Neurology

Question 1

What are the key features of a tonic-clonic seizure?

Answer 1

Loss of consciousness
Tonic (muscle tensing)
Clonic (muscle jerking)
Prolonged post-ictal period (confused, drowsy, irritable, low)

Question 2

What is first line treatment for tonic-clonic seizures?

Answer 2

Sodium valproate

2nd - lamotrigine / carbamazepine

Question 3

What do focal seizures effect?

Answer 3

Hearing, speech, memory and emotions - this is because they start in the temporal lobes.

Question 4

How can a focal seizure present?

Answer 4

Hallucinations, deja vu, memory flashbacks, feeling like you’re in autopilot.

Question 5

What is the treatment for focal seizures?

Answer 5

1. Lamotrigine / Carb

2. Sodium valproate

Question 6

What syndrome is associated with atonic seizures?

Answer 6

Lennox-Gastaut Syndrome (epilepsy syndrome with really abnormal EEGs)

Question 7

How is infantile spasms (West Syndrome) classified?

Answer 7

Starting around 6 months

Cluster of full body spasms

Question 8

What are the treatment options for West Syndrome?

Answer 8

Prednisolone

Vigabatrin

Question 9

How does Sodium valporate work?

What are some side effects of it?

Answer 9

Increasing the activity of GABA.

Teratogenic
Hair loss
Tremor
Liver damage and hepatitis

Question 10

What side effects are associated with carbamazepine?

Answer 10

Agranulocytosis
Aplastic anaemia
P450 system drug interactions

Question 11

What side effects are associated with lamotrigine?

Answer 11

Stevens-Johnson syndrome - life threatening rash

Question 12

What is the classification of Status Epilepticus?

Answer 12

> 5 minutes

> 3 seizures in one hour

Question 13

How do you manage S.E?

Answer 13

Secure airway
High [O2]
Assess cardiac + resp function
Check blood glucose levels
Gain IV access
IV lorazepam - repeat after 10 minutes if seizure continues.
If still continuing give IV phenobarbital or phenytoin.

(if in community use buccal midazolam or rectal diazepam).