(PM3B) Epilepsy

Question 1

What percentage of the population are affected by epilepsy?

Answer 1

~1%

Question 2

What is epilepsy?

Answer 2

Neuronal hyperexcitability disorder

Arises from excess excitability/ disinhibition

Question 3

What is disinhibition?

Answer 3

Inability to suppress inappropriate behaviour

Question 4

What are the principle types of seizure?

Answer 4

(1) Partial seizures

(2) Generalised seizures

Question 5

How is epilepsy most often characterised?

Answer 5

(1) Convulsions – impairment of motor activity
(2) Impaired consciousness
(3) Impaired perception
(4) Impaired behaviour

Question 6

Why is the term ‘fit’ now archaic when referring to a seizure?

Answer 6

Implies it is voluntary

Question 7

What is the most prevalent symptom of epilepsy?

Answer 7

Seizures

Question 8

Is a seizure the same as epilepsy?

Answer 8

No

Seizures are a symptom of epilepsy

Epilepsy is not a seizure

Question 9

What is a convulsion?

Answer 9

Sudden, violent, irregular movement of a limb or of the body, caused by involuntary contraction of muscles

Question 10

Is a convulsion the same as a seizure?

Answer 10

No

A seizure is a type of convulsion

A seizure is a convulsion due to epileptiform brain activity

Question 11

Is an isolated seizure considered to be epilepsy?

Answer 11

No

Question 12

What are some possible triggers of an isolated seizure?

Answer 12

(1) CNS infection/ inflammation
(2) Stroboscopic lighting
(3) Metabolic dysfunction
(4) Head injury
(5) Fever
(6) Drug-related

Question 13

How can an isolated seizure be associated with epilepsy?

Answer 13

Repeated isolated seizures can increase risk of epilepsy development

Question 14

What are some co-morbidities of epilepsy?

Answer 14

(1) Depression
(2) Anxiety
(3) Cognitive decline
(4) Agitation/ anger
(5) Suicide
(6) ADHD
(7) Reproductive problems
(8) Insomnia
(9) Migraine

Question 15

What association is there between Alzheimer’s disease and epilepsy?

Answer 15

There is an increased prevalence of seizures in patients with AD

Question 16

What seizure types are there?

Answer 16

(1) Generalised
(2) Partial
(3) Secondary generalisation
(4) Simple/ complex

Question 17

What is a generalised seizure?

Answer 17

Involves entire brain

Tonic-clonic/ absence seizures

Question 18

What is a partial seizure?

Answer 18

Involves one specific area of the brain

Question 19

What is a secondary generalisation seizure?

Answer 19

Partial seizures which can spread to affect the whole brain

Question 20

What is a simple seizure?

Answer 20

A partial seizure

Unimpaired consciousness

Question 21

What is a complex seizure?

Answer 21

A partial seizure

Impaired consciousness

Question 22

How is a tonic-clonic seizure characterised?

Answer 22

Impairment of consciousness + motor activity

Question 23

How is a myoclonic seizure characterised?

Answer 23

Impairment of motor activity ONLY

Jerking of limbs

Question 24

How is an absence seizure characterised?

Answer 24

Brief periods of reduced awareness

Impairment of attention + consciousness

Question 25

How is a partial seizure characterised?

Answer 25

Depends on lobe affected Frontal/ parietal/ occipital/ temporal

Question 26

What is a grand-mal seizure?

Answer 26

Archaic name for a tonic-clonic seizure

Question 27

What is a tonic-clonic seizure?

Answer 27

(1) Rigidity for approx. 1 minute (2) Violent jerking of limbs for approx. 2-4 minutes (3) Feelings of confusion, illness, and disorientation following recovery

Question 28

What is a generalised absence seizure?

Answer 28

Occur frequently Less physically dramatic Typically stares vacantly ahead, unaware of surroundings Tends to recover quickly with no after effects

Question 29

What are partial seizures?

Answer 29

Remains restricted to a local brain area Accompanied by simple symptoms e.g. involuntary movements/ abnormal sensory experiences Rarely lose consciousness e.g. Jacksonian epilepsy, psychomotor epilepsy

Question 30

What are the main aims of pharmacological treatment of epilepsy?

Answer 30

(1) Reduce number of seizures (ideally to 0) | (2) Maximise quality of life

Question 31

What are the principle treatments for epilepsy?

Answer 31

(1) Sodium channel blockers (2) Enhancement of GABA action (3) Vagal nerve stimulation

Question 32

Why are sodium channel blockers used in treatment of epilepsy?

Answer 32

Prevention of action potential generation Inhibition prevents/ ameliorates seizures e.g. phenytoin, carbamazepine, valproate

Question 33

Why are GABA enhancers used in treatment of epilepsy?

Answer 33

Enhancement of GABA-mediated Cl- channels Increases inhibition Leads to attenuation of seizures e.g. phenobarbitone, diazepam

Question 34

What are AEDs?

Answer 34

Anti-epileptic drugs