Generalised seizures

Question 1

What is the definition of epilepsy?

Answer 1

Epilepsy is characterized by recurrent seizures without a cause

Question 2

What are generalised seziures?

Answer 2

1. Seizures which engage both sides of the brain

2. All generalized seizures have a complete loss of consciousness and awareness

Question 3

How can generalised seizures be further divided into?

Answer 3

1. Motor

2. Non Motor

Question 4

What are the subtypes of generalised motor seizures?

Answer 4

1. Tonic clonic
2. Tonic
3. Clonic
4. Myoclonic
5. Atonic

Question 5

What are the subtypes of generalised non motor seizures?

Answer 5

Typical absence seizures - Petit Mal

Question 6

Pathophysiology of epilepsy

Answer 6

1. Excess excitation
   - Excess levels of glutamate released to bind onto NMDA receptor channels resulting in long term activation
2. Too little inhibition
   - too little of GABA neurotransmitter binds to GABA receptor and causes opening of CL- ion channels

Question 7

What is the definition of atonic seizure?

Answer 7

all muscles suddenly relax and become floppy

Question 8

What is the definition of tonic seizures?

Answer 8

all muscles become stiff and flexed

Question 9

What is the definition of tonic-clonic seizures?

Answer 9

Tonic phase where muscles tense up followed by clonic phase where the muscles contract and relax.

Question 10

What is the definition of clonic seizures?

Answer 10

violent muscle contractions known as convulsions

Question 11

Name 3 conditions associated with epilepsy?

Answer 11

1. Cerebral palsy
2. Mitochondiral disease
3. Tuberous sclerosis - rare genetic condition that causes cancerous, benign tumors to develop in different parts of the body.

Question 12

Ix for epileptic seizures

Answer 12

1. EEG

2. Neuroimaging - MRI

Question 13

Name 5 symptoms associated with epileptic seizures only

Answer 13

1. Postictal period - tired and drowsy ( may not remember ambulance coming or period straight after )
2. Todd’s Paresis - seziure in the motor cortex causes temporary muscle weakness and paralysis
3. Bowel incontinence is more likely in epilepsy
4. Tongue biting - specific areas of the tongue bitten such as side of tongue or inside of cheek indicate epileptic seizure
5. Auras

Question 14

Which ‘tongue biting’ signs are specific to epileptc seizures?

Answer 14

Side of the tongue for inside of the cheek

Question 15

What is the nature of movements in an epileptic seizure? (3)

Answer 15

1. Stiff / rigid / shaking
2. Synchronous movement
3. No resistance to eye opening

Question 16

What are the 5 steps of acute management of seizures?

Answer 16

1. Benzodiazepine
   - Lorazepam (IV) or Diazepam (rectal)

If seizure persists,

2. Administer benzodiazepine again
3. IV infusion of Phenytoin
4. General Anaesthetic
   - Modazelan / Profolol to sedate the patients

Question 17

How long do epileptic seizures last for?

Answer 17

< 5 minutes

Question 18

Feature of temporal lobe seizures (3)

Answer 18

1. Hallucinations
   - Auditory / Olfactory
2. Automatisms / Lip smacking
3. De ja vu

Question 19

First line tx for generalised seizures

Answer 19

1. Sodium valporate

Question 20

Second line tx for generalised seziures

Answer 20

2. Lamotragine

Question 21

What is the mechanism of action of sodium valporate?

Answer 21

Increases GABA activity

Question 22

Name 3 adverse effects of sodium valporate?

Answer 22

1. Teratogenic
2. P450 enzyme inhibitor
3. Weight gain