Seizures and Epilepsy

Question 1

What is Epilepsy?

What is the most common cause of it?
→ What are the other causes?

What occurs internally with a seizure?

What are the different types of seizures?

Answer 1

➊ Condition affecting the brain that makes one more likely to have seizures

➋ Idiopathic - 2/3 of cases
→ • Brain damage - e.g. Stroke, Trauma, Infection
• Brain tumours
• Embryological defects
• Genetics

➌ Transient episode of abnormal electrical brain activity

➍ Focal, Generalised (Tonic-Clonic, Absence, Atonic, Myoclonic)

Question 2

Focal:
What symptoms would be indicative of the location of the seizure?

How is it managed?

Answer 2

➊ • Frontal lobe – Motor features
• Parietal lobe – Sensory features
• Temporal lobe – Strange smells, lip smacking, hallucinations
• Occipital lobe – Visual aura

➋ • 1st line – Lamotrigine or Levetiracetam
• 2nd line – Carbamazepine

Question 3

Generalised:
What occurs in the Tonic-Clonic type?
→ What may these pts also have?
→ How is it managed?

What occurs in the Absence type?
→ In who does it typically occur in?
→ How is it managed?

What occurs in the Atonic type?
→ How is it managed?

What occurs in the Myoclonic type?
→ In who does it typically occur in?
→ How is it managed?

Answer 3

➊ LOC, Tonic (stiffening) phase before Clonic (jerking) phase, Tongue biting, Incontinence, Post-ictal phase
→ Temporary weakness/paralysis - Todd’s palsy
→ Sodium Valproate or Lamotrigine/Levetiracetam (if woman of child-bearing age)

➋ Pt becomes blank, staring into space and then abruptly return back to normal - Lasts 10-20 seconds
→ Children and most stop getting it as they get older
→ Ethosuxamide (1st line)

➌ Sudden loss of muscle tone, whilst retaining consciousness
→ Sodium Valproate or Lamotrigine/Levetiracetam (if woman of child-bearing age)

➍ Sudden jerk of a limb, trunk or face
→ Children as part of juvenile myoclonic epilepsy
→ Sodium Valproate or Lamotrigine/Levetiracetam (if woman of child-bearing age)

Question 4

Investigations:
What is needed for a proper diagnosis?

Which tests need to be done?

What may be seen O/E?

Answer 4

➊ Detailed Hx is needed to identify the type of seizure through what occurred before, during and after the seizure, with a collateral hx from a witness if possible

➋ Looking for any provoking causes:
* EEG - Done after 2nd tonic-clonic seizure
* MRI Brain - Look for any structural lesions/pathologies
* Lactate - Should be raised after a true seizure
* Other - ECG, U&Es, BM, Blood/Urine cultures or Lumbar puncture if evidence of infection

➌ Tongue-biting marks, Soiled clothing

Question 5

What important piece of general advice needs to be given to the pt?

Answer 5

MUST CONTACT DVLA!

• One off seizure – Stop and reapply in 6 months
• More than one seizure – Stop and reapply in 1 yr
• Seizure following change in antiepileptic meds – Reapply if seizure was 6+ months ago or you’ve been back on the previous meds for 6 months

Question 6

Anti-Epileptic Drugs:
How does Sodium Valproate work?
→ What is its main SE?
→ What are its other SEs?

What are the SEs of Carbamazepine?

Answer 6

➊ Increases GABA activity, which decreases brain activity
→ Teratogenic (important for pregnant women)
→ Weight gain, hair loss, oedema, ataxia, tremor

➋ Agranulocytosis, Aplastic anaemia