Epilepsy

Question 1

How can syncope and epilepsy be differentiated?

Answer 1

In syncope, recovery is rapid.

In seizure, recovery takes minutes-hours.

Question 2

Is examination useful in seizure?

Answer 2

No, only useful in ruling out syncope.

History is crucial.

Question 3

What test should be performed in any individual reporting a collapse?

Answer 3

ECG - regardless of clinical suspicion.

Question 4

Which arrhythmia commonly presents with collapse?

Answer 4

Prolonged QT syndrome

Question 5

How long must a patient avoid driving for after a seizure?

Answer 5

6 months

If HGV driver, this is 5 years.

Question 6

If a patient is diagnosed with epilepsy, how long are they unable to drive for?

Answer 6

Must be seizure-free for a year.

If HGV driver, 10 years seizure-free plus on no treatment during this.

Question 7

What factors can precipitate a seizure?

Answer 7

Head injury

Hypoglycaemia

Question 8

If seizure occurs in the context of a causative factor is it epilepsy?

Answer 8

No, epilepsy is diagnosed in seizures occurring in the absence of any other causative factor.

Question 9

What occurs in the brain during an epileptic seizure?

Answer 9

Spontaneous discharge of electrical activity disturbing normal brain activity.

Question 10

What is SUDEP?

Answer 10

A term used to describe sudden death in those with epilepsy.

An umbrella term.

Question 11

In focal epilepsy, the specific area of the brain affected (and which displays symptoms) is called what?

Answer 11

The seizure focus.

Question 12

What are the networks called that connect the different brain regions?

Answer 12

Cortical networks.

Question 13

What type of seizure can arise from focal epilepsy?

Answer 13

Focal seizures

Generalised seizures (if affecting the cortical networks)

Question 14

What type of seizure can arise from generalised epilepsy?

Answer 14

Generalised seizures

Question 15

What is epilepsy?

Answer 15

The tendency to have recurring seizures.

Question 16

What is a seizure where there is LOC called?

Answer 16

Disconscious epilepsy

Question 17

A focal seizure, producing motor symptoms, suggests which lobe is affected?

Answer 17

Frontal lobe

Question 18

A focal seizure, producing sensory symptoms, suggests which lobe is affected?

Answer 18

Parietal lobe

Question 19

A focal seizure, producing psychic symptoms, suggests which lobe is affected?

Answer 19

Temporal lobe

Question 20

Can focal seizures generalise?

Answer 20

Yes, if they spread to the cortical network.

Question 21

If a focal seizure generalises, which forms result?

Answer 21

Tonic

Tonic clonic

Question 22

What are the forms of generalised seiziure?

Answer 22

Absence
Myoclonic
Atonic
Tonic
Tonic clonic

Question 23

Which age group are affected by generalised seizures?

Answer 23

Young people

Thought to carry a genetic risk.

Question 24

Which age group are affected by focal seizures?

Answer 24

The elderly

Due to a structural abnormality.

Question 25

How is a primary generalised epilepsy treated?

Answer 25

Sodium valproate If female and of child-bearing age, give lamotrigine (as sodium valproate is teratogenic).

Question 26

How is focal epilepsy treated?

Answer 26

Lamotrigine (or carbamazepine). Gabapentin is 2nd line.

Question 27

In which situation is phenytoin used?

Answer 27

Acute management only as high dose can be given rapidly. Causes hirsutism and gingival hyperplasia when used long-term.

Question 28

What are side-effects of sodium valproate?

Answer 28

Weight gain Hair loss Teratogenicity

Question 29

What is the main issue with carbamazepine therapy?

Answer 29

Causes severe dizziness.

Question 30

Is carbamazepine suitable in generalised epilepsy?

Answer 30

No, it worsens epilepsy in these patients. Only suitable in focal epilepsy.

Question 31

Do anti-convulsants work alongside contraception?

Answer 31

No, they reduce effectiveness. Avoid anti-convulsants where possible as they have many drug interactions.

Question 32

What is status epilepticus?

Answer 32

A state of recurrent epileptic seizures where there is no full recovery of consciousness. A neurological emergency.

Question 33

After how long should a seizure be treated as status epilepticus?

Answer 33

If no spontaneous resolution following 10 minutes of fitting.

Question 34

What are potential causes of status epilepticus?

Answer 34

``` Hyponatraemia Pyridoxine deficiency Infection Head trauma Subarachnoid haemorrhage Abrupt withdrawal of anti-convulsants ```

Question 35

What can kill patients in status epilepticus?

Answer 35

Aspiration Hypotension Hyperthermia Rhabdomyolysis

Question 36

How is status epilepticus treated?

Answer 36

Give 10mg benzodiazepines. Check for response. If no recovery, give again 5 mins later. If still doesn't resolve, give phenytoin 5 mins after that.

Question 37

What is a potential issue with giving benzodiazepines?

Answer 37

They can cause respiratory depression.

Question 38

After 1 hour of status epilepticus, what should be done?

Answer 38

Patient should be moved to ITU.

Question 39

What are non-epileptic attacks?

Answer 39

Behavioural episodes that look like seizures, caused by stress.

Question 40

How are non-epileptic attacks best treated?

Answer 40

Deal with trauma rather than treat symptoms.

Question 41

What is the most common trigger of a non-epileptic attack?

Answer 41

Sexual assault

Question 42

What occurs in a tonic clonic seizure?

Answer 42

A burst of electricity affecting the motor cortex of the frontal lobe resulting in all the muscles of the body contracting. Proceeds to relax-jerk in a pattern.

Question 43

Do functional attacks last longer than epileptic seizures?

Answer 43

Yes, usually 10-20 mins.

Question 44

What form of activity is seen in a functional attack?

Answer 44

Prominent motor activity, or Episodic collapse with no movement, or Abreactive attacks

Question 45

How is a functional attack treated?

Answer 45

Remove any epilepsy medication Reassure patient CBT