Epilepsy And Blackouts

Question 1

What is epilepsy

Answer 1

Chronic disorder characterised by recurrent seizures which may vary from a brief lapse of attention or muscle jerks, to severe or prolonged convulsions

Question 2

What are the differential diagnosis of a sudden collapse

Answer 2

Vasovagal syncope
Seizure
Cardiac syncope
Cataplexy
Hypoglycaemic attacks

Question 3

What is a vasovagal syncope (faint)

Answer 3

Syncope is a sudden impairment of conscioussness with loss of tone caused by reduced blood/oxygen to the brain

Question 4

What are the provoking factors for vasovagal syncope

Answer 4

Blood
Pain
Dehydration

Question 5

What are the pre-syncopal symptoms

Answer 5

Ligh headednes
Warm
Dizziness that builds up in intensity
Loss of vision

Question 6

What is a seizure

Answer 6

Abnormal synchronous cortical dishcharges

Question 7

What can happen with a seizure

Answer 7

Post event confusion for longer than 2 minutes
Deeply bitten lateral border of the tongue
Prolonged tonic then clonic movement lasting more than 1 min
Deep cyanosis

Question 8

What are the cardiac syncope clues on a 12 lead ECG

Answer 8

Long QT interval
Prior MI
Anterior (v1-3) inversion, QRS duration on v1-3/4-6 less than 1.2
Ectopy
Bradycardia
Av conduction delay/block
Bifasciular block
Ventricular hypertrophy

Question 9

What is cataplexy

Answer 9

Attacks of postural tone and provoked by emotion

Question 10

What is the definition of an epilepsy

Answer 10

Tendency to have a spontanous recurrent seizure (2 or more seizures)

Question 11

What are the causes of epilepsy

Answer 11

Any disease of the brain:
Brain tumour
Infection
Degenerative 
Trauma
Genetic

Question 12

What are the classification of seizures

Answer 12

Partial or generalised

Question 13

What is partial seizure

Answer 13

When the seizure starts in a particular area of the brain

Question 14

What is a generalised seizure

Answer 14

When the seizure starts in both hemispheres of the brain

Question 15

What can partial seizure be further classed into

Answer 15

Simple: aware
Complex: not aware

Question 16

What can a generalised seizure be classed into

Answer 16

Tonic: muscle stiffness
Clonic: rythmic jerking
Tonic clonic: muscle stiffness then rhythmic jerking
Myoclonus: brief jerking
Absence: losing and gaining consciousness can be like
Atonic

Question 17

What are the investigations for a seizure

Answer 17

EEG

MRI

Question 18

What can a MRI show

Answer 18

Hippocampal sclerosis (scarring in the hippocampus) in the temporal lobe

Question 19

When do yout start treating seizures

Answer 19

When there is 2 spontanous seizures

Question 20

Which anti-epileptic drug has teratogenic effects

Answer 20

Valproate

Question 21

What is the mechanism of action of valproate

Answer 21

Increase in GABA and inhibits sodium channels

Question 22

What is the action of barbiturates

Answer 22

Increase in GABA

Question 23

Which seizure type is barbiturates used in

Answer 23

Partial seizure

Question 24

What is the mechanism of action of benzodiazepines

Answer 24

Increase in GABA

Question 25

When is benzodiazepine used

Answer 25

Status epilepticus

Question 26

What is the mechanism of action of carbamazepine

Answer 26

Inhhibits sodium channels

Question 27

What seizure is carbamazepine used in

Answer 27

Tonic clonic

Question 28

What is the mechanism of action of phenytoin

Answer 28

Inhibits sodium and calcium channles

Question 29

When is phenytoin used

Answer 29

Status epilepticus

Question 30

What is status epielpticus

Answer 30

Seizures that last more than 5 minutes in totl

Question 31

What are the first line drugs for status epilepticus

Answer 31

Benzodiazepine

Phenytoin

Question 32

What is the mechanism of action of valproate

Answer 32

Increase gaba

Inhibit sodium channle

Question 33

When is valproate used

Answer 33

Partial, tonic clonus and absence seizures