neuro epilsepsy

Question 1

what is epilsepy

Answer 1

recurrent tendency to spontanous intermittent abnormal electriacl activity in the btrain - manifests in seizures

Question 2

types of seizures x2

Answer 2

generalised - both hemispheres

focal / partial - one cerebral hemisphere involved at onset

Question 3

what is required to be classed a s chronic disease in epilspsy

Answer 3

need at least 2 seizures over 24hrs apart to be epileptic

ecg normal between

Question 4

what is an aura

Answer 4

part f a seisure patient is unaware of

Question 5

types of generalised seizures

Answer 5

tonic 
clonic
tonic clonic
atonic
absence
myoclonic

Question 6

types of focal seizures

Answer 6

simple
complex
partial seizure w secondary generalised - spread to other hemisphere

Question 7

what is partial seizure w secondary generalised

Answer 7

starts in one hemisphere, electrical activity then spreads to other hemisphere
jerkin

Question 8

epidem

Answer 8

pre 20 post 60

1% prevalence

Question 9

dx of epilsepsy

Answer 9

2+ unprovokedn seizures over 24hrs apart
ecg normal in between
mri to ideniftu any strctural abnormalities i.e tumour

Question 10

ddx of epilsepsy

Answer 10

hypoglycaemia
tia
syncope
non epilieptic attacks

Question 11

diff between epileptic it and non epileptic attacks

Answer 11

non epileptic - eyes closed and longer

Question 12

diff between epileptic fit and syncope

Answer 12

syncope eyes closed and no tongue biting
incontinence rarer than vs epilepsy
can avoid by changing posture

Question 13

what is conceiuousness levels in each partial seizure

Answer 13

simple - remain concsious

complex - impaired conciousness

Question 14

causes of epilepsy

Answer 14

2/3 - idiopathic
cerebal tumours
viral enceph
meningitis
alcohol withdrawal
cocaine
sle
stroke
ms

Question 15

pahtophysicological basis behind epilsepys

Answer 15

too much excitation - glutamate - Ca IN

too little inhibition - GABA - Cl in is inhib - dysfunctional gaba receptor

Question 16

what is status epilepticus

Answer 16

continuous seizure over 30 mins
increased duration increased cerebral ddmaage
without recovery between

Question 17

Mx of status epilepticus

Answer 17

IV lorazepram (= a benzodiazepine like in huntingtons chorea)
rectal diazepam
2- phenytoin loading
3 - o2 and anaesthetic

Question 18

effects of partial seizures if affecting frontal lobe

Answer 18

MOTOR AND THOUGHT
JACKSONIAN MARCH, where they are fully aware of what they are doing but have no control. - up n down motor homunculus starts face/thumb –> entire side
TODDS PARALYSIS = hemiparalysis - 2 days - post ictal

TODD the marching Frog - playing drums - F for frog and frontal

Question 19

effect of seizures affecting temporal lobe partial seizure

Answer 19

MEM EMOTION RECEPTIVE SPEECH
aura – de ja vu., jamais fu, olfactory hallucinations
automatisms - lipsmacking
can devel into secondary generalised seizure

Question 20

effect of parietal lobe partial seizure

Answer 20

SENS DISTURBANCES
tingling
numbness

Question 21

effect of occipital lobe seizure

Answer 21

visual phenomena - zig zag lines

Question 22

what is clin features of a simple partial seizure

Answer 22

remains consious - awareness unimplaired - no postictal symptoms

Question 23

Length of seizures,

Answer 23

30 seconds -120 seconds. generally under 3 minutes

Question 24

examination a=of a seizure, things you can ask witness

Answer 24

How long did the seizure last
what was the character of the seizure, how did it change, phases of the seizure. the speed of convulsions.
if incontinence.
Sequence of events of seizure.
any post ictal signs they have noticed like dysphasia

Question 25

Examination of a seizure, what would you ask the patient

Answer 25

what were you doing before seizure
did you notice any preictal symptoms, deja vu jamais vu, auras, general feeling.
did you retain consciousness during the seizure. do you have monory of what happened
post ictal features, dysphasia, todd’s Palsy.
does their tongue hurt, indication of tongue biting.
incontinence during seizure

Question 26

commonest cause of seizures

Answer 26

2/3. Idiopathic generalised epilepsy, usually familial.

Question 27

Management of seizures

conservative

Answer 27

education on potential triggers, alcohol, substance, stress. medications
education on maintaining safety, driving. avoid baths, locking doors.

Question 28

Pharmacological management of seizures

Answer 28

antiepileptic drugs- carbamazepine - for tonic clonic, and partial seizures
sodium valproate- for all other kinds

Question 29

What is a seizure?

Answer 29

The clinical manifestation of dyssynchronous neuronal discharge

Question 30

What are the tonic and clonic phases of a grand mal seizure?

Answer 30

Tonic - rigid stiff limbs

Clonic - generalised, bilateral, rhythmic jerking

Question 31

What are the characteristics of a simple partial seizure?

Answer 31

Awareness unimpaired
Focal motor/sensory/autonomic symptoms
No post-ictal symptoms

Question 32

What is the treatment of primary generalised seizures?

Answer 32

sodium Valproate or lamotrigine

Question 33

What is the treatment of absence seizures?

Answer 33

sodium Valproate or ethosuximide

Question 34

What is the treatment of partial seizures?

Answer 34

Carbamazepine or lamotrigine

Question 35

Surgical management of seizures

Answer 35

Vagus nerve stimulation,

Question 36

When can a patient drive with epilepsy?

Answer 36

Free of daytime seizures for at least one year

must inform DVLA

Question 37

hwo does carbamezapine treat partial seizures

Answer 37

inhibits Na channels SE=drowsy

Question 38

how does iamotrigine treat partial seizures

Answer 38

inhibits glutamate relase - less excitory

SE - blurred vision