Epileptic/Seizure Disorders

Question 1

Causes of epilepsy

Answer 1

• Dementia
• Genetic predisposition
• Brain trauma
• Tumours
• Strokes
• Infectious diseases
• Cdtns - i.e. TB

Question 2

Epilepsy is characterised by seizures. What are the two different types?

Answer 2

1. Generalised seizures - entire brain is affected (always presents w/LOC)
2. Focal seizures - only 1 area of the brain is affected

Question 3

What are the different types + sx of focal seizures?

Answer 3

Simple focal:
* No LOC
* Focal sx present
* No post-ictal sx

Complex focal:
* LOC post aura or seizure onset
* Originates from temporal lobe
* Post-ictal sx i.e. confusion

Secondary generalised:
* Pts experience focal seizure that evolves into generalised seizure (typically tonic-clonic)

Question 4

What are the different types + sx of generalised seizures?

Answer 4

1. Absence - stare blankly for 10 sec then back to normal
2. Tonic-clonic - LOC, stiffening (tonic) + jerking (clonic), upgazing eyes, tongue bite, incontinence, post-ictal confusion
3. Myoclonic - sudden jerks of a limb, trunk or face
4. Atonic - sudden loss of muscle tone causing pts to fall w/ consciousness retained

Question 5

What sx will be present if a seizure happens in:
1. Temporal lobe
2. Frontal lobe
3. Parietal lobe
4. Occipital lobe

Answer 5

1. Automatism (lip smacking, hand rubbing), auras (dejavu), auditory (ringing), post-ictal sx
2. 2 types: Jacksonian (seizure begins in one part of the body and spreads to the other muscles on same side) OR Todds palsy (seizure followed by brief period of temporary analysis)
3. Paraesthesia and numbness
4. Cisual sx

Question 6

Ix for epilepsy?

Answer 6

EEG
CT/MRI head
Bloods - rule out infx

Question 7

Which epileptic drug should not be given to women of childbearing age and why?

Answer 7

Sodium valproate - associated with a significant risk of neurodevelopmental delay in children.

Question 8

Tx of the following:
* Generalised tonic-clonic seizures
* Focal seizures
* Absence seizures
* Myoclonic/atonic seizures

Answer 8

Generalised tonic-clonic seizures:
* 1st line: Males/ females (non childbearing age) - sodium valproate
* Females (childbearing age) - lamotrigine or levetiracetam

Focal seizures:
* 1st line: lamotrigine or levetiracetam
* 2nd line: carbamazepine

Absence seizures:
* 1st line: ethosuximide

Myoclonic/atonic seizures:
* Males: sodium valproate
* Females: lamotrigine or levetiracetam

Question 9

What is infantile spasms and how can it be treated?

Answer 9

aka West syndrome. Rare disorder starting in infancy at around 6 mths of age and characterised by clusters of full body spasms.

First line treatments are:
* Prednisolone
* Vigabatrin

Question 10

Rules for driving with epilepsy, if someone has a:
* Car/motorbike license
* Bus/coach/lorry license

Answer 10

Car/motorbike license:
* One off seizure - reapply for license in 6 mths
* >1 seizure - reapply in 1 year
* Seizure following change in antiepileptic meds - reapply if seizure >6mths or if you went back on previous med for 6 mths.

Bus/coach/lorry license:
* One off - reapply in 5 yrs
* >1 - reapply once you haven’t had a seizure for 10 yrs

Question 11

What are febrile convulsions?

Answer 11

Type of seizure that occur in association with fever w/out evidence of intracranial infx.

The seizures predominantly occur in children aged between 6 months and 5 years.

Question 12

Causes of febrile convulsions?

Answer 12

Viral/bacetrial infx - MC upper respiratory tract infections, ear infections

Question 13

Sx of febrile convulsions?

Answer 13

• High fever >38c
• Short lived, tonic-clonic seizures, lasting less than 15 minutes
• LOC
• Postictal drowsiness or confusion

Question 14

Ix for febrile convuslions?

Answer 14

Bloods - identify infx sx
LP - if CNS infx sus
EEG

Question 15

Mx of febrile convulsions?

Answer 15

Tx of source of fever + use antipyretics (i.e. paracetamol or ibuprofen)
Parental advice i.e. advice against sponging child to cool them down