Seizures, Blackouts And Epilepsy

Question 1

Remember to always ask about occupation and driving status.

Answer 1

…

Question 2

What is the definition of syncope?

Answer 2

Reflex bradycardia with or without peripheral vasodilatation.

Question 3

Reflex anoxic is a type of syncope, what is it?

Answer 3

It is seen when young children hold their breath, causing them to fit and faint.

Question 4

What is a stokes Adams attack?

Answer 4

Transient arrhythmias causing reduced cardiac output and loss of consciousness.

Pre-attack: palpitations.

Attack: fall to the ground with LOC, pallor and slow or absent pulses.

Recovery: within seconds and associated with flushing.

Question 5

Who do drop attacks usually present in and what are the features?

Answer 5

Sudden weakness in the legs not associated with and warning. No associated confusion.

Most often seen in elderly women.

Question 6

Definition of epilepsy?

Answer 6

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

Question 7

List a few examples of aura in epilepsy?

Answer 7

Deja vu
Flashing lights (visual changes)
Funny tastes and smell (gustatory and olfactory)
Strange feeling in the gut.

Question 8

How long does a seizure usually last?

Answer 8

Usually lasts less than 5 minutes. Patient becomes unresponsive and commonly associated with tongue biting and urinary incontinence.

Question 9

Temporary weakness in the post ictal phase is known as what?

Answer 9

Todd’s palsy. (Focal weakness)

Question 10

Simple partial seizure?

Complex partial seizure?

Answer 10

Simple = without impaired consciousness
Complex = with impaired consciousness

Question 11

What is a Jacksonian seizure?

Answer 11

Usually frontal lobe, partial seizure in which there are twitching movements of the upper limb that spread to the face and lower limb.

Commonly associated with Todd’s palsy.

Typically cause no change in awareness or alertness.

Question 12

What is an absence seizure and how does it appear on EEG?

Answer 12

Brief lapses of awareness in which patient stops what they are doing and stares blankly.

EEG: Spike and wave at 3Hz.

Question 13

What is a myoclonic seizure and how does it show up on EEG?

Answer 13

Seizure than manifests and clonic like jerks without the tonic contraction.

e..g juvenile myoclonic epilepsy; usually seen around puberty and associated with early morning myoclonic seizures. Most patients go on to develop tonic clonic.

EEG: photosensitive poly spike and wave.

Question 14

What is an atonic seizure?

Answer 14

Seizures that manifest as sudden loss of all muscle tone with maintenance of consciousness which differentiates it from narcolepsy.

Question 15

Diagnosis of epilepsy?

Answer 15

Largely clinical diagnosis.
CT/MRI to identify potential structural abnormality.
EEG:
- To classify epilepsy
- Confirm non-epileptic attack’s
- Evaluate patients being considered for surgery.
- To confirm non convulsive status epileptics.

Question 16

What is the management of focal epilepsy?

Answer 16

1) Carbamazepine

2) Lamtoragine, valproate, topiramate.

Question 17

What is the first line drug used for generalised seizures?

Answer 17

Sodium valproate.

Not suitable for younger women because of teratogenicity.

Question 18

Side effects of sodium valproate?

Answer 18

Nausea, tremor, ataxia, pancreatitis, thrombocytopenia, liver failure, encephalopathy.
Reversible hair loss.

Question 19

Lamotrogine: Facts and side effects

Answer 19

Generally well tolerated and can be used in both generalised and focal seizures but main issue is it takes several months to titrate to effect.

Side effects: maculpaupular rash, Steven Johnson syndrome, Disseminated intravasuclar coagulation, Diplopoda and photosensitivity.

Question 20

3 main side effects of topiramate?

Answer 20

Sedation
Dysphasia
Weight loss

Question 21

Carbamazepine, when is it used and side effects?

Answer 21

Not use in generalised epilepsy as it may make seizures worse.

Leukopenia, drowsiness, double or blurred vision, impaired balance.

Question 22

What is SUDEP?

Answer 22

Sudden unexplained death in epilepsy

Risk is increased if epilepsy is poor controlled, patient smokes, drinks and uses illicit drugs.

Question 23

Driving and epilepsy:

Answer 23

1st seizure: cannot drive for 6 months or HGV for 5 years.

If have a seizure: no driving for 12 months.

• If medication changed/withdrawn in last 6 months then do not drive for 12 months.
• Need to be off medication for 10 years and seizure free to drive HGV.

Question 24

Definition of status epilepticus

Answer 24

Seizure that has lasted for more than 5 minutes.
Multiple seizures within 30minutes.
Second seizurethat occurs before full neurological recovery from the first.

Question 25

Management of status epilepticus?

Answer 25

ABCDE

1st line = IV lorazepam (2-4mg) (maximum doses = 2). (Usually a 4mg bonus repeated once after 10-20minutes)

2nd line = Phenytoin (15-18mg/kg) at rate of 50mg/minute

3rd line -= general anaethesia e.g. propofol or midazolam

Question 26

What is non-epileptic attack disorder?

Answer 26

Functional seizures that are largely mediated at the subconscious level and have a strong correlation with past trauma, especially childhood sexual abuse.

Question 27

Presentation of non epileptic attack disorder?

Answer 27

Excessively long seizures; 10-20minutes.
Coordinated, symmetrical, florid convulsions with large movements.
Maintenance of normal breathing.
No associated tongue biting or incontinence.
Made worse by used of anticonvulsants.

Management = counselling and psychological therapies.