Epilepsy

Question 1

What is epilepsy?

Answer 1

Neurological condition characterised by recurrent seizures

Question 2

What conditions have an association to epilepsy?

Answer 2

• Cerebral palsy
• Tuberous sclerosis
• Mitochondrial disease

Question 3

What are the other causes of seizures other than epilepsy?

Answer 3

• Febrile convulsions
• Alcohol withdrawal seizures
• Psychogenic non-epileptic seizures

Question 4

What 3 features help to classify epilepsy seizures?

Answer 4

1. Where the seizure begins in the brain
2. Level of awareness during a seizure
3. Other features of seizures

Question 5

What is the cause of epilepsy?

Answer 5

*No identifiable cause in 1/2 people

*Other 1/2 various factors:
>Genetic influence
>Head trauma
>Brain conditions
>Infectious disease: meningitis, AIDS
>Prenatal injury
>Developmental disorders

Question 6

What is the causes the seizure in epilepsy?

Answer 6

*Sudden synchronous electrical discharge of cerebral neurones causing symptoms or signs apparent to either patient or observer

Question 7

What are focal seizures? Presentations?

Answer 7

*Start in a specific area, on one side of brain

Presentation:
>Varying level of awareness
>Motor e.g. Jacksonian march
>non-motor e.g. deja vi or having aura features

Question 8

What are generalised seizures?
Presentations?
Sub-divided Types?

Answer 8

*These engage or involve networks on both sides of the brain at the onset

*Presentation:
>Consciousness lost immediately

Types:
> Tonic-clonic (grand mal)
> Tonic
> Clonic
> Typical absence 
> myoclonic 
> Atonic

Question 9

What is a generalised myoclonic seizure?

Answer 9

*Brief, rapid muscle jerks

Question 10

What does tonic mean?

Answer 10

*Tonic relates to tone, meaning stiffening

Question 11

What does clonic mean?

Answer 11

*Clonic relates to movement, meaning twitching or jerking

Question 12

What is a focal to bilateral seizure?

Answer 12

Starts on one side of the brain in a specialised area before spreading to both lobes

Question 13

What is West Syndrome (infantile spasms)? Presentation?

Answer 13

Type of epilepsy that begins in first few months of life

• Presentation:
  1. Flexion of head, trunk, legs&raquo_space; extension of arms (Salaam attack) lasts 1-2 secs, repeat up to 50 times

Question 14

What is the prognosis of infantile spasms?

Answer 14

• Progression mental handicap

* Poor prognosis

Question 15

How is Epilepsy diagnosed?

Answer 15

*ECG

Question 16

What signs and symptoms are important to ask about to differentiated epilepsy from a black-out/collapse?

Answer 16

• Bite their tongue

* urinary incontinance

Question 17

What is the presentation of Juvenile Myoclonic epilepsy (Janz Syndrome)?

Answer 17

• Typical onset in teens
• Moe common in girls
• Infrequent generalized seizures, often in morning
• Daytime absences
• Sudden, shock like myoclonic seizure

Question 18

What is the postictal phase of epilepsy?

Answer 18

Following a seizure patients may feel drowsy and tired for 15mints afterwards

Question 19

When do neurologist start antiepileptics?

Answer 19

Following a second epileptic seizure

Question 20

As a general rule what is used first line to treat epilepsy with generalised and partial seizures?

Answer 20

• Sodium valproate 1st line for patients with generalised seizures
• Carbamazepine 1st line patient with partial seizures

Question 21

What the rules of driving for a patient who has had a seizure?

Answer 21

• Patients cannot drive for 6months following a seizure

* Patients with established epilepsy must be fit free for 12months before being able to drive

Question 22

When a woman taking anti-epileptic medication wants to get pregnant, what needs to be done? Why?

Answer 22

• Take advice from neurologist prior to becoming pregnant
• Antiepileptics are teratogenic, particularly sodium valproate
• Often switch to lamotrigine as rate of congenital malformations low

Question 23

How can anti-epileptics affect the contraceptive pill?

Answer 23

Antiepileptics affects the P450 system and therefore can affect how the hormonal contraceptives are metabolised

Question 24

What are commonly used antiepileptic drugs?

Answer 24

• Sodium valproate
• Carbamazepine
• Lamotrigine
• Phenytoin

Question 25

When is lamotrigine used?

Answer 25

2nd line for generalised and partial seizures

Question 26

P450 inducer or inhibitor:

Carbamazepine

Answer 26

Inducer

Question 27

P450 inducer or inhibitor:

Lamotrigine

Answer 27

Neither

Question 28

P450 inducer or inhibitor:

Phenytoin

Answer 28

Inducer

Question 29

P450 inducer or inhibitor:

Sodium Valproate

Answer 29

Inhibitor

Question 30

What is the acute management of a seizure that hasn’t terminated for 5mins?

Answer 30

*Benzodiazpine such as diazepam -administered rectally or intranasal/under tongue

Question 31

What are the features of a focal seizure localizing to the temporal lobe?

Answer 31

HEAD mneumonic

• Hallucinations
• Epigastric rising/emotional
• Automatisms e.g. lip smacking/grabbing/plucking
• Deja vu/Dysphasia post ictal

Question 32

What are the features of a focal seizure localizing to the frontal lobe?

Answer 32

Motor

• Head/leg movements
• Posturing
• post-ictal weakness
• jacksonian march

Question 33

What are the features of a focal seizure localizing to the parietal lobe?

Answer 33

Sensory

*paraesthesia

Question 34

What investigations can be done if epilepsy is susespected?

Answer 34

• EEG

* MRI brain scan

Question 35

In what scenarios should antiepileptics be started after having just one seizure?

Answer 35

• Patient has neurological deficit
• brain imaging shows structural abnormality
• EEG show unequivocal epileptic activity
• Patient or family consider risk of having further seizure unacceptable