seizures

Question 1

what is syncope?

Answer 1

reflex bradycardia with or without peripheral vasodilation

Question 2

what are pre syncope symptoms?

Answer 2

light headedness, dizziness, sweating, nausea, pallor, tachycardia

Question 3

what can cause syncope?

Answer 3

vasovagal - can only occur when standing up

Question 4

what can provoke vasovagal syncope?

Answer 4

emotion
fear
pain
standing too long

Question 5

what are strokes Adams attacks?

Answer 5

transient arrhythmias causing reduced cardiac output and loss of consciousness

Question 6

what occurs pre attack in a stroke Adams?

Answer 6

palpitations

Question 7

what happens during an attack in stroke Adams?

Answer 7

fall to ground with LOC
pallor
slow or absent pulses

Question 8

what is the recovery like in stroke adams?

Answer 8

within seconds

associated with flushing

Question 9

what can cause a drop attack?

Answer 9

cataplexy - associated with narcolepsy

Question 10

what is the attack like in a drop attack?

Answer 10

sudden weakness in legs with no warning symptoms

LOC

Question 11

what is epilepsy?

Answer 11

recurrent tendency to spontaneous, intermittent, abnormal electrical activity in brain that manifests as convulsions or abnormal behaviour

Question 12

what causes epilepsy?

Answer 12

too much excitation - glutamate
OR
not enough inhibition - GABA

Question 13

how many events needs to have taken place for a diagnosis of epilepsy?

Answer 13

2

Question 14

what can cause epilepsy?

Answer 14

idiopathic

structural abnormalities - SOL, stroke

Question 15

what is aura? what are examples of it?

Answer 15

individualised symptoms that proceed the seizure by minutes

• deja vu
• flashing lights
• funny tastes or smells
• strange feeling in gut

Question 16

what happens during an epilepsy seizure?

Answer 16

period when patient losses awareness and becomes unresponsive
lasts less than 5 mins
associated with tongue biting and urinary incontinence

Question 17

what happens post ictal epilepsy seizure?

Answer 17

slow recovery that is often associated with confusion, headache, muscle ache, temporary weakness

Question 18

what is the temporary weakness after an epileptic seizure called?

Answer 18

Todd’s palsy

Question 19

what are focal epileptic seizures?

Answer 19

increased activity in only one hemisphere

Question 20

what are simple focal epileptic seizures?

Answer 20

localised symptoms
no loss of awareness
no post ictal symptoms

Question 21

what are complex focal epileptic seizures?

Answer 21

localised symptoms with
aura
LOC
post ictal symptoms

Question 22

what are focal epileptic seizures with secondary generalisation?

Answer 22

localised symptoms that

proceed to generalised seizures

Question 23

in focal seizures in the temporal lobe, what symptoms would you experience?

Answer 23

dysphasia 
deja vu
flashback 
odd tastes or smells 
visual and auditory hallucinations 
lip smacking

Question 24

in focal seizures in the frontal lobe, what symptoms would you experience?

Answer 24

posturing movements
head and leg movements
Jacksonian seizure

Question 25

what is Jacksonian seizure? what is it associated with?

Answer 25

twitching movement of the upper limbs that spread to face and lower limbs Todd's palsy

Question 26

in focal seizures in the parietal lobe, what symptoms would you experience?

Answer 26

numbness (sensory disturbance)

Question 27

in focal seizures, in the occipital lobe, what symptoms would you experience?

Answer 27

lines and flashes (visual disturbance)

Question 28

what are generalised seizures?

Answer 28

epileptic seizures that occur due to simultaneous abnormal activity in multiple parts of the brain

Question 29

is there LOC in generalised seizures?

Answer 29

LOC occurs immediately

Question 30

what can trigger generalised seizures?

Answer 30

flashing lights | sleep deprivation

Question 31

what happens during the tonic phase of tonic colonic seizures?

Answer 31

patients falls to the ground and becomes rigid and cyanosed as they stop breathing

Question 32

during which phase would tongue biting and incontinence occur in a tonic-colonic seizure?

Answer 32

tonic phase

Question 33

what it the colonic phase in a tonic-colonic seizure?

Answer 33

asymmetrical convulsive jerks eyes roll into back of head start breathing again

Question 34

what are absence seizures?

Answer 34

brief lapses in awareness | patient stops what they are doing and stares blankly

Question 35

are people aware they are having an absence seizure?

Answer 35

no but they recover quickly

Question 36

what is seen on an EEG in an absence seizure?

Answer 36

spike and wave at 3Hz

Question 37

what are myoclonic seizures?

Answer 37

colonic like jerks without the tonic contraction

Question 38

what are atonic seizures?

Answer 38

sudden loss of all muscle tone with maintenance of consciousness

Question 39

how do you diagnose epilepsy?

Answer 39

clinical diagnosis

Question 40

what other investigation can be done for epilepsy?

Answer 40

CT/MRI - rule out structural abnormality | EEG - confirm non epileptic attacks

Question 41

when would you start an anti-epileptic?

Answer 41

after 2nd seizure

Question 42

what is first line treatment in absence seizures?

Answer 42

valproate | ethosuximide

Question 43

what is first line treatment in myoclonic seizures?

Answer 43

valproate

Question 44

what is second line treatment in myoclonic seizures?

Answer 44

lamotrigine | clonazepam

Question 45

what is first line treatment in atonic/tonic colonic seizures?

Answer 45

valproate

Question 46

what is second line treatment in atonic/tonic colonic seizures?

Answer 46

lamotrigine | carbamazepine

Question 47

what is first line treatment in focal seizures?

Answer 47

carbamazepine

Question 48

how does sodium valproate work?

Answer 48

increases GABA activity

Question 49

who is sodium valproate not suitable for?

Answer 49

young woman - teratogenic

Question 50

what are the side effects of sodium valproate?

Answer 50

``` teratogenicity nausea vomiting tremor weight gain liver failure ```

Question 51

what is the main issue with lamotrigine?

Answer 51

taken several months to titrate to effect

Question 52

what are the side effects of lamotrigine?

Answer 52

steven johnson syndrome maculo-papular rash disseminated intravascular coagulation (DIC)

Question 53

is topiramate well tolerated?

Answer 53

no | causes mediation, dysphasia, weight loss

Question 54

can carbamazepine be used in generalised epilepsy?

Answer 54

no | will make seizures worse

Question 55

what are the side effects of carbamazepine?

Answer 55

``` leucopenia drowsiness double or blurred vision impaired balance P450 inducer ```

Question 56

what is SUDEP?

Answer 56

sudden unexplained death in epilepsy

Question 57

what increases your risk of SUDEP?

Answer 57

poorly controlled | patient smokes, drinks, uses illicit drugs

Question 58

how long after your first seizure are people not allowed to drive for?

Answer 58

car - 6 months | HGV - 5 years

Question 59

with a diagnosis of epilepsy with seizures, how long can you not drive for?

Answer 59

12 months

Question 60

with a diagnosis of epilepsy, if you have changed medication how long can you not drive for?

Answer 60

6 months

Question 61

what affect does valproate have on contraception?

Answer 61

reduces efficacy avoid progesterone only COCP reduced larger dose of morning after pill

Question 62

how can risk of congenital abnormalities from anti-convulsants be reduced?

Answer 62

folate 5mg daily during first trimester

Question 63

are anti-convulsants safe during breast feeding?

Answer 63

they pass into the breast milk and advice needs to be given | usually all safe to use

Question 64

what is status epileptics?

Answer 64

seizures lasting more than 5 mins multiple seizures in 30 mins second seizure before recovery from first

Question 65

what are triggers for status epileptics?

Answer 65

``` infection head injury eclampsia abrupt withdrawal of anti-convulsants metabolic upset - hypoglycemic/natremic ```

Question 66

what is the management for status epileptics?

Answer 66

ABCDE 1st line IV lorazepam 2nd line phenytoin 3rd line general anaesthetic

Question 67

what is non-epileptic attack disorder?

Answer 67

functional seizures at a subconscious level | strong association with past trauma - childhood sexual absue

Question 68

what is the presentation of non-epileptic attack disorder?

Answer 68

long lasting 10-20 mins coordinated, symmetrical, large movements maintain normal breathing and awareness no tongue biting or incontinence

Question 69

what makes non-epileptic attack disorder worse?

Answer 69

anti-convulsants