Neurology - Epilepsy

Question 1

What is epilepsy?

Answer 1

A condition characterised by seizures, which are transient episodes of abnormal electrical activity in the brain

Question 2

What are the main types of seizures seen in adults?

Answer 2

• Generalised tonic-clonic seizures
• Partial seizures (focal seizures)
• Myoclonic seizures
• Tonic seizures
• Atonic seizures

Question 3

What types of seizures are more common in children?

Answer 3

• Absence seizures
• Infantile spasms
• Febrile convulsions

Question 4

What characterises generalised tonic-clonic seizures?

Answer 4

Involves tonic (muscle tensing) and clonic (muscle jerking) movements

Complete loss of consciousness

Grand mal seizures

Patient may experience an aura

Question 5

What can occur during a seizure?

Answer 5

Tongue biting
Incontinence
Groaning
Irregular breathing

Question 6

What is an aura in relation to seizures?

Answer 6

An abnormal sensation that gives a warning that a seizure will occur.

Question 7

What happens during the post-ictal period after a seizure?

Answer 7

The person may be confused, tired, and irritable or low

Question 8

What are partial seizures?

Answer 8

Focal seizures

Occur in isolated part of the brain, often the temporal lobe

Patient remains awake

Remain aware during simple partial seizures
Lose awareness during complex partial seizures

Question 9

What symptoms can be associated with partial seizures?

Answer 9

• Déjà vu
• Strange smells, tastes, sights, or sounds
• Unusual emotions
• Abnormal behaviours

Question 10

What are myoclonic seizures characterised by?

Answer 10

Sudden, brief muscle contractions, like an abrupt jump or jolt

Remain awake

Can occur as part of juvenile myoclonic epilepsy in kids

Question 11

What occurs during tonic seizures?

Answer 11

Sudden onset of increased muscle tone, resulting in stiffness of the entire body

Causes a fall if patient is standing, usually backwards

Lasts only a few seconds or minutes

Question 12

What are atonic seizures?

Answer 12

Drop attacks

Sudden loss of muscle tone causing a fall

Last only briefly

Patient are aware

Being in childhood

Question 13

What can an atonic seizure indicate?

Answer 13

Lennox-Gastaut Syndrome

Question 14

What happens during absence seizures?

Answer 14

Usually seen in children

The patient becomes blank, stares into space, and then abruptly returns to normal

Unaware of surroundings and do not respond

Lasts 10-20 seconds

Most stop having seziures as they get older

Question 15

What are infantile spasms?

Answer 15

West syndrome

Starts at 6 months of age

Presents with clusters of full-body spasms

Asscoiated with developmental regression and poor prognosis

Treatment with ACTH and vigabatrin

Question 16

What is the characteristic EEG finding in infantile spasms?

Answer 16

Hypsarrhythmia

Question 17

What are febrile convulsions?

Answer 17

Tonic-clonic seizures that occur in children during a high fever

Not due to any underlying pathology

Cause no lasting damage

1/3 will have another febrile convulsion, slightly increased risk of epilepsy

Question 18

What age group is most affected by febrile convulsions?

Answer 18

Children aged between 6 months and 5 years

Question 19

What is essential for differential diagnosis of seizures?

Answer 19

• Vasovagal syncope
• Pseudoseizures
• Cardiac syncope
• Hypoglycaemia
• Hemiplegic migraine
• Transient ischaemic attack

Question 20

What investigations are used for epilepsy?

Answer 20

EEG
MRI brain - diagnose structural pathology

ECG
Serum electrolytes
Blood glucose - hypoglycaemia and diabetes
Blood culutres, urine cultures and LP - sepsis, encephalitis or meningitis

Question 21

What safety precautions should be advised to patients with seizures?

Answer 21

• Remove driving licence until criteria are met (must be seizure-free for one year)
• Take showers instead of baths (major risk of drowning)
• Caution with swimming, heights, traffic, and dangerous equipment

Question 22

What is the goal of epilepsy treatment?

Answer 22

To be seizure-free on the minimum anti-epileptic medications, ideally monotherapy

Question 23

Complete the table

Answer 23

Question 24

What are some less common anti-epileptic drugs used for epilepsy?

Answer 24

Carbamazepine
Phenytoin
Topiramate

Question 25

How does sodium valproate work?

Answer 25

Increases GABA activity- calming effect on the brain

Question 26

What notable side effects are associated with sodium valproate?

Answer 26

• Teratogenic effects
• Liver damage and hepatitis
• Hair loss
• Tremor
• Reduced fertility

Question 27

What does sodium valproate cause in pregnancy?

Answer 27

Neural tube defects
Developmental delay

Question 28

What is status epilepticus?

Answer 28

Medical emergency
- Seizure lasting more than 5 minutes
- Multiple seizures without regaining consciousness in the interim

Question 29

How is status epilepticus managed?

Answer 29

A-E
- Secure airway
- High concentration oxygen
- Check blood glucose
- IV access

Question 30

What is the first-line medical treatment for status epilepticus?

Answer 30

First-line
A benzodiazepine, repeated after 5-10 minutes if seizure continues

Second-line (after two doses of benzodiazpine)
- IV levetiracetam, phenytoin or sodium valproate

Third-line
- Phenobarbital
- General anaesthesia

Question 31

What are the options for benzodiazepines in status epilepticus management?

Answer 31

• Buccal midazolam (10mg)
• Rectal diazepam (10mg)
• Intravenous lorazepam (4mg)