Seizure and Epilepsy

Question 1

What is epilepsy?

Answer 1

Recurring and spontaneous seizures affecting 1 in 100-200 people

Question 2

What are primary generalizes onset seizures?

Answer 2

Electrical discharges appear to start over the whole brain at the same time without a warning

Question 3

What are secondary generalized seizures?

Answer 3

Electrical discharges start in one area and then either remain localised or spread over the whole brain. There is a warning

Question 4

What are idiopathic generalized seizures?

Answer 4

Onset is in childhood or adolescence
Usually no focal symptoms/signs
Polygenic cause
Provoked by sleep deprivation

Question 5

What is Juvenile myoclonic Epilepsy (JME)?

Answer 5

The most common form of generalised epilepsy

It has juvenile onset
Can be with or without absences
Photosensitive and triggered by sleep deprivation

Question 6

What are generalised tonic clonic seizures?

Answer 6

Sudden onset, without warning in primary generalised epilepsy

Question 7

What are the stages in a tonic, clonic seizure?

Answer 7

Tonic phase: continuous muscles spasm, fall, cyanosis, tongue biting, incontinence

Clonic phase: Rhythmic jerking slows and gets larger in amplitude as attack ends (lasts 1-3 minutes)

Post-ictal stage: Coma, drowsiness, confusion, headache, muscle aching, memory loss

Question 8

What is a grand mal seizure also known as?

Answer 8

A generalised tonic clonic seizure

Question 9

What is a petite mal?

Answer 9

An absence lasting 5-20 seconds

It happens multiple times a day
Tone is preserved
Person is unresponsive and looses memory for that interval

Question 10

What is a simple partial seizure?

Answer 10

The patient is aware because there is an aura

Now called a focal seizure with awareness

Question 11

What is a complex partial seizure?

Answer 11

An aura with a level of reduced awareness

Now called a focal seizure with reduced awareness

Question 12

Where do partial seizures most commonly occur?

Answer 12

In the temporal lobe (70%) and frontal (25%)`

Question 13

Why are deep sited seizures often missed?

Answer 13

Because the EEG measures extracellular activity and it’s hard with a deep seizure

Question 14

What are some causes of temporal lobe seizures?

Answer 14

Hippocampal sclerosis (50%)
Tumour (18%)
Birth hypoxia (10%)
Post traumatic (8%)

Question 15

What are some signs and symptoms of temporal lobe epilepsy?

Answer 15

• Hallucinations of taste, speech and smell
• Pallor, flushing, heart rate changes
• Automatisms likes semi-purposeful limb movements and lip smacking

Question 16

What are some signs and symptoms of a frontal lobe seizure?

Answer 16

Forced head
Eye deviation to the contralateral side
Jacksonian spread with Todd’s paresis

Question 17

What is a Jacksonian March?

Answer 17

A type of focal partial seizure

Question 18

What is Todd’s paresis

Answer 18

A paralysis that follows a seizure

Question 19

What are some symptoms of parietal lobe seizures?

Answer 19

Positive sensory symptoms
Tingling/pain
Distortion of body shape/image
Jacksonian march

Question 20

What are some symptoms of occipital lobe seizures?

Answer 20

• Typically simple visual hallucination like calls of coloured or flashing lights
• Amaurosis (blackout or whiteout) at onset

Question 21

What is the difference between a blackout and a whiteout?

Answer 21

Blackout- loss of memory

Whiteout- fainting

Question 22

What is the definition of epileptogenesis?

Answer 22

The process by which parts of a normal brain are converted into hyperexcitable brain

Question 23

Which channelopathies are associated with epilepsy?

Answer 23

• Na+ channel inactivation is too slow in excitatory neurones. Caused by a Na+ channel mutation and causes impaired action potential repolarization
• Reduced number of functional Na+ channels in inhibitory neurones. Causes impaired action potential generation
• Reduced number of K+ channels in excitatory neurones. Causes impaired action potential repolarisation

Question 24

What do anti-epileptic drugs (AED’s) do?

Answer 24

They prevent the spread of a seizure of epileptic discharges so that the seizure is more controlled

They don’t prevent seizures

Question 25

How does the drug Perampanel work?

Answer 25

It’s a non-competitive inhibitor of AMPA glutamate receptors. Release of glutamate cannot overcome the block

It reduces spread of seizure but can also affect mood and behaviour

Question 26

How does the drug Levetiracetam work?

Answer 26

It’s a high affinity synaptic vesicle protein-2A ligand that helps modulate glutamate neurotransmitter release

It can cause low mood and agitation. It has no drug interactions

Question 27

Which drugs are first line treatments for primary generalized epilepsy?

Answer 27

Sodium Valproate or Lamotrigine

Question 28

Which drugs are first line treatments for partial focal onset epilepsy?

Answer 28

Carbamazepine or Lamotrigine

Question 29

Which anti-epileptic drugs exacerbate generalised seizures like myoclonus or absences?

Answer 29

Phenytoin
Carbamazepine
Gabapentin/Pregabalin

Question 30

What are some symptoms of using benzodiazepines for epilepsy?

Answer 30

Dose related: Drowsiness, ataxia, hyperactivity, cognitive impairment

Long term: Tolerance/ Dependence

Question 31

What are some symptoms of using Phenytoin for epilepsy?

Answer 31

Dose related: Ataxia, Diplopia, Nystagmus

Long term: Gingival hyperplasia, Osteomalacia, Cerebellar atrophy

Question 32

What are some symptoms of using Sodium Valproate for epilepsy?

Answer 32

Dose related: Sedation, Tremor

Long term: Hair thinning, weight gain, menstrual irregularities, encephalopathy, Parkinsonism

Question 33

What is the teratogenicity of Sodium Valproate?

Answer 33

30% impaired cognitive development
Reduced infant IQ
Higher rate of congenital malformations

More common in mothers with intellectual disability