Epilepsy and Blackouts

Question 1

What is the definition of epilespy?

Answer 1

Neurological disorder marked by sudden recurrent seizures accompanied by abnormal electrical activity in the brain

Question 2

What are the risk factors for epilepsy?

Answer 2

Developmental or aquired CNS abnormality e.g. cerebral palsy or stroke
Family history of epilepsy
Prolonged or multiple febrile convulsions

Question 3

What are some non epileptic causes of seizure?

Answer 3

Infection
Drug withdrawl
Metabolic derangement e.g. liver failure
Toxicity
Autoimmune disease
Drugs can lower seizure threshold e.g. TCAs
Structual lesions such as slow evolving malignancy can cause seizures

Question 4

What are the classifications of focal seizures?

Answer 4

They originate within networks linked to one hemisphere

• Without impairment of consciousness (simple) - awareness unimpaired but have focal motor or sensory symptoms, non post-ictal symptoms
• With impairment of consciousness (complex) - post ictal confusion is a feature
• Evolving to bilateral, convulsive (secondary generalised) - Starts focally then spreads to generalised seizure

Question 5

What are the classifications of generalised seizures?

Answer 5

• Absence - Brief (<10s) lapse in consciousness that may not be noticable
• Tonic-clonic - loss of consciousness - limbs stiffen (tonic) then jerk (clonic)
• Myoclonic - Sudden jerk of limb, face or trunk
• Aclonic - Sudden loss of muscle tone

Question 6

What is status epilepticus?

Answer 6

Seizure that lasts greater than 5 mins or multiple small seizures without recovery inbetween

Question 7

What is the management for status epilepticus?

Answer 7

Manage airway and give IV bolus
Take bloods and give a lorazepam (benzodiazepine) bolus and phenytoin infusion (blocks sodium channels)
Give glucose and pabrinex (contain thiamine and other vitamins for rapid absoprtion)

Question 8

What are the main anti epileptic drugs that are used?

Answer 8

Carbamezipine (sodium channel blocker) and sodium valproate (blocks sodium channels and increases GABA)

Question 9

What are the surgical options available for epilepsy?

Answer 9

Vagal nerve stimulation can be done if there is pre-ictal tachycardia as this slows the heart
Deep brain stimulation can be used