seizures

Question 1

investigations in someone having a seizure

Answer 1

vital signs: o2, finger prick glucose
ECG - performed on anyone with LOC
neurological exam
bloods - acute metabolic disturbances e.g. hyponatremia and hypocalcemia can give rise to seizures
CT - if abnormal findings on neurological exam, rarely needed
EEG - rarely used, diagnosis of seizure is made clinically
MRI - structural abnormalities suggestion of focal onset on history, examination or EEG seizures

Question 2

causes/ RF of epilepsy

Answer 2

birth history - premature, difficult delivery, postnatal difficulties
childhood milestones or developmental delay
seizures in childhood/infancy
significant head injuries
any history of CNS infection: meningitis, encephalitis, abscess
FH
medications - some lower seizure threshold
recreational drugs/alcohol

Question 3

diagnosis of epilepsy

Answer 3

detailed history needed

based on description of attack and different symptoms

Question 4

when choosing an anti epileptic drug, consider:

Answer 4

interaction with pill - all except progesterone only pill
tetragenicty
drug interactions including warfarin
side effects

Question 5

temporal lobe seizures signs

Answer 5

memory disturbance e.g. deja vu
olfactory and auditory hallucinations
feeling of a rising epigastric sensation
fear
bizarre psychic phenomena: delirium and depersonalisation, even attacks of elation
automatism: lip smacking, repetitive mumbling or repetition of a stereotypical phrase

Question 6

generalised tonic seizure signs

Answer 6

well until lost consciousness, no warning to the loss of consciousness
can’t remember anything after until in ambulance
aching all over, painful tongue on one side
no incontinence
briefly stared blankly then fell stiffly to the floor
stiffened further, violent rhythmic shaking of limbs, lasts around 5 mins
blue lips and rigid jaw
confused, disorientated and agitated for 15 mins following seizure

Question 7

complete and simple partial seizure

Answer 7

partial seizure = focal onset, with features referable to a part of one hemisphere

simple = awareness isn’t impaired, no post-ictal symptoms

complex = awareness is impaired, may have aura or

Question 8

primary general seizures

Answer 8

simultaneous onset of electrical discharge throughout cortex, with no localising features referable to only one hemisphere

Question 9

absence seizures

Answer 9

brief <10 seconds pauses, e.g. suddenly stops mid sentence and then carries on where they left off
present in childhood

Question 10

tonic-clonic seizures

Answer 10

LOC
limbs stiffen (tonic), then jerk (clonic)
may have one without the other
post-itcal confusion and drowsiness

Question 11

myoclonic seizures

Answer 11

sudden jerk of a limb, face or trunk

patient may be thrown to the ground suddenly or have a violent disobedient limb

Question 12

first line AED for generalised tonic-clonic

Answer 12

carbamazepine
lamotrigine
oxcarbazepine
sodium valproate

Question 13

first line AED for tonic or atonic seizure

Answer 13

sodium valproate

Question 14

first line AED for absence seizure

Answer 14

exthosuximide
lamotrigine
sodium valproate

Question 15

first line AED for myoclonic seizure

Answer 15

levetiracetam
sodium valproate
topiramate

Question 16

first line AED for focal or partial seizure

Answer 16

carbamazepine
lamotrigine 
levetiracetam
oxcarbazepine
sodium valproate