birth

Question 12

The most common type of epilepsy in adults which happens to have the most complex presentation

Answer 12

Temporal lobe epilepsy

Presentation includes: abdominal pain, de ja vu, delusional behaviour, complex motor phenomena

Question 13

Focal aware seizures

Answer 13

Can cause:
stiffness or twitching in part of the body eg hand, arm
tingling
strange smells, tastes
deja vu
Remain awake and aware

Question 14

Focal impaired awareness seizures

Answer 14

Lose your sense of awareness and make random movements such as:
lip-smacking, moving arms around, chewing/swallowing, rubbing hands

Question 15

Status epilepticus is

Answer 15

A seizure that lasts a long time or series of seizures between which the patient does not re-gain consciousness

Question 16

What makes seizures so dangerous

Answer 16

Patient can stop breathing or ventilate very little during making them potentially fatal

Question 17

What is happening in the brain during an epileptic seizure

Answer 17

Sudden excessive, synchronous, high frequency neuronal discharge in the cerebral cortex

Question 18

Dormant basket cell hypothesis of epilepsy

Answer 18

GABAergic inhibitory interneurones are dormant as they lose excitatory input > so they are not excited to inhibit pyramidal cells via GABA

Question 19

Fundamentally, what is the pathology of epilepsy?

Answer 19

Excitatory/inhibitory balance is lost
A loss of GABAergic inhibition of pyramidal cells
An increase in glutamatergic excitation of pyramidal cells

Question 20

A hallmark of epilepsy - axonal sprouting

Answer 20

Some of the cells providing afferent excitation to pyramidal cells are lost so pyramidal cells do axonal sprouting in response. Cells connect in an abberant way and create a dense extensive network so that much more glutamate is released - balance is shifted in favour of excitation.

Question 21

Tonic-clonic seizure

Answer 21

Tonic phase - body goes stiff & person may fell

Clonic phase - body jerks and twitches, may lose control or bladder/bowel, bite tongue, breathing may be difficult

Question 22

How is epilepsy diagnosed

Answer 22

Look at pre-ictal, ictal, post-ictal symptoms
Bystander account helpful
MRI & EEG

Question 23

What is an aura

Answer 23

Part of the seizure that the patient is aware of, preceding other manifestations. Usually suggests focal seizures. Could be a strange feeling, smell etc

Question 24

When is surgery appropriate in epilepsy?

Answer 24

Resistant to multiple AEDs and has a single epileptogenic focus in brain

Question 25

Epilepsy treatments

Answer 25

AEDs Vagus nerve stimulation therapy Brain surgery Ketogenic diet