Neuro

Question 1

Define seizure.

Answer 1

A convulsion caused by a paroxysmal discharge of cerebral neurones.

Question 2

Define epileptic seizure.

Answer 2

Excessive, unsynchronised neuronal discharges in the brain cause paroxysmal changes in behaviour, sensation or cognitive processes.

Question 3

How long do epileptic seizures tend to last for?

Answer 3

30 - 120 seconds.

Question 4

What are febrile convulsions?

Answer 4

Febrile convulsions are epileptic seizures accompanied by fever. They usually occur early in viral infection and tend to be brief generalised tonic-clonic seizures.

Question 5

How long do non-epileptic seizures tend to last for?

Answer 5

1 - 20 minutes.

Question 6

Give 3 signs of non-epileptic seizures.

Answer 6

1. Eyes closed.
2. Talking/crying.
3. Pelvic thrusting.

Question 7

What is the first line AED offered to those suffering from focal seizures?

Answer 7

Carbamazepine. Surgery may also be offered.

Question 8

What would you expect to see in a myoclonic seizure?

Answer 8

Isolated muscle jerking.

Question 9

What would you expect to see in a tonic seizure?

Answer 9

Generalised increase in tone.

Question 10

What would you expect to see in an atonic seizure?

Answer 10

Transient loss of muscle tone.

Question 11

What would you expect to see in a generalised tonic-clonic seizure?

Answer 11

Sudden onset rigid phase followed by a convulsion in which the muscles jerk rhythmically.

Question 12

What is the first line AED offered to those suffering from generalised tonic-clonic seizure?

Answer 12

Sodium valporate.

Question 13

Why must you do an ECG in those suffering from seizures?

Answer 13

To check for arrhythmia as the cause e.g. long-QT syndrome

Question 14

What investigations might you want to do in someone presenting with seizures.

Answer 14

1. Eye witness account/video is invaluable!
2. ECG.
3. EEG.
4. MRI or CT.

Question 15

Give 3 potential side effects of AED’s.

Answer 15

1. Cognitive disturbances
2. Heart disease.
3. Drug interactions.
4. Teratogenic.

Question 16

Define syncope.

Answer 16

A transient loss of consciousness due to global cerebral hypoperfusion with rapid onset, short duration and spontaneous complete recovery.

Question 17

What are absence seizures?

Answer 17

Seizures where there is a transient loss of consciousness with an abrupt onset and termination.
Momentary unresponsive stare with motor arrest, lasts <30s.
Developmentally normal but can interfere with school.

Question 18

How might you investigate suspected absence seizures?

Answer 18

1. Observe an episode - hyperventilation, ask the child to blow on a windmill.
2. EEG - would show 3-second spike and wave discharges.

Question 19

What medications can be given to treat absence seizures?

Answer 19

Ethosuximide or Sodium Valporate.

Question 20

Give some possible side effects of Ethosuximide and Sodium Valporate.

Answer 20

Ethosuxamide - rash, nausea, D+V.

Sodium Valporate - weight gain, hair loss, teratogenic.

Question 21

What can absence seizures evolve into?

Answer 21

Juvenile myoclonic epilepsy (JME).

Question 22

What are the signs of juvenile myoclonic epilepsy?

Answer 22

Clumsiness and GTCS that occur shortly after waking and are often provoked by sleep deprivation.

Question 23

Describe the epidemiology of infantile spasms (West syndrome).

Answer 23

Presents in the first 4 to 8 months of life
More common in male infants
Often associated with a serious underlying condition Carries a poor prognosis

Question 24

Give 2 features of infantile spasms.

Answer 24

1. characteristic ‘salaam’ attacks: flexion of the head, trunk and arms followed by extension of the arms. This lasts only 1-2 seconds but may be repeated up to 50 times
2. progressive mental handicap

Question 25

Give 2 ix and results of infantile spasms.

Answer 25

EEG shows hypsarrhythmia in two-thirds of infants

CT demonstrates diffuse or localised brain disease in 70% (e.g. tuberous sclerosis)

Question 26

Give 2 mx of infantile spasms.

Answer 26

vigabatrin is now considered first-line therapy

ACTH is also used