Seizure disorders

Question 1

What can cause blackouts?

Answer 1

Circulation - Syncope (most common)
 -hypotension
-cardiogenic
Neurological
 - epilepsy
-psychogenic
-sleep disorders
-raised ICP
Metabolic disorder

Question 2

Define an epileptic seizure.

Answer 2

Paroxysmal even in which changes of behaviour, sensation or cognitive processes are caused by excessive, hypersynchronous neuronal discharges in the brain.
(lecture 21.1.18)

Question 3

Describe the symptoms and signs of an epileptic seizure.

Answer 3

30-120 seconds

1. positive ictal (during seizure) symptoms: hallucinations
2. lateral tongue bite
3. deja vu
4. negative post-ictal symptoms
5. Todd’s paralysis

Question 4

What causes an epileptic seizure?

Answer 4

There is an imbalance between the parts of the brain trying to initiate a seizure and those trying to stop it. It can be brought on during sleep because the latter parts are less active.

Question 5

How would you define a seizure in which there is unilateral movement and stiffness, which gradually changes to bilateral rhythmic convulsions?

Answer 5

Secondary generalised seizure.It starts focal (hence ‘secondary’), and as the discharges decrease in amplitude and the seizure spreads across the corpus collosum, the stiffness becomes bilateral rhythmic jerking.
(lecture - video)

Question 6

What does a temporal lobe focal seizure look like?

Answer 6

Deja vu, dysphasia, automatisms, fear, derealisation, olfactory/ gustatory hallucinations.

Question 7

What does a frontal lobe focal seizure look like?

Answer 7

Motor, dysphasia.

Question 8

What does syncope look like?

Answer 8

5-30 seconds

• vasovagal - when it is hot, occurs from sitting or standing
• cardiogenic - less warning, history of heart disease.
• presyncopal symptoms
• swift recovery and re-orientation compared to seizures.

Question 9

What does a parietal lobe focal seizure look like?

Answer 9

Numbness, tingling, pins and needles.

Question 10

Describe the characteristic features of a non-epileptic/ dissociative seizure.

Answer 10

Situational
1-20 minutes
Eyes closed
Dramatic motor phenomena, prolonged atonia
Ictal crying and speaking
Slower post-ictal recovery
Associated with psychiatric illness and somatoform disorders.

Question 11

Describe the management of focal epilepsy.

Answer 11

Correct diagnosis is essential for effective treatment - eg carbamazepine worsens myoclonic seizures but helps focal epilepsy.
Lamotrigine
Carbamazepine

Question 12

Describe the management of generalised/ tonic-clonic epilepsy.

Answer 12

Lamotrigine, 
Sodium valproate (teratogenic - beware pregnancy)

Question 13

Give 3 consequences of misdiagnosed epilepsy.

Answer 13

Treatment with anticonvulsants
Stopped from driving
Actual problem not treated, diagnosis delayed.

Question 14

Describe the management of myoclonic seizures.

Answer 14

Levetiracetam

Valproate

Question 15

Define focal epilepsy.

Answer 15

Common type of epilepsy associated with focal brain abnormality. It may start at any age and can be simple (with awareness) or complex (loss of awareness). Can spread to become a secondary generalised seizure.

Question 16

Define genetic generalised epilepsy.

Answer 16

Common type of epilepsy, usually affecting under 30s. Includes myoclonic, absence or primary generalised tonic-clonic.
(lecture)

Question 17

What is a myoclonic seizure?

Answer 17

A type of genetic generalised epilepsy.

Question 18

Describe the management of a non-epileptic attack.

Answer 18

Parents: rectal benzodiazepine or buccal midazolam to prevent an attack.
Ambulance: lorazepam
ABCDE
Hospital: IV phenobarbital or phenytoin; anaesthesia.

Question 19

How does lamotrigine work and what can it be used to treat?

Answer 19

Sodium channel inhibitor in the presynaptic neurone, decreasing firing rate. Can treat focal and generalised epilepsy.

Question 20

How does levetiracetam work and what can it be used to treat?

Answer 20

Inibits neurotransmitter release from synaptic vesicles. Used to treat myoclonic seizures.

Question 21

What is refractory epilepsy and how is it treated?

Answer 21

Seizures persist despite treatment, especially temporal lobe epilepsy. Often monotherapy (lowest possible dose) used to reduce side-effects. Temporal lobectomy works for some patients with hippocampal sclerosis.

Question 22

When would vagal nerve stimulation be used?

Answer 22

28% mean seizure reduction, used for palliative treatment.

Question 23

What investigations would you do if you suspect epilepsy?

Answer 23

MRI if focal or considering surgery.
CT if secondary to injury
EEG
ECG
Glucose, U&E, LFT, calcium - exclude metabolic causes.

Question 24

What are absence seizures and how are they treated?

Answer 24

Short seizures with staring spells.

Treatment: Valproate, ethosuximide.