lecture 10 - epilepsy

Question 1

What is a seizure?

Answer 1

A convulsion or transient abnormal eventing resulting from a paroxysmal discharge of cerebral neurons

Question 2

What is a common clinical definition of epilepsy?

Answer 2

At least 2 unprovoked seizures occurring more than 24 hours apart

Question 3

What are the 3 types of onset of a seizure?

Answer 3

Focal onset, generalised onset, unknown onset

Question 4

Which type of seizure will always alter consciousness?

Answer 4

Generalised - entire CNS is affected

Question 5

What are the 3 different categories that epileptic seizures are classified under?

Answer 5

focal vs generalised,
aware vs unaware,
motor vs non-motor

Question 6

What is the term for a non-motor generalised seizure?

Answer 6

Absence seizure

Question 7

What is the alternate term for an absence seizure?

Answer 7

Petit mal

Question 8

What is the alternate term for a tonic-clonic seizure?

Answer 8

Grand mal

Question 9

What is an atonic seizure?

Answer 9

A seizure where there is partial or total loss of muscle tone

Question 10

What is a myoclonic seizure?

Answer 10

A seizure characterised by arrhythmic, random muscle jerks

Question 11

What is a tonic-clonic seizure?

Answer 11

A seizure characterised by extension/flexion (tonic) and then rhythmic jerking (clonus)

Question 12

What investigation is used to diagnose seizures?

Answer 12

EEG (electroencephalogram)

Question 13

What are the basic characteristics of an EEG during a generalised seizure?

Answer 13

Spikes/waves across all EEG leads, may be of varying height but all start at the same time

Question 14

What are the basic characteristics of an EEG during a partial seizure?

Answer 14

Spikes/waves in some leads, though others may be affected later due to spread (focal to bilateral seizure)

Question 15

What are some differential diagnoses for seizure?

Answer 15

syncope, migraine, TIA, hypoglycaemia, pseudoseizures

Question 16

What are some causes of non-epileptic seizures?

Answer 16

Trauma, surgery, space occupying lesions, pyrexia, vascular issues, drugs/ drug withdrawal, encephalitis, metabolic abnormalities, degenerative neural disorders

Question 17

What are the 2 main classes of drugs used in epilepsy/seizure management?

Answer 17

Anti-convulsants, benzodiazipines

Question 18

What 2 drugs are most commonly used in focal seizures and most generalised seizures?

Answer 18

Valproate, levetiracetam

Question 19

What drugs are most commonly used in focal seizures?

Answer 19

Phenytoin, carbamazepine, pregabalin

Question 20

What anticonvulsant drug is only effective in treating absence seizures?

Answer 20

Ethosuximide

Question 21

What is the clinical definition of status epilepticus?

Answer 21

Recurring seizure without recovery or a single seizure lasting for greater than 5 minutes

Question 22

What is the first line treatment for status epilepticus?

Answer 22

benzodiazipines, followed by AEDs or barbiturates

Question 23

Why is status epilepticus dangerous?

Answer 23

After 30 minutes, there is a high risk of long-term brain damage or death due to respiratory and airway dysfunction

Question 24

What are the principles of bystander/paramedic management of a seizure in the community?

Answer 24

position patient on their side, remove dangers, put pillow under head, reassure bystanders, assess airway patency, nasopharyngeal airway, oxygen therapy after seizure, IM/IV benzos, gain history from family/patient, head-to-toe check, signs of stroke

Question 25

What are the principles of a history taking following a seizure?

Answer 25

history of epilepsy, last known seizure, drug management, skipped doses, typical seizure pattern, recent injury/illness, seizure type (generalised/focal), alcohol/benzo use