Epilepsy (Zero to Finals)

Question 1

What is epilepsy?

Answer 1

An umbrella term for a condition where there is a tendency to have seizures.

Question 2

What are seizures?

Answer 2

Transient episodes of abnormal electrical activity within the brain.

Question 3

Investigations for epilepsy?

Answer 3

EEG - to show typical patterns in different forms of epilepsy and to support the diagnosis.

MRI brain - to visualise the structure of the brain. Used to diagnose structural problems that may be associated with seizures and other pathology i.e. tumours.

Other investigations can be used to exclude other pathology, particularly on ECG to exclude heart problems.

Question 4

What are tonic clonic seizures?

Answer 4

• Loss of consciousness and tonic (muscle tensing) and clonic (muscle jerking) episodes.
• Typically the tonic phase comes before the clonic phase.
• May have associated tongue biting, incontinence, groaning and irregular breathing.
• After seizure there is a post-ictal period where the person is confused, drowsy and feels irritable or depressed.

Question 5

Tonic clonic seizure management?

Answer 5

First line: sodium valproate
Second line: lamotrigine or carbamazepine

Question 6

What are focal seizures?

Answer 6

Originate in the temporal lobes. They affect hearing, speech, memory and emotions.

Question 7

What do focal seizures present with?

Answer 7

Hallucinations
Memory flashbacks
Deja vu
Doing strange things on autopilot

Question 8

Management of focal seizures?

Answer 8

First line: lamotrigine or carbamazepine
Second line: sodium valproate or levetiracetam

TREATMENT IS THE REVERSE OF TONIC - CLONIC SEIZURES

Question 9

Absence seizures typically happen in children. True/false?

Answer 9

True. The patient becomes blank, stares into space and then abruptly turns back to normal.

Question 10

During absence seizures. Patients are completely aware of surroundings and are responsive. True/false?

Answer 10

False, patients are unaware of surroundings and won’t respond.

Question 11

Absence seizures lasts around 10-20 seconds. True/false?

Answer 11

True

Question 12

Management of absence seizures?

Answer 12

Sodium valproate or ethosuximide

Question 13

What are atonic seizures characterised by?

Answer 13

Characterised by brief lapses in muscle tone. Don’t usually last more than 3 minutes. Typically begins in childhood.

Question 14

Another name for atonic seizures?

Answer 14

“Drop attacks”

Question 15

Management of atonic seizures?

Answer 15

First line: sodium valproate
Second line: lamotrigine

Question 16

How do myoclonic seizures present and what is treatment?

Answer 16

Present as sudden brief muscle contractions, like a sudden “jump”. Patient is usually wake during the episode.

First line: sodium valproate
other options: lamotrigine or topiramate

Question 17

What are infantile spasms?

Answer 17

AKA “west syndrome”. Characterised by clusters of full body spasms.

Question 18

Infantile spasm have a good prognosis. True/false?

Answer 18

False, has a poor prognosis. 1/3 of patients die by age 25. 1/3 are seizure free.

Question 19

First line treatments for infantile spasms?

Answer 19

Prednisolone
Vigabatrin

Question 20

What is status epilepticus?

Answer 20

Classified as a medical emergency
Defined as seizures lasting longer than 5 minutes or more than 3 seizures in 1 hour.

Question 21

Management of status epilepticus in hospital?

Answer 21

Take an ABCDE approach:

Secure the airway
Give high-concentration oxygen
Assess cardiac and respiratory function
Check blood glucose levels
Gain intravenous access (insert a cannula)
IV lorazepam 4mg, repeated after 10 minutes if the seizure continues
If seizures persist: IV phenobarbital or phenytoin

Question 22

Status epilepticus medical options in the community:

Answer 22

Buccal midazolam
Rectal diazepam

Question 23

What anti-epileptic drug can cause peripheral neuropathy (numbness and tingling in extremities)?

Answer 23

Phenytoin

Question 24

Side effects of lamotrigine?

Answer 24

Skin reactions (including potentially serious ones i.e. SJS)
Dizziness
Ataxia (loss of full control of body movements).
Blurred vision

Question 25

Side effects of sodium valproate?

Answer 25

GI disturbances (nausea and vomiting), tremor, weight gain and hair loss.

Question 26

Side effects of ethosuximide?

Answer 26

Mainly used for absence seizures, can also lead to GI disturbances.