Introduction to epilepsy

Question 1

Epilepsy

Answer 1

Defined as recurring, unprovoked (spontaneous) seizures

Question 2

Causes of acute symptomatic seizures

Answer 2

Acute insults such as stroke, alcohol withdrawal, metabolic disturbances

Question 3

Causes of epilespy

Answer 3

Traumatic brain injury

Tumour

Stroke

Idiopathic

Alcohol

Question 4

Generalised onset

Answer 4

Electrical discharges appear to start over the whole brain at the same time

Question 5

Partial/ focal onset

Answer 5

Electrical discharge appears to start in one cortical region and then may remain localised or spread over the whole brain- secondary generalised

Question 6

Types of Idiopathic generalised seizures

Answer 6

Limited repertoire of seizures

Tonic clonic seizures (grand mal)

Absences (petit mal)

Tonic seizures

Atonic seizures

Myoclonic seizures

Question 7

Idiopathic generalised seizures

Answer 7

Onset in childhood or adolescence

Usually no focal symptoms/ signs

Often a number of seizure types cluster

Polygenic cause preseumed

Generalised spike and wave discharges on EEG

Photosensitivity may be present

Question 8

Juvenile myoclonic epilepsy

Answer 8

Commonest form of primary generalised epilepsy

3-12% all epilepsy

Juvenile onset, probably lifelong

Early morning myoclonic jerks

Photosensitive, sleep deprivation triggers

Generalised tonic clonic seizures

Occur without warning

Question 9

Tonic clonic seizures ‘grand mal’

Answer 9

Occurs without warning- risk of injury

Tonic phase

Clonic phase

Post-ictal phase

Question 10

Tonic phase

Answer 10

Continuous muscle spasm

Fall

Cyanosis

Tongue biting

Incontinence

Question 11

Clonic phase

Answer 11

Rhythmic jerking slows and gets larger in amplitude as attack ends

Question 12

Post ical (post seizure) phase

Answer 12

Coma

Drowsiness

Confusion

Headache

Muscle aching

Question 13

Absences ‘petit mal’

Answer 13

Abrupt

Short 5-20 seconds

Multiple times/ day- can lead to learning difficulties

Unresponsive, amnesia for the gap

Tone preserved

Eyelid flickering

Absences only, tend to remit in adulthood

Question 14

Partial seizures- focal onset seizures

Answer 14

Simple partial seizure- patient aware- aura

Complex partial seizure- aura/ warning with a level of reduced awareness

Can be secondary generalised- patient may experience a prior warning

Question 15

Secondary generalised tonic clonic seizures

Answer 15

Warning/ aura- epigastric rising sensation, altered smell, deja vu, fear

Cannot abort attack

Onset sudden

Duration 1-3 minutes

Fall, lose consciousness as seizure generalises

Rigidity/ convulsive jerks/ excess salivation/ excess salivation/ incontinence/ tongue bite

Question 16

Temporal lobe epilepsy symtoms

Answer 16

Hallucinations of taste/ speech/ smell/visual

Epigastric rising sensation

Pallor/ flushing/ heart rate changes

Oral lip smacking/ chewing movements

Dystonic posturing

Deja vu

Speech arrest

Fear, elation, depression, anger

Question 17

Frontal lobe seizures

Answer 17

10-30 seconds

Rapid recovery

Predominantly nocturnal

Forced head/ eye deviation

Motor activity often bizarre, thrashing

Often misdiagnosed as non-epileptic

Question 18

Parietal lobe epilepsy symptoms

Answer 18

Positive sensory symptoms

Tingling, pain

Distortion of body shape/ image

Jacksonian march of positive sensory symptoms

Question 19

Occipital lobe epilepsy symptoms

Answer 19

Typically simple visual hallucinations- balls of coloured or flashing lights

Amaurosis (blackout or whiteout) at onset

Question 20

Which patients to scan

Answer 20

Jacksonian motor or sensory seizures

Patients with focal neurological deficit

Alcohol withdrawal seizure; only scan if subdural haematoma suspected