Epilsepy

Question 1

What is a seizure?
What neurotransmitters is it caused by?

Answer 1

Sudden uncontrolled electrical disturbance in the brain
Caused by: too much excitatory (glutamate) or not enough inhibitory (gaba)

Question 2

What are the different types of seizures?

Answer 2

Focal
Abscence
Myoclonic
Tonic
Atonic
Tonic-clonic

Question 3

How does a focal seizure present?

Answer 3

Changes in focal vision
Blurred vision

Question 4

How does an absence seizure present?

Answer 4

Blank stares
Daydreaming
Unresponsiveness

Question 5

How does a tonic seizure present?

Answer 5

Falls backwards
Muscle contractions constantly

Question 6

How does an atonic seizure present?

Answer 6

Muscle relaxation
Falls forward

Question 7

How does a tonic-clonic seizure present?

Answer 7

Tonic phase- muscles stiffen
Clonic phase- muscles convulsions

Question 8

How does a myoclonic seizure present?

Answer 8

Short lived
Muscles twitch or twitches

Question 9

How does a clonic seizure present?

Answer 9

Convulsions
Eg rhythmic muscle contractions

Question 10

How is epilepsy diagnosed?

Answer 10

FBC
Electrolytes
Blood glucose
LFT
RFT
Calcium
EEG
Neuro exam
Clinical history exam

Question 11

What differs epilsepy from other conditions eg cardiovascular collapse?

Answer 11

Epileptic episodes are accompanied by postictal state eg confusion, drowsiness, sleepiness, amnesia for hours

Question 12

What is administered for focal seizures?

Answer 12

Carbamazepinen or lamotrigine

Question 13

What is administered for absence seizures?

Answer 13

Ethosuximide

Question 14

What is administered for all other seizures to a man or non child bearing woman?

Answer 14

Sodium valporate

Question 15

What is administered for all other seizures to a child bearing/breastfeeding woman?

Answer 15

Lamotrigine or Levetiracetam

Question 16

What is the action mechanism of lamotrigine?

Answer 16

Blocks voltage gated Na+ channels stopping Na+ influx and therefore depolarisation of glutaminergic neurons reducing excitotoxicity

Question 17

What is the action mechanism of diazepam?

Answer 17

Increases Cl- influx by binding to benzodiazepine site on GABA-A at post synaptic neuron leading to hyperpolarisation of excitatory neurones

Question 18

What is the action mechanism of sodium valporate?

Answer 18

Inhibits GABA transaminase preventing the breakdown of GABA which increases conc. of GABA at the presynaptic neuron.

Question 19

What is the action mechanism of levetiracetam?

Answer 19

Inhibits the synaptic vesicle protein SVA2 and stops vehicle exocytosis. This reduces glutamate secretion and exitotoxicity

Question 20

What is the action mechanism of carbamazepine?

Answer 20

Blocks sodium channel by binding to it which stops glutamate exitotoxicity

Question 21

What are the side effects of lamotrigine?

Answer 21

Rash
Suicidal thoughts
Steven Jonson syndrome
Drowsiness

Question 22

What are the side effects of sodium valproate

Answer 22

Abdominal pain
Diarrhoea
Weight gain
Hair loss
Pancreatitis
Hepatoxicity

Question 23

What are the side effects of diazepam?

Answer 23

Drowsiness
Respiratory depression
Haemolytic anaemia
Jaundicd

Question 24

What are the side effects of levetiracetam?

Answer 24

Dizziness
Fatigue
Headache

Question 25

What happens if lamotrigine and the oral contraceptive pill are taken together? What can be done to combat this issue?

Answer 25

OCO makes an enzyme which metabolises lamotrigine faster, this reduces the effects produced by it. Increase lamotrigine in weeks 1-3 and decrease it in week 4 (due to placebo effect) Could go on a progesterone only contraceptive eg the implant

Question 26

Why is there a difference between men and child potential bearing women treatments?

Answer 26

Sodium valproate can cause neural tube defects, decreased IQ and autism in fetus’

Question 27

How are epileptic seizures treated in A&E?

Answer 27

Benzodiazepams- IV lorazepam first followed by diazepam. Midazolam can also be given buccally if out on the street

Question 28

How do oestrogen and progesterone impact seizures? Why do people with epilepsy need to be monitored more during pregnancy?

Answer 28

Progesterone- seizure inhibiting Oestrogen- seizure promoting During pregnancy this needs to be monitored in people with epilepsy- lamotrigine levels may be decreased in fear of harming baby which will also add to likelihood of seizures occurring