NEURO 232 Epilepsy

Question 1

What is an epileptic seizure?

Answer 1

A transient event experienced by a subject as a result of synchronous and excessive discharge of cerebral neurones

Question 2

What type of generalised seizures are there?

Answer 2

Tonic clonic
Absence
Myoclonic

Question 3

Describe generalised tonic clonic seizures

Answer 3

Stereoyped, sudden onset LOC with limb stiffening and synchronous muscle jerking
Often also: cyanosis, tongue biting, incontinence and post-ictal confusion

Question 4

Describe absence seizures

Answer 4

Begins in childhood, patient stares and pales slightly for a few seconds, maybe mild jerking - they will continue where they left off

Question 5

Describe myoclonic seizures

Answer 5

Isolated muscle jerking

Question 6

What are partial seizures

Answer 6

Seizures with a focal onset with features referable to one part of a hemisphere

Question 7

What can partial seizures be classified into

Answer 7

Complex or simple

Question 8

Describe complex partial seizures

Answer 8

impairment of awareness, may have aura, post ictal confusion, include automatisms

Question 9

Describe simple partial seizures

Answer 9

No impairment of awareness, may have focal motor, sensory, autonomic is psychic symptoms - nothing post-ictal

Question 10

What are common presentations with temporal complex partial seizures?

Answer 10

Aura - rising epigastric sensation, smells and tastes and fear. Motor and speech arrest, automatism with no recollection

Question 11

What are non-epileptic attacks?

Answer 11

Psychogenic seizures

Question 12

Describe non-epileptic attacks

Answer 12

retention of awareness, gradual onset, prolonged and frequent, no response to AED’s
asynchronous movements such as back arching, biting tip of tongue
Aura - autonomic arousal
Common with traumatic childhod experiences and a history of MUS

Question 13

What investigations must be done in suspected seizure?

Answer 13

ECG, EEG and Imaging

Question 14

What is heterotopic grey matter?

Answer 14

A developmental malformation resulting in island of grey matter that have failed to migrate towards the gyrae leaving a rim of grey matter around the ventricles

Very eliptogenic but normal intelligence

Question 15

What is idiopathic generalised epilepsy?

Answer 15

A group of generalised seizures with normal imaging but abnormal EEG triggered by alcohol excess and lack of sleep - usually presents in childhood or adolescence

Question 16

Describe juvenile myoclonic epilepsy

Answer 16

an IGE
upper limb jerking with seizures on waking
photosensitivity
good response to aed’s

Question 17

What other genetic disease may cause epilepsy and is why you should check the skin?

Answer 17

tuberous sclerosis

Question 18

What are some causes of epilepsy in adulthood?

Answer 18

IGE’s, head injury, alcohol, vascular malformations, hippocampal sclerosis

Question 19

What is hippocampal sclerosis?

Answer 19

Scarring of the hippocampus which acts as an eliptogenic focus in partial complex seizures - difficult to control and associated with febrile seizures in infancy

Question 20

What is usually the 1st sign of a brain tumour in adulthood?

Answer 20

Seizures

Question 21

What is the commonest cause of epilepsy worldwide?

Answer 21

neurocysticercosis - eggs of pork tapeworm migrate to the brain

Question 22

What are the principles of treating epilepsy?

Answer 22

Aim for one drug at the lowest dose and make increases over long periods of time

Question 23

What is the main treatment for generalised epilepsy?

Answer 23

Sodium valproate, or lamotrigine, levitiracetam (women)

Question 24

What is the main treatment for partial epilepsy?

Answer 24

carbamaxepine, lamotrigin and leviterecetam

Question 25

When would you consider drug withdrawal?

Answer 25

2 years seizure free

Question 26

What is status epilepticus?

Answer 26

Seizures/series of lasting 30 minutes without regaining consciousness = a medical emergency

Question 27

What are some causes of status epilepticus?

Answer 27

encephalitis, tumours, trauma or missed dose/infection in those with epilepsy

Question 28

What do you give immediately/early in status epilepticus?

Answer 28

iv lorazepam 4mg and repeat once after 10 minutes

Question 29

What do you give in established status epilepticus?

Answer 29

iv phenytoin 15mg/kg given 50mg in 1 minute

Question 30

What is the management in refractory status epilepticus?

Answer 30

ITU, GA, IV propofol/thiopental/midazolam

Question 31

What is SUDEP?

Answer 31

Sudden unexpected death in epilepsy - non traumatic unwitness

Question 32

What are the risk factors for SUDEP?

Answer 32

high seizure frequencym polytherapy, medication changes, young onset, poor compliance

Question 33

How long must you be seizure free for to have a group 1 license?

Answer 33

1 year
6 months if single seizure and normal investigations
only in sleep - 1 year

Question 34

What is the cingulate cortex involved in?

Answer 34

learning memory and emotion

Question 35

What is the septal area in the brain?

Answer 35

The relay between the hippocampus and the hypothalamus with medial and ventral nuclei

Question 36

What is the hippocampus important for?

Answer 36

all types of memory and is one of the most active sites for neurogenesis
post/dorsal = place cells - spatial memory/learning

Question 37

What is the amygdala involved in?

Answer 37

fear and aggression

Question 38

What personality changes can occur in temporal lobe epilepsy and why?

Answer 38

Due to the effect on the amygdala, hippocampal etc

hypergraphia, hypo-sexuality, emotional viscosity, mood swings, excessive religion