232 Epilepsy

Question 1

What is the function of the cingulate gyrus?

Answer 1

Part of the limbic system - learning, memory and emotion

Question 2

What is the septal area?

Answer 2

Considered pleasure zone in animals - reward and reinfocement Connections with the hippocampus etc - part of limbic system

Question 3

Which part of the brain is important in spatial memory and learning?

Answer 3

Hippocampus

Question 4

Which area of the brain is associated with fear and emotion?

Answer 4

Amygdala

Question 5

Name 2 personality traits associated with Geschwind syndrome (7 listed)

Answer 5

Hypergraphia Hypo sexuality Emotional viscosity/stickiness Turbulent emotions Mood swings Psychotic and quasi psychotic phenomena Hyper-religiosity

Question 6

Where in the brain is epilepsy most common?

Answer 6

Temporal lobes

Question 7

What is the difference between a simple partial seizure and complex partial seizures?

Answer 7

Complex = LOC

Question 8

What kind of seizure is characterised by lip smacking and swallowing?

Answer 8

Complex partial seizure originating from the temporal lobe.

Question 9

What are of the brain would cause a ‘jacksonian march’ epileptic seizure?

Answer 9

Frontal lobe

Question 10

What is a generalised epileptic seizure?

Answer 10

Tonic clonic seizure

Question 11

Which limbs are affected predominantly in a tonic clonic seizure?

Answer 11

Upper limbs

Question 12

Which type of epileptic seizures often begin in childhood/adolescence and show a 3 per second generalised spike and wave pattern on EEG with an immediate recovery

Answer 12

Absent

Question 13

When do myoclonic seizures normally happen?

Answer 13

In the morning

Question 14

What kind of seizures are associated with Lennox-Gastaut syndrome?

Answer 14

Atonic/tonic

Question 15

What are the 3 gold standard investigations following a seizure?

Answer 15

ECG EEG Imaging

Question 16

Name 2 causes of epilepsy in young infants (4 listed)

Answer 16

Perinatal intracranial trauma/hypoxia Congenital abnormalities Infection Metabolic disturbances

Question 17

Name 2 causes of epilepsy in adults

Answer 17

Following injury as children Brain tumours

Question 18

What is the most common cause of epilepsy in the >50s?

Answer 18

CV events

Question 19

Name 3 rarer causes of epilepsy

Answer 19

Tay Sachs Neurofibromatosis PKU Tuberous sclerosis

Question 20

Name 2 anti-epileptic drugs (4 listed)

Answer 20

Carbamazepine Sodium valproate Lamotrigine Leviteracetam

Question 21

Which AED inhibits sustained repetitive firing at Na channels? - carbamazepine - sodium valproate - lamotrigine - leviteracetam

Answer 21

Carbamazepine

Question 22

Which AED inhibits voltage gated Na channels and can cause a rash? - carbamazepine - sodium valproate - lamotrigine - leviteracetam

Answer 22

Lamotrigine

Question 23

Which AED is the most teratogenic? - carbamazepine - sodium valproate - lamotrigine - leviteracetam

Answer 23

Sodium valproate

Question 24

Which AED is thought to increase GABA as well as inhibiting Na channels? - carbamazepine - sodium valproate - lamotrigine - leviteracetam

Answer 24

Sodium valproate

Question 25

Which AED is thought to stimulate SV2A, inhibiting neurotransmitter release? - carbamazepine - sodium valproate - lamotrigine - leviteracetam

Answer 25

Leviteracetam

Question 26

What is the first line treatment for epilepsy in a woman of childbearing age with a generalised epilepsy?

Answer 26

Lamotrigine

Question 27

What is the first line treatment for a partial/focal epilepsy?

Answer 27

Carbamazepine

Question 28

Which AED can the OCP and warfarin affect?

Answer 28

Carbamazepine

Question 29

What is the initial treatment for early status epilepticus?

Answer 29

ABCs IV lorazepam

Question 30

What is the drug of choice for treatment of established status epilepticus?

Answer 30

IV phenytoin

Question 31

What is the treatment for non convulsive status epilepticus?

Answer 31

benzos

Question 32

What are roving eye movements in a coma a sign of?

Answer 32

Intact brainstem

Question 33

What could papilloedema in a comatose patient indicate?

Answer 33

Raised ICP SAH

Question 34

What does horizontal deviation of the eyes indicate? (choice of 2)

Answer 34

Ipsilateral frontal lobe damage Contralateral pontine damage

Question 35

What is the oculocephalic response?

Answer 35

Turning the head and eyes are like 'dolls eyes'...

Question 36

What is the diagnosis if the pupils are non-responsive to light?

Answer 36

Large brainstem lesion

Question 37

Name 2 drugs which may make the pupils react to light despite there being a big brainstem lesion during coma (4 listed)

Answer 37

Atropine Cocaine Ecstatsy Aphetamines

Question 38

What is the most common outcome of coma other than death?

Answer 38

Minimally conscious state

Question 39

What is most likely outcome of a coma (other than death) caused by: 1. Hypoxia 2. Cerebrovascular 3. Drug OD

Answer 39

1. Persistent vegetative state 2. Persistent vegetative state 3. Good recovery

Question 40

What is the best treatment for hypoxic ischaemic encephalopathy?

Answer 40

Therapeutic hypothermia

Question 41

Name 3 signs of brainstem death

Answer 41

Absent pupil response Absent corneal response Absent vestibulo cochlear reflex Absent cough Absent motor response to pain No respiratory response to hypercapnia