Epilepsy NOT FINISHED

Question 1

How do you determine the class of seizure

Answer 1

location of onset, type of discharge, pattern of spread

Question 2

describe the 2 types of seizures

Answer 2

partial( starts in a focus and spreads) and generalised (boths hems)

Question 3

list the type of generalised seizures

Answer 3

typical absence, myoclonus, tonic clonic, atypical absence tonic, atonic

Question 4

describe an absence seizure

Answer 4

mainly childhood onset
frequent short lived brief attacks 
sudden loss and return of consciousness
no aura no post ictal 
some involuntary movement eg walking around, gaze everted

Question 5

describe a myoclonus

Answer 5

sudden bilateral arm jerking, often worse in the mornings, precipitated by sleep deprivation and alcohol

Question 6

when does myoclonus occur

Answer 6

epilepsy syndromes and certain non epileptic causes

Question 7

describe tonic clonic seizures

Answer 7

sudden onset fall. tonic phase - muscles stiffen

clonic phase limbs jerk. tongue bitten and incontinence, noisy breathing. headache and muscle pain after

Question 8

describe an atonic seizure

Answer 8

muscles suddenly lose strength and you drop

very short and common in children

Question 9

what does atonic seizure often occur in

Answer 9

learning disability

Question 10

name the 3 categorise of partial seizures

Answer 10

simple - aware
complex - areness lose
2y generalised - evolves to TC

Question 11

Describe a temporal lobe seizure

Answer 11

AURA - epigastric rising, olfactory gustation, deja vu
SEIZURE - blank stare, oral + manual automatisms (lip smacking and movements)
POST ICTAL

Question 12

describe a frontal lobe seizure

Answer 12

wild vocalisation, quick recovery, movement (twisting grimicing) upper limbs tonic clonic

Question 13

process of a seizure in relation to a neurone

Answer 13

1. initiation - increased frequency ossilations
2. depolarisation
3. oscillation
4. synchronisation - local and long range effect (synaptic and non synaptic e.g. gap junctions)
5. termination - synaptic inhibition

Question 14

What goes wrong in absence seizures?

Answer 14

bursts of abnormal activity from the cortex –> thalamus

reticular nucleus inhibiting TC relay

Question 15

drugs that can worsen absence seizures

Answer 15

carbamezapine, phenytoin, baclofen

Question 16

what causes some epilepsys

Answer 16

mutations in Na channels therefor increased function

Question 17

Name 4 mechanisms of epilepsy treatments

Answer 17

promote inhibition (benzodiazepines)
reducing gaba reuptake - longer inhibition 
increasing potassium channels
blocking AMPA receptors

Question 18

difference between idiopathic epilepsy and symptomatic epilepsy + how they respond to treatment

Answer 18

Idiopathic - no associated neurological damage
responds well to treatment
Symptomatic - treatment resistant - neurological deficit?

Question 19

name some causes of symptomatic epilepsy

Answer 19

cerebal palsy, stroke, tumors, trauma, hoppocampal sclerosis

Question 20

what must you do when starting epilepsy treatment

Answer 20

start low dose and explain side effects and interactions

Question 21

main treatment for general epilepsy and partial epilepsy

Answer 21

G - sodium valproate

P - carbamazepine

Question 22

describe carbamazepine
what is it NOT helpful for
1 -ve

Answer 22

acts on sodium channels to suppress bursts
absence and myoclonus
causes enzyme induction

Question 23

Which seizure is valproate used for

1-ve

Answer 23

myoclonus, absence and photosensitive seizures

important side effect, especially women ( affects fertility)

Question 24

phenytoin

not helpful for

Answer 24

not good for myoclonus and absence, inhibs Na channels, causes some enzyme induction

Question 25

what is lamotrigine

Answer 25

new first line for G and P

Question 26

which seizures should you use for
1 valproate, ethosuzimide, lamotrigine, benzos
2 valproate, benzos, levetricetam 
3 CBZ, valproate, pheytoin, topiraminde
4 carbamazepine, lamotrigine, topiramate

Answer 26

1. absence
2. myoclonus
3. GTC
4. partial