Epilepsy And Pseudo Seizures 2

Question 1

Epilepsy is

Answer 1

Disease of brain defined by any of the following

1. At least 2 unprovoked seizures occurring >24 hours apart
2. One unprovoked seizure and probability of further seizures , occurring in the next 10 years
3. diagnosis of epilepsy syndrome

Question 2

Epilepsy is considered to be resolved when

Answer 2

Individuals who had an age dependant epilepsy syndrome but now are past the applicable age

Or those who have remained seizure free for last 10 years, with no medication for the last 5 years

Question 3

Provoked seizure is

Answer 3

Acutecsymptomatic
= within 7 days of brain insult

Acute brain insult= stroke, haemorrhage, TBI, Encephalitis

Question 4

Treat seizures when

Answer 4

1) seizures are provoked by metabolic disturbances or drugs -> correct or withdraw provocative factor
2) short term benzodiazepine - reduce risk of seizures in alcohol and DT
3) following an acute brain insult or neurosurgery
4) following an acute brain insult, AESs used to treat the provoked seizure should be withdraw After 7 days
5) AED treatment is not indicated for concussive convulsions

Question 5

AED is

Answer 5

Anti epileptic drug

Question 6

Risk of reoccurrence in low risk group

Answer 6

6 months= 26%
2 years= 39%

5 years= 51%

8 years= 52%

Question 7

Are AEDs given after a seizure

Answer 7

Immediate AED reduces the occurrence of seizures in next 1-2 years

Does not affect long term remission in individuals with single or infrequent seizures

Question 8

EEG is abnormal in what %

Answer 8

In 50% in epileptics

Question 9

Best drug for generalised seizures

Answer 9

Valproate

Question 10

Which is the best drug?

Answer 10

50% seizure free after any first treatment

No significant differences in 6-12 months measure of seizure freedom

Question 11

Drug metabolism responsiveness and toxicity depends on

Answer 11

Genetic predisposition and ethnicity

Question 12

Risk of hypersensitivity reactions

Answer 12

More frequent with aromatic AEDs

Cross reactivity

Severe skin reactions

AED hypersensitivity syndrome

• > multiorgan symdrome (liver)
• > followed by skin rash

Stop drug

Question 13

DVLA?

Answer 13

If you have a seizure stop driving for a year
If scans + EEG go well then 6 months

Get a 3 year licences then reassess

Question 14

Epileptic drugs and pregnancy

Answer 14

AED reduce effectiveness of oral contraceptives

Question 15

Preg an Andy /pregnancy supplements

Answer 15

Folic acid
Anticonvulsants - risks
Don’t stop drugs suddenly

Question 16

Major fetal malformation is

Answer 16

Life threatening or require surgery

Question 17

Risk of MFM on pregnant women taking AEDs

Answer 17

Doubled to 4.5%

But still low chance so must take drugs as the seizures could kill mother

Question 18

Valproate risk

Answer 18

Is dose related 6-9%

6-10 points lower verbal IQ

Question 19

Sodium valproate must no longer be prescribed to

Answer 19

Women of child bearing age

Question 20

Cognitive teratogeneisis is

Answer 20

Minor fetal malformations

(Valproate)

Preventable to some extent on folate supplements

Question 21

Effect of maternal seizures

Answer 21

Foetus- small for gestational age, decreased verbal IQ

Fetal heart rate decelerations

Question 22

Vitamin k whilst pregnant

Answer 22

Enzyme inducing AEDs effect vitamin K

Give oral vitamin K in last 4 weeks of preg

Give Vit K to new born

Question 23

Which AEDs are safe in breastfeeding

Answer 23

Phenytoin, Carlazepine and valproate

Question 24

Types of epileptic surgery

Answer 24

Respective - remove area generating seizures
E.g lesionectomy, lobectomy, hemispherectomy

Functional neurosurgery - change brain function to improve epilepsy

Question 25

GCSE

NCSE is

Answer 25

Generalized convulsive status epilepticus

Non convulsive status epilepticus

Question 26

Status epilepticus is

Answer 26

Failure of mechanisms responsible for seizure termination

Initiation of mechanisms which lead to abnormallly prolonged seizures

Can have long term consequences like neuronal death and neuronal injury and alteration of neuronal networks

Question 27

Status epilepticus

Answer 27

Resistant to bento,s
Phenobarbitone
Propofol

Question 28

One scale with epilepsy

Answer 28

Treatment more likely to work earlier on

Seizure activity may cause neuronal loss and atrophy

Accumulation of toxic metabolites may cause further damage

Question 29

Stages of status epilepticus

Answer 29

Early SE

Established status

Refractory status

Question 30

Step 1 early convulsive SE

Answer 30

First choice - IV lorazepam: 2-4 mg if needdd repeat

If IV not possible then Buccal midazolam 10 mg

If not then IM midazolam 10mg

If not rectal diazepam 10 mg

Question 31

If seizures stop

Answer 31

Recurrence rate is high ; the majority of patients need IV stage 2 anti epileptic drugs

Question 32

Epileptic seizure then take what action

Answer 32

ABCDE

Question 33

Step 2 established SE

Answer 33

Phenytoin 18mg/kg

Or
Levetiracetam 30mg/kg

Or sodium valproate 30/kg

Question 34

Hazards of IV phenytoin

Answer 34

Precipitation of crystals

Hypotension and arrhythmia

Question 35

Step 3 refractory convulsive SE

Answer 35

Anaesthesia and ventilation