Patho- Epilepsy

Question 1

What is epilepsy?

Answer 1

A group of CNS disorders in which recurrent seizures occur, due to chronic underlying processes

Question 2

What are the two main pathologies of epilepsy?

Answer 2

Primary/idiopathic

Secondary/symptomatic

Question 3

What is primary epilepsy?

Answer 3

No causative event behind it

Question 4

What is secondary epilepsy?

Answer 4

Epilepsy caused by something else

Question 5

What can cause secondary epilepsy?

Answer 5

Trauma
Neoplasm
Hydrocephalus
Infection
Developmental abnormalities
Cerebrovascular disease

Question 6

What are the two main categories of epilepsy?

Answer 6

Generalised

Focal

Question 7

Which part of the brain does generalised epilepsy affect?

Answer 7

All of it

Question 8

Name some forms of generalised seizures

Answer 8

Grand mal/generalised tonic-clonic
Petit mal/absence
Myoclonic
Tonic
Atonic
Akinetic
Infantile spasms/febrile convulsions
Functional

Question 9

What is a differential for generalised seizures?

Answer 9

Vasovagal

Question 10

What is vasovagal reaction?

Answer 10

Loss of consciousness due to reacting to trigger (blood etc).
Quick recovery

Question 11

Describe grand mal/generalised tonic-clonic

Answer 11

Tonic rigidity followed by a tremor.

Question 12

What is the tonic phase?

Answer 12

Body rigidity

Question 13

What can happen in the tonic phase?

Answer 13

Incontinence

Tongue biting

Question 14

How long does a tonic episode tend to last?

Answer 14

Seconds to a minute

Question 15

What is a clonic phase?

Answer 15

Convulsions

Question 16

What can happen in a clonic phase?

Answer 16

Mouth frothing

Jerking

Question 17

How long can a clonic phase last?

Answer 17

Minutes

Question 18

What follows a generalised tonic-clonic seizure?

Answer 18

Drowsiness, confusion or coma

Question 19

IS it possible to be conscious during a seizure?

Answer 19

No- if conscious then cannot be epilepsy!!!

Question 20

How do you treat a generalised tonic-clonic seizure?

Answer 20

Leave generally and will resolve

Diazepam or phenytoin

Question 21

How do you prevent generalised tonic-clonic seizures?

Answer 21

Sodium valproate
Lamotrigine in women of childbearing age
Carbamazepine

Question 22

What causes an absence seizure?

Answer 22

Developmental abnormalities of neuronal control.

Question 23

What are the symptoms of an absence seizure?

Answer 23

10-45 s (maybe 100/day) with consciousness altered- blank out.
3 Hz spike-and-wave EEG activity
Mild clonic spasms may occur

Question 24

Who develops absence seizures?

Answer 24

Children

Question 25

How do you prevent absence seizures?

Answer 25

Ethosxumide | Valproate

Question 26

What must you NOT give to those with absence seizures?

Answer 26

Carbamazepine | Phenytoin

Question 27

What is myoclonic seizure?

Answer 27

Isolated clonic jerks

Question 28

How does myoclonic seizure present on EEG?

Answer 28

3Hz spike and wave

Question 29

WHat are the symptoms of a myoclonic seizure?

Answer 29

Rhythmic series of clonic seizures | Isolated clonic jerks

Question 30

How do you prevent a myoclonic seizure?

Answer 30

Sodium valproate Clonazepam Lamotrigine

Question 31

What should you not give to someone with myoclonic seizures?

Answer 31

Carbamazepine

Question 32

What is a tonic seizure?

Answer 32

Intense stiffening of body without jerks

Question 33

What is an atonic seizure?

Answer 33

Sudden loss of posture leading to collapse

Question 34

What is an akinetic seizure?

Answer 34

Cessation of movement, falling and loss of consciousness

Question 35

What is an Infantile spasms/febrile convulsions?

Answer 35

A syndrome with bilateral attacks of brief recurrent myoclonic jerks.

Question 36

What causes Infantile spasms/febrile convulsions?

Answer 36

Fever

Question 37

How do you treat an Infantile spasms/febrile convulsions?

Answer 37

Leave if under 15m | Diazepam >15m

Question 38

What is a functional seizure?

Answer 38

Trigger will cause the person to trash when they see or hear something

Question 39

What is a functional seizure often a sign of?

Answer 39

Abuse

Question 40

What are partial seizures?

Answer 40

Seizure affecting only one part of the brain

Question 41

Give some examples of partial seizures

Answer 41

Simple partial Complex partial Temporal lobe Partial seizures secondarily generalized

Question 42

What is a Partial seizures secondarily generalized?

Answer 42

Partial seizure immediately preceding a GTC seizure

Question 43

What is a simple partial seizure?

Answer 43

Just motor clonic restricted to one or a few muscles

Question 44

Where does a simple partial seizure originate?

Answer 44

Motor cortex

Question 45

What is The March of the Seizures?

Answer 45

In simple partial the clonic movement starts at the edge of the mouth and moves elsewhere

Question 46

How is consciousness impaired in a simple partial seizure?

Answer 46

No concious loss

Question 47

What is complex partial seizure?

Answer 47

SImilar to simple but with consciousness impairment/confusion/falling and Automatisms

Question 48

What are Automatisms?

Answer 48

Unconscious movement that may resemble simple repetitive tics

Question 49

What are some symptoms of a temporal lobe seizure?

Answer 49

Feeling of unreality or undue familiarity with the surroundings Blank episodes of staring, vertigo, visual hallucinations Auditory and balance affected “Reality is unreal”

Question 50

What is the buzzword for a temporal lobe seizure?

Answer 50

Lipsmacking

Question 51

How do you treat partial seizures?

Answer 51

Carbamazepine or lamotrigine

Question 52

What is status epilepticus?

Answer 52

A life-threatening neurological condition defined as 5 or more minutes of either continuous seizure activity or repetitive seizures without regaining consciousness. Used to be 30 minutes

Question 53

How serious is status epilepticus?

Answer 53

Medical emergency!

Question 54

What is the pathophysiology of epilepsy?

Answer 54

High frequency AP bursts Hypersynchronization Failure of synaptic inhibition

Question 55

What is the seizure threshold?

Answer 55

The minimum threshold at which seizures will occur

Question 56

How do you diagnose epilepsy?

Answer 56

EEG History Rule out syncope- BP and ECG

Question 57

How do you rule out syncope?

Answer 57

BP and ECG

Question 58

How does a seizure appear on EEG?

Answer 58

High voltage spike-and-wave activity | Normal between attacks

Question 59

When should you CT in epilepsy?

Answer 59

``` Clinical or radiological skull fracture Deteriorating GCS Focal signs Head injury with seizure Failure to be GCS 15/15 4 hours after arrival Suggestion of other pathology (e.g. SAH) ```

Question 60

How do you actually treat epilepsy?

Answer 60

``` Leave Diazepam Midazolam Phenytoin Treat underlying cause (hypoglycemia etc) ```

Question 61

What are some side effects of phenytoin?

Answer 61

Gum hypertrophy | Hirtuism

Question 62

How often should phenytoin be given?

Answer 62

Once a day MAX!

Question 63

How should epilepsy prophylaxis be given?

Answer 63

Start low and go slow

Question 64

Name four main antiepileptic drugs for prophylaxis

Answer 64

Clonazepam Sodium valproate Carbamazepine Lamotrigine

Question 65

What are the side effects of Lamotrigine?

Answer 65

Rash | Headache

Question 66

What is clonazepam mainly used for?

Answer 66

Myotonic seizures

Question 67

What are some side effects of clonazepam?

Answer 67

Sleep

Question 68

What group should sodium valproate not be given to?

Answer 68

WOmen of child bearing age

Question 69

What are some side effects of sodium valproate?

Answer 69

``` Weight gain/appetite stim Teratogenic Hair loss Thrombocytopenia Fatigue Tremor ```

Question 70

What are some side effects of Carbamazepine?

Answer 70

``` Presyncope Nausea Headache Hyponatremia Rash ```

Question 71

What can Carbamazepine interfere with?

Answer 71

Morning after pill