Epilepsy symposium

Question 1

What is Epilepsy

Answer 1

A recurring, unprovoked spontaneous seizure.

Question 2

What are 6 causes of epilepsy in order of most common to least common

Answer 2

1. Idiopathic
2. CVD
3. Other
4. Alcohol
5. Tumour
6. Post traumatic

Question 3

What are the two seizure types

Answer 3

Focal/partial and Generalised

Question 4

What is a generalised seizure and what is the first line of treatment?

Answer 4

Electrical discharges appear to start all over the whole brain at the same time. No warning/ dangerous for the patient
Sodium Valproate

Question 5

Who can not be prescribed sodium valproate and why

Answer 5

pregnant women bc it is teratogenic

Question 6

What is a partial/focal onset seizure

Answer 6

electric discharge appears to start in one cortical region and then may remain localised or spread over the whole brain (secondary generalised)

Question 7

Name three main types of Primary generalised seizures

Answer 7

Tonic clonic seizure (grand mal)
Absencs (petit mal)
Myoclonic seizures

Question 8

Juveline myoclonic seizures

Answer 8

most common
Juvenile onset, probably lifelong
Early morning myoclonic jerks
Photosensitive sleep deprivation triggers
plus or minus absences

Question 9

Tonic-clonic seizures (Grand mal)

Answer 9

Occurs without warning
Tonic phase–> continuous muscle spasm, fall, cyanosis, tongue biting, incontinence
Clonic phase–> rhythmic jerking slows and gets larger in amplitude as attack ends
Post seizure phase–> coma, drowsiness, confusion, muscle aching, headaches

Question 10

Absences (petit mal)

Answer 10

abrupt
short (5-20 seconds)
Multiple times a day and can lead to learning difficulties
Unresponsive amnesia for the gap, rapid recovery
Tone preserved or mildly reduced
eyelid flickering
absences only, tend to remit in adulthood

Question 11

Types of focal seizure

Answer 11

Simple partial seizure- aura warning. patient aware
Complex partial seizure- aura warning. reduced awareness
Temporal
Frontal
Parietal/occipital

Question 12

Temporal love epilepsy

Answer 12

epigastric rising sensation
pallor/flushing
deju vu
speech arrest
fear
depression

Question 13

Frontal lobe seizures

Answer 13

brief
rapid recovery
predominantly nocturnal
falling onto one side (jacksonian march)

Question 14

Parietal/occipital lobe epilepsy

Answer 14

parietal- positive sensory symptoms, tingling pain

occipital- simple visual hallucinations, blackout or whiteout at onset

Question 15

Epileptogenesis

Answer 15

the process by which parts of a normal brain are converted to a hyperexcitable brain

Question 16

why is the brain prone to seizure activity

Answer 16

inherently unstable (pos feedback)
intrinsic excitability
thus a network of excitatory neurons connected together in convergent and divergent poathways is potentially explosive
to avoid this explosion the brain requires at least as much inhibition as excitation bymeans of inhibitory synapses
epilepsy represents a failure of inhibitory regulation either focally or generally

Question 17

Channelopathies (in regions can be focal or generalised)

Answer 17

1. Na channel inactivation too slow. (AP repolarisation impaired)
2. Reduction in the number of functional K+ channels (AP repolarisation impaired)

Question 18

How drugs work to prevent spread of epileptic discharges

Answer 18

Sodium channel blockers
Controlling glutamate release (usually excitatory)
block glutamate receptor
Blocking calcium channels in the thalamus (for absence seizures)
GABA enhancers

Question 19

Examples of sodium channel blockers

Answer 19

Carbamazepine and Phenytoin

Question 20

Carbamazepine

Answer 20

inhibits voltage gated sodium channels by binding to it in its inactive state, prolonging the period between successive firings

Question 21

Sodium valproate

Answer 21

facilitates GABAergic transmission

Question 22

Ideal antiepileptic drug

Answer 22

good efficacy
no interactions
no side effects
cost effective

Question 23

some drugs exarcebate generalised seizures such as myoclonus and absences

Answer 23

phenytoin
carbamazepine
gabapentin/pregabalin
consider this if patients are worse on treatment