Epilepsy and seizure 3A

Question 1

What is the acronym for the many causes of seizures?

Answer 1

VITAMIN DE

Question 2

What does Vitamin DE stand for?

Answer 2

Vascular
Infection
Trauma
Autoimmune eg. SLE
Metabolic diseases
Idiopathic –> EPILEPSY
Neoplasms (cancer)
Dementia + drugs (cocaine)
Eclampsia + everything else

Question 3

RF for seizures?

Answer 3

Congenital (NFM 1, tuberous sclerosis, CP)

Acquired (meningoencephalitis, febrile convulsions)

Dementia

Question 4

What is the pathology behind seizures/epilepsy?

Answer 4

Normal balance between GABA (-) & Glutamate (+) shifts towards glutamate

Neurones synchronously active (at same time)
More excitatory = Increased glutamate stimulation = Increased GABA inhibition

Question 5

what meds / conditions decrease seizure threshold?

Answer 5

Hypoglycaemia
alcohol
stress
Meds : TCA, Lithium, ciprofloxacin, Clozapine, AED non adherence, tramadol, antipsychotics

Question 6

What is epilepsy?
What classifies epilepsy from a one off seizure?

Answer 6

Idiopathic cause of seizures
>2 episodes more than 24hr apart

Question 7

2 RF for epilepsy?

Answer 7

Familial inherited
Dementia (10x more likely)

Question 8

What 3 things differ an epileptic and non epileptic fit?

Answer 8

eyes OPEN
synchronous movements
can occur in sleep

Question 9

How long do epileptic seizures last?

Answer 9

less than 2 mins

Question 10

What are the different phases before/after a seizure?

Answer 10

Prodrome
Aura
Ictal event
Post ictal

Question 11

What happens in prodrome?

Answer 11

mood changes
days before

Question 12

What happens in Aura?

Answer 12

Mins before
Deja Vu and Automatisms (lip smacking and rapid blinking)

Not always present, mostly seen in temporal lobe epilepsy

Question 13

What is the ictal event?

Answer 13

Seizure

Question 14

What happens in the post ictal period?

Answer 14

headache
Confusion and reduced GCS
Amnesia (what the heck happened)
Todd’s paralysis
Dysphasia
Sore Tongue - only in epileptic seizures, not in syncope (tongue often bitten)

Question 15

What are the 2 classifications of epileptic seizures?

Answer 15

Generalised
Focal

Question 16

Generalised seizures
Unilateral or bilateral?
LOC?

Answer 16

Bilateral (both hemispheres)
Always Loss of consciousness

Question 17

What are the diff types of Generalised seizures?

Answer 17

Tonic
Atonic
Tonic Clonic
Myoclonic
Absence

Question 18

What happens in tonic clonic seizures?

Answer 18

Bilateral, LOC

No aura
Tonic phase = rigid/stiff, fall to floor
Clonic = Jerking of limbs, convulsions

+ up gazing open eyes, incontinence, tongue bitten

Question 19

What happens in absence seizures?
Which age group?

Answer 19

Childhood
Stare off blankly for a few moments (secs - mins) then carry on where they left off

3 Hz spike on EEG

Question 20

What is Tonic seizures?

Answer 20

Just rigid

Question 21

What happens in myoclonic seizures?

Answer 21

Short muscle twitches

Question 22

What happens in Atonic seizures?

Answer 22

Relaxed, sudden floppy limbs and muscles

Question 23

What are focal seizures?
Which part of brain do they effect?

Answer 23

Features confined to one region of brain eg. temporal
May progress to 2^ generalised

Question 24

What are the 2 types of focal seizures?

Answer 24

simple focal
complex focal

Question 25

What happens in simple focal?
LOC?

Answer 25

No LOC, Px aware + awake
Just uncontrollable muscle jerking

Question 26

What is complex focal?
LOC?

Answer 26

LOC, Px unaware, post ictal period

Question 27

What do the Sx depend on?

Answer 27

where the focal neurology is

Question 28

What Sx are seen if frontal lobe affected?

Answer 28

Jacksonian march - Starts in one part of the body and spreads

Todd’s palsy - motor cortex affected - temporary paralysis and muscle weakness after

Question 29

What Sx are seen if parietal lobe affected?

Answer 29

Parasthesia (sensory loss)

Question 30

What Sx are seen if occipital lobe affected?

Answer 30

Visual change

Question 31

What Sx are seen if temporal lobe affected?

Answer 31

Aura (mood change)
Dysphasia
Post ictal period
Hearing disturbances

Question 32

What requirement must be to consider epilepsy?

Answer 32

must have had 2 or more seizures 24hr apart

Question 33

What investigations are done?

Answer 33

Bloods - rule out metabolic cause, infection, electrolytes or hypoglycaemia

ECG

Lying and standing BP (LSBP)

CT head + MRI
(examine hippocampus, check bleeds, SOL)

GS = EEG - 3Hz wave in absence

Question 34

what is high in a true epileptic seizure? Not in mimics

Answer 34

Prolactin and lactate are high

Question 35

Tx for epilepsy?

Answer 35

Sodium valproate to all (increases GABA)

Question 36

Tx for seizures:
Focal?
Gen tonic clonic?
Absence?
Myoclonic?

Answer 36

Focal = Lamotrigine or Levetiracetam

Gen tonic clonic =
M = Sodium valproate
F = Lamotrigine or Levetiracetam

Absence = Ethosuxamide

Myoclonic =
M = Sodium valproate
F = Levetiracetam (Keppra)

Question 37

Who is sodium valproate not given to and why?

Answer 37

Females of child bearing age (15-45)
It is teratogenic

Question 38

What is given instead?

Answer 38

Lamotrigine

Question 39

What is a complication?

Answer 39

status epilepticus (neuro emergency)

Question 40

What happens in status epilepticus?

Answer 40

Epileptic seizures without a break back to back
or
Seizure lasting more than 5 mins

Question 41

Tx for status epilepticus?

Answer 41

1. Lorazepam (4mg IV) or buccal midazolam or rectal diazepam
2. IV Lorazepam 4mg
3. IV phenytoin / sodium valproate / carbamezapine
4. IV phenobarbital under specialist guidance + ITU

Question 42

SE of Sodium valproate?
mechanism?

Answer 42

GABA - Ergic
- Teratogen (spina bifida, cleft palate)
- Hepatotoxic in kids

Question 43

SE of Lamotrigine?

Answer 43

Stevem Johnson syndrome - flu Sx + purple/red rash

Question 44

SE of carbamezapine?
mechanism?

Answer 44

P450 inducer
SIADH
Ataxia

Question 45

SE of ethosuximide?

Answer 45

Agranulocytosis
erythema nodosum

Question 46

SE of phenytoin?

Answer 46

-Gingival hyperplasia
-Teratogenic (fetal hydantoin syndrome - CHD, cleft lip, limb hypoplasia, hirsutism)
-Hirsutism
-Lymphadenopathy