Epilepsy (focal onset)

Question 1

What does a focal seizure usually indicate?

Answer 1

The seizure is attributal to only one part of one hemisphere

Question 2

What usually causes focal epilepsy?

Answer 2

A focal abnormality

• Stroke
• Space occupying lesion

Question 3

What symptoms are present with focal epilepsy?

Answer 3

May have an aura
- Can be like an olfactory aura if the temporal lobe is affected

May generalise to a tonic clonic seizure

Question 4

What are the two types of focal seizure?

Answer 4

Simple (aware)

Complex (loss of consciousness)

Question 5

DDx of focal epilepsy?

Answer 5

Vasovagal syncope

Hypoxic seizure

Concussion

Arryhthmia

Question 6

Tests?

Answer 6

EEG - arryhthmia

Hypoventilation and photic stimulation studies
- Elicit a seizure while an EEG is on to see what it looks like

MRI - look for space occupying lesion

Video telemetry studies

Question 7

Surgical treatment?

Answer 7

If a resectable focal abnormality or stroke

Question 8

1st line pharmacological management?

Answer 8

1st line :

Carbamezapine
Lamitrigine

Question 9

2nd line?

Answer 9

2nd line :

Sodium valproate
Topiramate
Leviterecetam