Epilepsy

Question 1

define epilepsy

Answer 1

tendency for recurrent, usually spontaneous epileptic seizures. There is an abnormal electrical discharge from the brain that can be excitatory or inhibitory

Question 2

classification of epilepsy

Answer 2

1. generalised

2. focal

Question 3

associations with generalised epilepsy

Answer 3

childhood/teens
EEG
sodium valporate

Question 4

example of a generalised epilepsy

Answer 4

juvenile myoclonic epilepsy

Question 5

risk factors in juvenile myoclonic epilepsy

Answer 5

low sleep

flashing lights

Question 6

what causes focal epilepsy?

Answer 6

underlying structural cause e.g. stroke in adults

Question 7

management of focal epilepsy?

Answer 7

carbamazepine

Question 8

presentation of epilepsy

Answer 8

tonic-clonic seizure= all muscles contract causing rigidity before refractory relaxation period
aura

Question 9

what brain lobe is activated in tonic-clonic seizures?

Answer 9

frontal

Question 10

diagnosis of epilepsy

Answer 10

history= onset (environment, photosensitivity versus hyperventilation), syncopal symptoms, movements, recovery
drugs (avoid tramadol in epileptics)
ECG
EEG

Question 11

speed of recovery of epilepsy

Answer 11

syncope is fast

seizure is slow

Question 12

why do those with a seizure get an ECG?

Answer 12

prolonged QT can present with collapse and jerks caused by hypotension

Question 13

what can EEG distinguish in seizure?

Answer 13

epileptic versus non-epileptic attacks

localisation

Question 14

management of epilepsy

Answer 14

safety e.g. driving, swimming, bathing, climbing ladders

pharmacology

Question 15

old anticonvulsants

Answer 15

phenytoin
sodium valporate
carbamazepine

Question 16

use of phenytoin

Answer 16

acute only as high dose can be given very quickly

Question 17

side effects of sodium valporate

Answer 17

teratogenic
weight gain
hair loss
fatigue

Question 18

when should carbamazepine be used?

Answer 18

focal only as makes generalised worse

Question 19

new anticonvulsants

Answer 19

lamotrigine
levetiracetam
topiramate
gabapentin and pregabalin

Question 20

adverse of lamotrigine

Answer 20

long time to titrate

SJS risk

Question 21

adverse of levetiracetam

Answer 21

mood swings

Question 22

adverse of topiramate

Answer 22

weight loss
sedation
dysphasia

Question 23

when is pregabalin and gabapentin used?

Answer 23

neuropathic pain

Question 24

which anticonvulsants induce hepatic enzymes and can alter efficacy of the OCP?

Answer 24

carbamazepine

phenytoin

Question 25

what is status epilepticus?

Answer 25

acute emergency of a recurrent epileptic seizure lasting >30 minutes without full recovery of consciousness

Question 26

types of seizure in status epilepticus

Answer 26

generalised
non-convulsive state (conscious but altered state)
epilepsia partialis continua

Question 27

what are the risks in status epilepticus?

Answer 27

excess cerebral damage to contract muscles leading to respiratory insufficiency, hypotension, hyperthermia and rhabdomyolysis

Question 28

management of status epilepticus

Answer 28

stabilise, ABCDE

anticonvulsants= first line is BZDs, second line is phenytoin

Question 29

what is non-epileptic attack disorder?

Answer 29

functional attack that tends to have prolonged duration of 10-20 minutes

often associated with previous trauma, need CBT