Epilepsy

Question 1

Generalised tonic-clonic seizures

Answer 1

LOC and tonic (muscle tensing) and clonic (jerking) episodes

Prolonged post-ictal period

Management:
- first-line: sodium valproate
- second line: lamotrigine or carbamazepine

Question 2

Focal seizures

Answer 2

Start in temporal lobes

Hallucinations, memory flashbacks, deja vu, doing strange things on autopilot

Management
- first-line: lamotrigine or carbamazepine
- second line: sodium valproate

Question 3

Absence seizures

Answer 3

Blank, stare into space then abruptly return to normal

Typically last 10-20seconds

First line: sodium valproate or ethosuximide

Question 4

Atonic seizures

Answer 4

Drop attacks

Brief lapses in muscle tone, don’t usually last more than 3 minutes

Management
- first line: sodium valproate
- second line: lamotrigine

Question 5

Myoclonic seizures

Answer 5

Sudden brief muscle contracts

Management
- first line: sodium valproate
- second line: lamotrigine, levetiracetam, toprimate

Question 6

Infantile spasms

Answer 6

West syndrome

Cluster of full body spasms

1/3 die by 25, 1/3 seizure free

First line: prednisolone, vigabatrin

Question 7

Febrile convulsions

Answer 7

Typically age 6m to 5y

Usually occur early in viral infections

Typically brief and generalised tonic/ tonic-clonic

Question 8

Alcohol withdrawal seizures

Answer 8

Chronic alcohol enhances GABA and inhibits NMDA type glutamate receptors

Alcohol withdrawal does the opposite

Peak incidence is 36 hours after cessation

Often given benzos to reduce risk

Question 9

Psychogenic non-epileptic seizures

Answer 9

Epileptic-like siezures with no characteristic electrical discharges

May have history of mental health problems or personality disorder

Question 10

Sodium valproate side effects

Answer 10

Increased appetite and weight gain

Alopecia

P450 enzyme inhibitor

Ataxia

Tremor

Hepatitis

Pancreatitis

Thrombocytopeania

Teratogenic

Question 11

Carbamazepine side effects

Answer 11

P450 enzyme inducer

Dizziness and ataxia

Drowsiness

Leucopenia and agranulocytosis

SIADH

Visual disturbances

Question 12

Lamotrigine side effects

Answer 12

Steven-Johnson syndrome

Question 13

Phenytoin side effects

Answer 13

P450 enzyme inducer

DIzziness and ataxia

Gingival hyperplasia, hirsutism, coarsening of facial features

Megaloblastic anaemia

Peripheral neuropathy

Enhanced vitamin D metabolism causing osteomalacia

Lymphadenopathy

Question 14

Status epilepticus management

Answer 14

ABCDE

Secure airway

Give high-conc oxygen

Check blood glucose

Gain IV access

IV lorazepam 4mg, repeated after 10 minutes of seizure continues

If seizure persists IV phenobarbitural or phenytoin

Question 15

Status epilepticus medical management in the community

Answer 15

Buccal midazolam

Rectal diazepam