FN: Epilespy

Question 1

Definition

Answer 1

Recurrent tendancy to spontaneous, intermittant, abnormal electrical activity in part of the brain manifest as seizures

Question 2

Causes

Answer 2

2/3 are idiopathic (often familial)

1. Congenital
2. Acquired
3. Non-epileptic/provoked seizures

Question 3

Congenital causes

Answer 3

NG
Tuberous sclerosis
TORCH
Perintal anoxia

Question 4

Acquired

Answer 4

Vascular: CVA
Cortical scarring: trauma infection
SOL
Other: SLE, PAN, MS, sarcoidosis

Question 5

Non epileptic/ provoked seizures

Answer 5

1. Withdrawal: EtOH, opiates, benzos
2. Metabolic: glucose, Na, Ca, urea, Nh3
3. Raised ICP: trauma, haemorhage, cortical venous thrombosis
4. Infection: meningitis, encephalitis, cycticerosis HIV
5. Eclampsia
6. Pseudoseizures

Question 6

Prodrome defintion

Answer 6

Patient or others may notice change in mood or behaviour lasting hours - days
Not part of seizure

Question 7

Aura

Answer 7

A simple partial seizure (usually temporal) which may precede other manisfestations
Experienced as a strange feeling:
1. Epigastric rising
2. Deja/jamais vu
3. Automatism
4. Smells, lights, sound

Question 8

PArtial (focal)

Answer 8

Features referable to part of one hemisphere

Question 9

Primary Generalised

Answer 9

No warning/aura

Discharge throughout cortex w/o localising features

Question 10

simple

Answer 10

awareness unimpaired

Question 11

Complex

Answer 11

Awareness impaired

Question 12

Secondary generalised

Answer 12

Focal seizure - generalised

e.g. aura - tonic-clonic

Question 13

Diagnostic pointers

Answer 13

Aura
Specific trigger e.g. flashing lights
Lateral tongue biting (>incontinence)
Typical movements e.g. tonic-clonic
Cyanosis
Post-ictal phase

Question 14

Simple partial presenting features

Answer 14

Focal motor, sensory, autonomic or psychic symptoms

Question 15

Complex partial : 5As

Answer 15

Aura
Autonomic change in skin colour, temperature, palps
Awareness lost: motor arrest, motionless stare
automatism:lip-smacking, fumbling, chewing, swallowing
Amnesia

Question 16

Complex partial seizures usually arise form

Answer 16

Temporal lobe

Question 17

Abscences (Petit mal)

Answer 17

Abrupt onset and offset

Short

Question 18

Tonic-clonic (Grand mal)

Answer 18

LOC
Tonic: limbs stiffen
Clonic: rhythmic jerking of limbs
± cyanosis, incontinence, tongue biting (lateral)
Post-ictal confusion and drowsiness

Question 19

Myoclonic seizure

Answer 19

Sudden jerk of limb, face or trunk

Question 20

Atonic (akinetic seizures)

Answer 20

Sudden loss of muscle tone – fall

No LOC

Question 21

West syndrome/ Infantile Spasms

Answer 21

Clusters of head nodding and arm jerks

EEG shows hypsarrhythmia

Question 22

Temporal localising features

Answer 22

Automations: lip smacking, chewing, fumbling
Deja/jamais vu
Delusional behaviour
Abdominal: rising, n/v
Emotional disturbance: terror, panic, anger, elation
Tastes, smells

Question 23

Frontal localising features

Answer 23

Motor features: arrest, jacksonian march, Todds palsy

Question 24

Parietal localising features

Answer 24

Sensory disturbance: tingling, numbness

Question 25

Occipital localising features

Answer 25

Visual phenomena: spots, lines, flashes