Epilepsy

Question 1

Epilepsy Definition

Answer 1

• Not a single diagnosis but a symptom with many underlying causes
• At least two unprovoked or reflex seizures occurring more than 24 hours apart
• One unprovoked or reflex seizure with a probability of further seizures at least 60% or
• Diagnosis of an epilepsy syndrome

Question 2

Epilepsy Classification

Answer 2

I. Focal seizures
A. Simple focal (no LOC)
B. Focal dyscognitive
1. With impairment of consciousness at onset
2. Simple onset followed by impairment of consciousness
C. Focal seizure evolving to generalised tonic-clonic

II. Generalised seizures (convulsive or non-convulsive bilateral discharges; impaired consciousness and distorted activity of both sides of the brain
A. Absence
B. Myoclonic
C. Tonic
D. Clonic
E. Tonic-clonic
F. Atonic

III. Unclassified

Focal and generalised divided into idiopathic (presumed genetic) or symptomatic syndromes (caused by structural lesion)

Question 3

Epilepsy Aetiology

Answer 3

• Most are idiopathic
• Cerebrovascular disease
• Head injury
• Cranial surgery
• Focal epilepsy tends to be caused by structural disease

Question 4

Epilepsy Presentation

Answer 4

Features suggesting genetic generalised epilepsies include

• Childhood or teenage onset
• Triggered by sleep deprivation
• Early morning tonic-clonic seizures or myoclonic jerks
• EEG

Features suggesting focal epilepsies

• History of potential cause
• Aura
• Focal motor activity during seizure
• Automatisms

Complex focal seizures may have features of

• Motor: automatism, lip-smacking, plucking at clothes
• Sensory: transient paraesthesiae
• Autonomic: odd epigastric sensation, nausea
• Psychiatric: unreality, deja v, fear

Question 5

Epilepsy SUDEP

Answer 5

-?

Question 6

Epilepsy Differentials

Answer 6

• Misdiagnosis is common
• Vasovagal syncope
• Cardiac syncope
• TIA

Question 7

Epilepsy Ix

Answer 7

• Bloods to identify cause and comorbidity
• ECG
• EEG only to support a diagnosis (high rate of false positive)
• Neuroimaging to identify structural abnormalities in focal or treatment resistant seizures

Question 8

Epilepsy Management

Answer 8

• Comprehensive care plan with epilepsy specialist nurses
• Monotherapy
• If unsuccessful try a different drug
• If unsuccessful try a combination of two
• Further management includes surgical resection
• If unsuitable; deep brain stimulation
• If provoked (occurring within 7 days of acute condition e.g. encephalitis, metabolic disturbance) correct provocative factors
• Do not offer valproate to women of childbearing age