Epilepsy

Question 1

What is the definition of a seizure?

Answer 1

The transient occurrence of signs or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.

Question 2

How many people does epilepsy affect worldwide?

Answer 2

~ 70 million people

Question 3

What is SUDEP?

Answer 3

Sudden Unexpected Death in Epilepsy

Question 4

What are the risk factors for epilepsy?

Answer 4

• Premature birth
• Complicated febrile seizures
• Brain development malformation
• Family history
• Head trauma
• Infections e.g. meningitis
• Tumours
• Cerebrovascular disease/stroke
• Dementia and neurodegenerative disorders
• Drugs and alcohol withdrawal

Question 5

What investigations are done in order to diagnose epilepsy?

Answer 5

• EEG
• Blood tests
• ECG
• Neuro-imagining
• Genetic testing
• Antibody testing
• Neuropsychological assessment

Question 6

How is epilepsy diagnosed in neonates?

Answer 6

EEG

Question 7

What are the three main groups of seizures?

Answer 7

Focal, generalised, unknown

Question 8

What are epilepsy-related deaths thought to be caused by? (3)

Answer 8

• Epileptic condition
• The antiepileptic treatment
• Co-morbidities

Question 9

What are focal seizures?

Answer 9

Increased neuronal activity originating and remaining in one hemisphere of the brain.

Question 10

What are simple focal seizures?

Answer 10

Focal seizures with no loss of consciousness.

Question 11

What are complex or focal dyscognitive seizures?

Answer 11

Focal seizures with impaired awareness.

Question 12

What are generalised seizures?

Answer 12

Increased neuronal activity which is widespread across both hemispheres of the brain.

Question 13

What 2 sub groups are generalised seizures divided into?

Answer 13

• Motor
• Non motor

Question 14

What is a tonic seizure?

Answer 14

Sustained increased muscle contraction (tense and rigid muscles)

Question 15

What is a myoclonus seizure?

Answer 15

Muscle twitching (can involve one or multiple muscle groups)

Question 16

What is an atonic seizure?

Answer 16

Muscles becoming limp.

Question 17

What is a clonic seizure?

Answer 17

Jerking rhythmic twitching movements.

Question 18

What is a tonic-clonic seizure?

Answer 18

Where the seizure starts off in the tonic phase then moves into clonic phase.

Question 19

What is an absence seizure?

Answer 19

Vacant staring, movement stops.

Question 20

What is status epilepticus?

Answer 20

A prolonged convulsive seizure lasting 5 minutes or longer, or recurrent seizures one after the other without recovery in between.

MEDICAL EMERGENCY

Question 21

What can cause status epilepticus? (4)

Answer 21

• Head injury
• Metabolic disturbance (hypoglycaemia)
• Cerebrovascular event (stroke)
• Alcohol withdrawal

Question 22

Overview of anti-epileptic treatment

Answer 22

1. Mono therapy of an AED
2. If that fails switch to another AED
3. If second AED fails, consider combination therapy

Question 23

Are regular blood tests required during anti-epileptic treatment?

Answer 23

No

Question 24

What are the possible reasons for blood tests and/or therapeutic monitoring during anti-epileptic treatment? (5)

Answer 24

• To identify non-adherence
• Investigate suspected toxicity
• Adjustment of phenytoin doses
• Managing interactions with other medications
• For specific clinical conditions e.g. organ failure or pregnancy