Epiilepsy and Seizures

Question 1

Is awareness impaired in:
Focal seizures?
Generalised seizures?

Answer 1

Focal - no impairment

Generalized - impairment

Question 2

Focal seizures can go on to progress to secondary generalised seizures - T/F?

Answer 2

TRUE

Question 3

What can the presence of aura’s help you decide?

Answer 3

Whether or not the pt is fit to drive

Question 4

Focal aware seizures (SIMPLE focal seizure) have symptoms dependent on their anatomical localisation in the brain.
What kind of symptoms would be present in the parietal lobe?

Answer 4

Sensory - tingling / numbing / pain

Question 5

where in the brain would a simple focal seizure be present if the symptoms they described:
changes in mood & behaviour
rising epigastric sensation

Answer 5

Temporal lobe

Question 6

frontal lobe seizure symptoms

Answer 6

stiffness
twitching
spasm
spreading from distal limb to face

Question 7

Complex focal seizures have impaired awareness - T/F?

Answer 7

TRUE

Question 8

where do complex focal seizures most commonly arise?

Answer 8

temporal lobe

Question 9

pathophysiology behind temporal lobe complex focal seizures

Answer 9

hippocampal sclerosis

Question 10

3 key features of complex focal/’‘partial’’ seizures

Answer 10

aura
absence (loss of consciousness)
automatism (repetitive stereotyped movement)

Question 11

what can happen after a seizure occurs

Answer 11

post-ictal confusion

Question 12

is an absence seizure focal or generalized?

Answer 12

generalised

Question 13

what happens during absence seizures

Answer 13

sudden loss of consciousness
all motor activity stopped
abrupt duration - 10 secs
pt is unaware the attack has happened and continues on as if nothing happened (no post-ictal confusion)

Question 14

EEG characteristic in absence seizure

Answer 14

3 Hz spike wave

Question 15

what are myoclonic seizures

Answer 15

brief contraction of one or more muscles resulting in a small twitch or severe jerk

Question 16

what is juvenile myoclonic epilepsy

Answer 16

brief myoclonic jerks occurring 1 hour after awakening
affects mainly shoulders + arms
12-18 y/o
generalised tonic-clonic seizures also occur months/years after onset of myoclonus

Question 17

Juvenile myoclonic epilepsy has a poor response to treatment - T/F?

Answer 17

F

complete response in 80-90% cases BUT for some lifelong therapy may be needed

Question 18

what is a clonic seizure

Answer 18

elbows, legs and head FLEX

Question 19

what group of individuals get clonic seizures

Answer 19

neonates & young kids

Question 20

what is a tonic seizure

Answer 20

brief loss of consciousness 
pt falls to ground 
EXTENSION of neck 
upturning of eyes 
back arched

Question 21

complications from tonic-clonic seizures

Answer 21

pt biting their tongue
cyanosis
incontinence

Question 22

what type of imaging can be used to help determine the type of seizures?

Answer 22

EEG (although this may show normal results)

MRI

Question 23

indications for getting an MRI for seizures

Answer 23

pt who develop epilepsy before 2 y/o

focal seizures

pt who continue to seizure despite 1st line medication

Question 24

titration of anti-epileptic drugs should start high and titrated down - T/F?

Answer 24

F

other way round

Question 25

Polytherapy is used when at least 2 drugs (used as monotherapy) have failed to control seizures

Answer 25

F | you need to use at least 3 drugs as monotherapy before you can start polytherapy

Question 26

1st line tx for tonic-clonic

Answer 26

sodium valproate

Question 27

if sodium valproate doesn't work for tonic clonic, what can be used?

Answer 27

lamotrigine

Question 28

2nd line for tonic-clonic seizures (name 2 options)

Answer 28

levetiracetam | topiramate

Question 29

can sodium valproate be used for all generalised seizures?

Answer 29

yes - 1st line for all (tonic-clonic/absence/myoclonic)

Question 30

2nd line tx for myoclonic seizure

Answer 30

levetiracetam

Question 31

what 2 drugs can be used for focal seizures?

Answer 31

lamotrigine | carbamazepine

Question 32

if a seizure is unclassified, what drugs can be used?

Answer 32

1st line - sodium valproate | 2nd line - lamotrigine & topiramate

Question 33

is toperimate ever used 1st line?

Answer 33

no - always 2nd line

Question 34

what anti-epileptic drugs work on the na+ channel?

Answer 34

carbamazepine phenytoin lamotrigine sodium valproate

Question 35

S/E of carbamazepine

Answer 35

diplopia ataxia teratogenic hyponatraemia

Question 36

when is phenytoin used for seizures?

Answer 36

as seizure prophylaxis

Question 37

S/E of phenytoin

Answer 37

``` nystagmus diplopia sedation gingival hyperplasia (gum bleeding) peripheral neuropathy ```

Question 38

what is the mechanism of the anti-epileptic drug ethosuximide

Answer 38

blocks Thalamic T-type Ca2+ channels

Question 39

when is ethosuximide used?

Answer 39

1st line in absence seizures (along with sodium valproate)

Question 40

sodium valproate is teratogenic - T/F?

Answer 40

TRUE

Question 41

what is status epilepticus

Answer 41

seizures which continue for a prolonged period (5+ mins)

Question 42

1st line community treatment for status epilepticus

Answer 42

buccal/rectal midazolam

Question 43

1st line hospital treatment for status epilepticus

Answer 43

IV lorazepam

Question 44

2nd line hospital treatment for status epilepticus

Answer 44

IV phenobarbital or phenytoin

Question 45

for cars/motorcycles: | how long do you have to stop driving if a seizure occurs when awake?

Answer 45

1 year

Question 46

if a seizure occurs when you are asleep, you can still drive - T/F?

Answer 46

TRUE | BUT only if there is no awake attack for 3 years

Question 47

if a seizure occurs when awake but doesn't affect consciousness, can you drive?

Answer 47

you can qualify for a licence if these are the only type of attack you've ever had and the first one was 12 months ago

Question 48

for buses/lorries: | if you have a one off seizure, you have to wait 10 years before you can drive again?

Answer 48

FALSE | You have to wait 5 years (you have to wait 10 if you have 2+ seizures or diagnosis of epilepsy)