Epilepsy and LoC

Question 1

What is epilepsy?

Answer 1

Neurological condition resulting in seizures

Question 2

What are the two main types of seizures?

Answer 2

General and Focal

Question 3

What are general seizures?

Answer 3

Involve both sides of the brain

Include
-tonic clonic= breath holding episode lasting <1min followed by generalised convulsions lasting several mins

• myoclonic= brief muscle jerks, consciousness in tact
• atonic= sudden drop attacks due to brief lapse in muscle tone
• tonic= rhythmic muscle movements
• absence= common in children, become blank and stare into space (like day dreaming) with no recollection

Question 4

What are focal seizures?

Answer 4

Where there is seizure activity in one particular aspect of the brain but can spread to rest of the brain and become more generalised

Consciousness can vary- patients can be fully aware or fully unaware

Can get hallucinations, memory flashbacks, de ja vu and doing strange things on autopilot

Question 5

What is status epilepticus?

Answer 5

Seizure lasting >5mins
OR
2 seizures occurring within 5 mins with no return to normal in between

Question 6

What is the management of status epilepticus?

Answer 6

After 5 mins give IV or rectal lorazepam

Wait 10mins and then administer another dose of IV or rectal lorazepam

If after 20mins the seizure has not terminated then commence IV phenytoin

If after 40-45mins no termination then consider GA and intubation

Question 7

How can different types of focal seizures indicate where in the brain the seizure is generating from?

Answer 7

Temporal

• Hallucinations
• lip smacking
• de ja vu

Frontal

• motor movements e.g. starting in one arm and then spreading
• Jacksonian March

Parietal
-Paraesthesia

Occipital
-visual disturbances

Question 8

What investigations are needed to diagnose epilepsy?

Answer 8

Bloods

• FBC
• U&Es
• LFTs
• Ca
• Mg
• Glucose
• pregnancy test

CT/MRI head for abnormalities

EEG to detect abnormal electrical activity of the brain

Question 9

What is the management of a generalised seizure (tonic clonic)

Answer 9

1) Sodium valproate (not in women of child bearing age)

2) Lamotrigine or Carbamazepine

Question 10

What is the management of focal seizures?

Answer 10

1) Carbamazepine or Lamotrigine

2) Sodium valproate

Question 11

What is the management of atonic seizures?

Answer 11

1) Valproate

2) Lamotrigine

Question 12

What is the management of absence seizures?

Answer 12

1) Valproate or ethosuximide

Question 13

What is the management of myoclonic seizures?

Answer 13

1) Valproate

2) Lamotrigine or levetiracetam

Question 14

What is the mode of action and side effects of valproate?

Answer 14

Increase action of GABA and relaxes brain

SE

• teratogenic
• liver damage
• hair loss
• tremor
• weight gain

Question 15

What are the side effects of lamotrigine?

Answer 15

Steven Johnson Syndrome

Leukopenia

Question 16

What are the side effects of Carbamazepine?

Answer 16

Can worsen absence and myoclonic seizures
Agranulocytosis
Aplastic anaemia
Drug interactions e.g. COCP

Question 17

What are the side effects of Phenytoin?

Answer 17

Folate and Vit D deficiency
Megaloblastic anaemia
Osteomalacia

Question 18

What are side effects of ethosuximide?

Answer 18

Night terrors

Rashes

Question 19

What are side effects of levetiracetam (keppra)?

Answer 19

Steven Johnson Syndrome

Question 20

What is the aim of treatment in epilepsy?

Answer 20

To be on lowest possible dose of anti epileptic