Epilepsy

Question 1

Definition

Answer 1

Tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain, manifesting as seizures

Question 2

Before seizure

Answer 2

may me a preceding promo done

Question 3

After

Answer 3

Post ictally- Headache, confusion, myalgia, temporary weakness

Question 4

Diagnosis

Answer 4

History v important
EEG
ECG
MRI
CT

Question 5

Things that suggest psuedoseizure

Answer 5

gradual onset, prolonged duration and abrupt termination. Are associated with closed eyes and resistance to eye opening, rapid breathing, fluctuating motor activity and episodes of motionless unresponsiveness

Question 6

Causes

Answer 6

structural abnormality, genetic

Question 7

types of seizure

Answer 7

Focal seizures- involving part of the brain

generalised seizures - involving entire brain

Question 8

Types of focal seizure

Answer 8

Focal simple- without impairment of conciousness
Complex- with impairment of conciseness
Secondary generalised- evolving to a bilateral convulsive seizure

Question 9

Types of generalised seizure

Answer 9

Tonic clonic- grand mal- limbs stiffen then jerk. Post octal confusion and drowsiness
Absence- brief <10s, pauses
Myoclonic- sudden jerk of a limb, face or trunk
Atonic- sudden loss of muscle tone

Question 10

Frontal lobe seizures

Answer 10

motor- head/leg movements, posturing, post octal weakness

Question 11

Parietal lobe seizures

Answer 11

Sensory- paresthesia

Question 12

Occipital lobe seizures

Answer 12

visual disturbances

Question 13

Temporal lobe seizures

Answer 13

HEAD- Hallucinations (auditory, gustatory etc), Epigastric rising/emotional, Automatisms (lip smacking/grabbing), Deja vu/dysphasia post ictal

Question 14

Differential diagnosis

Answer 14

syncope, non epileptic attack disorder, panic attacks, TIA, etc

Question 15

Epilepsy driving rules

Answer 15

1st seizure- can’t drive car for 6 months, HGV 5yrs

Epilepsy- 1yr/3yrs if during sleep, 10 yrs off medication for HGV

Question 16

Treatment- focal seizures

Answer 16

1st line- carbamazepine, lamotrigine

2nd line- levetiracetam, oxcarbazepine or sodium valproate

Question 17

Treatment- generalised tonic clonic seizures

Answer 17

1st line- sodium valproate or lamotrigine

2nd line- carbamazepine, clobazam, levetiracetam or topiramate

Question 18

Absence seizures

Answer 18

1st line- sodium valproate or ethosuximide

2nd line- lamotrigine

Question 19

Myoclonic seizures

Answer 19

1st line- sodium valproate

2nd line- levetiracetam, or topiramate

Question 20

Which drugs should be avoided in myoclonic seizures and why

Answer 20

carbamazepine and oxcarbazepine- may worsen seizures

Question 21

treatment- atonic

Answer 21

sodium, valproate or lamotrigine

Question 22

Drugs that interfere with COC

Answer 22

carbamazepine, oxcarbazepine, phenobarbitol, phenytoin, primdone, toperamate- they induce hepatic enzymes
Shouldn’t take POP, progesterone implants not effective
Morning after pill not adequate

Question 23

Side effects carbamazepine

Answer 23

leucopenia, diplopia, blurred vision, impaired balance, drowsiness, mild erythematous rash, SIADH rare

Question 24

side effects lamotrigine

Answer 24

maculopapular rash, can develop Stevens Johnson syndrome, diplopia, photosensitivity, tremor, agitation, vomiting, aplastic anaemia

Question 25

levetiracetam side effects

Answer 25

psychiatric side effects common

Question 26

sodium valproate side effects

Answer 26

teratogenic, nausea v common. Liver failure, pancreatitis, hair loss, oedema, ataxia, tremor,

Question 27

What drug should epileptics of child bearing age take

Answer 27

folic acid 5mg

Question 28

Status epilepticus

Answer 28

continued seizure activity for >30mins

Question 29

Management of status epilepticus

Answer 29

lorazepam 4mg IV or diazepam 20mg IV or rectal, midazolam 5-10mg IM

Question 30

Precipitants of status epilepticus

Answer 30

severe metabolic disorders, hyponatraemia, infection, head trauma, sub arachnoid haemorrhage