Seizures and Epilepsy

Question 1

What is epilepsy?

Answer 1

Tendency to recurrent, unprovoked seizures

Question 2

What is a focal/partial seizure?

Answer 2

Seizure activity in only one part of the brain

Question 3

What are the two types of partial seizure?

Answer 3

Simple

Complex

Question 4

What is a generalised seizure?

Answer 4

Whole brain is involved

Question 5

Describe a simple partial seizure

Answer 5

No loss of conc

Aura experienced

Question 6

Describe a complex partial seizure

Answer 6

Sudden loss of conc, no warning

Some repetitive movements eg, lip smacking, fidgeting, chewing

Question 7

What are the 5 main types of generalised seizure?

Answer 7

Atonic
Tonic
Tonic-clonic
Absence
Myoclonic

Question 8

Describe an atonic seizure

Answer 8

Sudden, “drop attack” and complete loss of muscle tone

No post-ictal symptoms

Question 9

Describe a myoclonic seizure

Answer 9

Brief, involuntary movements

No post-ictal symptoms

Question 10

Describe an absence seizure

Answer 10

Blank appearance, “space out”

Mild post ictal confusion

Question 11

Describe a tonic seizure

Answer 11

Sudden rigidity leading to fall

Rapid recovery

Question 12

Describe a generalised tonic clonic seizure

Answer 12

Tonic phase followed by clonic phase followed by relaxation

Post ictal drowsiness, confusion, myalgia, headache

Question 13

How is epilepsy investigated?

Answer 13

MRI or CT after first seizure

EEG

Question 14

What should be ruled out before epilepsy diagnosis?

Answer 14

TIA
Migraine
Syncope
Diabetes
NEAs

Question 15

What should the patient avoid in epilepsy?

Answer 15

Drugs
Alcohol
Any other known trigger

Question 16

Give examples of drugs which inhibit voltage activated Na+ channels

Answer 16

Sodium valproate
Carbamazepine
Lamotrigine
Phenytoin

Question 17

Which anti-epileptics increase the action of voltage gated K+ channels?

Answer 17

Retigabine

Question 18

What is the mechanism of action of levetiracetam?

Answer 18

Inhibit SV2A to prevent neurotransmitter release

Synaptic vesicle glycoprotein 2A

Question 19

Which anti-epileptics work on voltage gated Ca2+ channels?

Answer 19

Pregabalin

Gabapentin

Question 20

Which anti-epileptic is known to increase GABA synthesis?

Answer 20

Sodium valproate

Question 21

Which drugs are used to treat partial seizures first line?

Answer 21

Carbamazepine

Lamotrigine

Question 22

Which drugs are used to treat absence seizures first line?

Answer 22

Sodium valproate
Ethosuximide
(Or topiramate, levetiracetam second line)

Question 23

Which drugs are used to treat myoclonic seizures?

Answer 23

Sodium val
Levetiracetam
Clonazepam
(or lamotrigine or topiramate second line)

Question 24

Which drugs are used to treat atonic, tonic and generalised TC seizures?

Answer 24

Sodium val

Second line: lamotrigine, levetiracetam, topiramate

Question 25

Which contraceptive method cannot be used with anticonvulsant use?

Answer 25

POP

COCP also less effective

Question 26

What are the main side effects of carbamazepine?

Answer 26

Dizziness
Nausea
Ataxia
Rash

Question 27

What are the side effects of sodium valproate?

Answer 27

Weight gain
Hair loss
Tremor

Question 28

What are the side effects of lamotrigine?

Answer 28

Rash

Question 29

What are the side effects of phenytoin?

Answer 29

Gingival hypertrophy
Facial coarsening
Osteoporosis
Cerebellar features

Question 30

What are the side effects of topiramide?

Answer 30

Paraesthesia
Cog impairment
Speech disturbance
Kidney stones

Question 31

What are the side effects of levetiracetam?

Answer 31

Behaviour change

Irritability