Condition- Epilepsy

Question 1

Define Epilepsy

Answer 1

A neurological condition characterised by recurrent seizures (paroxysmal synchronised cortical electrical discharge)

Question 2

List some non-epileptic causes of seizures

Answer 2

• Febrile seizures
• Alcohol withdrawal seizures
• Psychogenic seizures

Question 3

List some conditions which are associated with seizures

Answer 3

• Cerebral Palsy
• Mitochondrial disease
• Tuberous sclerosis

Question 4

List the two classes of seizures and state the difference

Answer 4

• FOCAL SEIZURES: focal onset seizures localised to specific cortical regions
• GENERALISED SEIZURES: seizures that affect the whole of the brain. Affects consciousness

Question 5

What are the three subcategories of focal seizures?

Answer 5

• Focal aware
• Focal impaired awareness
• Focal seizures with secondary generalisation

Question 6

List and describe the different types of generalised seizures

Answer 6

• Tonic-clonic: Stiffening of muscles (tonic) and jerking (clonic)
• Tonic-atonic: Sudden loss of muscle tone => fall
• Myoclonic: Sudden jerking of a lib
• Absence: brief pause in activity

Question 7

List some questions/ features of a history of someone with an epileptic seizure that you might need to ascertain (Before, during, after structure)

Answer 7

BEFORE:

• Triggers: lack of sleep, flickering lights, alcohol, stress (usually idiopathic)
• Aura: strange smell, taste, flashing lights, feeling in gut, deja vu

DURING:

• Duration <3mins
• Tongue biting
• Incontinence
• Jerking

AFTER:

• slow- recovery
• headache
• confusion
• myalgia

Question 8

List some presetenting symptoms of someone with a focal seizure affecting the parietal lobe

Answer 8

• Sensory disturbance
  
  • Pains
  • Tingling
  • Numbness

Question 9

List some presetenting symptoms of someone with a focal seizure affecting the temporal lobe

Answer 9

• Aura: epigastric discomfort
• Automatism: lip smacking, finger
• Hallucinations

Question 10

List some presetenting symptoms of someone with a focal seizure affecting the frontal lobe

Answer 10

• Jacksonian march
• post ictal flaccidity (todd’s palsy)
• Disinhibition (involuntary action)

Question 11

List some presetenting symptoms of someone with a focal seizure affecting the occipital lobe

Answer 11

Visual phenomena: plashing lights, spots, lines

Question 12

What is the clinical diagnostic criteria for epilepsy

Answer 12

Two or more seizures more than 24 hours apart

Question 13

Which three investigations could you conduct for someone with Epilespy

Answer 13

• EEG: to id area affected + type of seizure
• Bloods: look for prolactinaemia (occurs post-ictally), tox screen
• CT/MRI: to rule out space occupying lesion

Question 14

List the first and second line treatments for someone with Generalised seizures

Answer 14

1. Sodium Valproate
2. Lamotrigine
   
   • May also give levetiracetam/ topiramate

Question 15

List the two first line treatments for someone with Focal seizures

Answer 15

• Carbamazepine
• Lamotrigine

Question 16

When is sodium valproate contraindicated? Which medication should be given instead?

Answer 16

• Contraindicated in pregnancy =. it’s teratogenic
• Give lamotrigine instead

Question 17

List two major side effects of carbamazepine

Answer 17

• Neutropenia
• Osteoporosis

Question 18

List a major side effect of lamotrigine

Answer 18

Steven Johnson’s syndrome

Question 19

What is status epilepticus defined as?

Answer 19

Seizure lasting >5mins / repeated seizures w/o recovery

Question 20

List three triggers for status epilepticus

Answer 20

• Treatment non-adherence
• Alcohol
• OD/ toxicity

Question 21

Go through the management of Status Epilepticus

Answer 21