25 Epilepsy

Question 1

What are the 3 main types of epilepsy?

Answer 1

1. Partial seizures
2. Generalised seizures
3. Status epilepticus

Question 2

Outline the ‘partial seizures’ type of epilepsy?

Answer 2

Patient retains conciousness (but can be impaired)

Symptoms include:

1. Involuntary muscle disturbances
2. Auras
3. Behavioural changes

Question 3

Outline the ‘generalised seizures’ type of epilepsy?

Answer 3

Electrical charge changes across both hemipheres of brain

Loss of conciousness

Types include:

1. Tonic-clonic
2. Absence

Question 4

What is status epilepticus? Why is it a medical emergency? What do you need to be mindful of?

Answer 4

CAN OCCUR WITH ANY TYPE OF EPILEPSY Seizures= prolonged (>5 mins) or repeated without recovery intervals

Medical emergency- brain uses up all resources and hypoxia occurs

Be mindful:

1. Can lead to death/death months later due to effects on the brain
2. Rhabdomyolysis- muscle contractions could lead to AKI

Question 5

What is epilepsy?

Answer 5

Discharge of abnormal electrical activity in brain leading to a seizure.

(Diagnosis requires recurrent seizure activities)

Question 6

What causes epilepsy?

Answer 6

Mostly idiopathic

Secondary causes (most commonly seen in elderly):

• Vascular disease
• Tumours

Question 7

What can precipitate an epileptic fit?

Answer 7

Flashing lights

Brain injury

Drugs and alcohol

Sugar levels

Drugs

Question 8

Anti-epileptic drugs are teratogenic.

Which one is the safest to use in pregnancy?

Which one can specifically cause neural tube defects?(What can be given to reduce these risks)

What should be given as a supplement in the third trimestre (if mother on antiepileptics)?

Answer 8

Safest in pregnancy:

• Lamotrigine

Neural tube defects:

• Valproate (give folate supplement)

Give Vitamin K supplement

• Anti-epileptic drugs associated with Vitamin K deficiency in new borns- coagulopathy and haemorrhage

Question 9

What should we give first line in each case?:

Partial seizure

Generalised seizure

Status epilepticus

Answer 9

Partial seizure

Carbamazapine

Generalised seizure

Valproate (switch to another drug if this fails)

Status epilepticus

1. Benzodiazepine by i.v.
2. If at home: diazepam (rectal or buccal)
3. Up dosage
4. Give phenytoin infusion
5. Induce coma