Epilepsy

Question 1

Epilepsy?

Answer 1

Recurring unprovoked seizures , 1 in 100-200

Question 2

Acute symptomatic seizures are provoked by?

Answer 2

Acute insults such as infection, stroke, metabolic disturbance, alcohol withdrawal

1 in 20

Question 3

Idiopathic generalised seizures are provoked by?

Answer 3

Sleep deprivation

Induced by hyperventilation and o photosensitivity testing

Question 4

Juvenile myoclonus epilepsy accounts for how much of all epilepsy?

Answer 4

3-12%

Question 5

Clinic phase normally lasts?

Answer 5

1-3 minutes

Question 6

Tonic phase contains?

Answer 6

Continuous muscle spasm, fall, cyanosis, incontinence, tongue biting

Question 7

Absences last?

Answer 7

5-20 seconds

Question 8

Absences are characterised by?

Answer 8

3hz spike and a wave

Question 9

Difference between simple and complex partial seizure?

Answer 9

Simple- focal seizure with awareness

Complex- focal seizure with reduced awareness

Question 10

Which lobe experiences partial seizures the most?

Answer 10

Temporal

Question 11

What is common cause for temporal lobe seizures?

Answer 11

Hippocampal sclerosis

Question 12

Risk factor for later epilepsy?

Answer 12

7% have febrile convulsions

Question 13

Hippocampal sclerosis?

Answer 13

Severe neuronal cell loss and gliosis in hippocampus

Question 14

Todds paresis?

Answer 14

Weakness or paralysis in part or all of the body after a seizure

Question 15

Temporal lobe epilepsy signs and symptoms?

Answer 15

Hallucinations of taste, speech, smell visual distortion

Heart rate changes
Fear elation
Automatism- semi purposeful limb movements
Oral automatism- lip smacking

Question 16

Frontal lobe seizure?

Answer 16

10-30 seconds 
Rapid recovery, 
Predominantly nocturnal 
Forced head
Eye deviation to contra lateral side
Thrashing 
Jacksonian spread 
Fencing posture

Question 17

Parietal lobe epilepsy?

Answer 17

Positive sensory symptoms
Tingling pain
Distortion of body shape and image
Jacksonian march

Question 18

Occipital epilepsy?

Answer 18

Visual hallucinations

Amaourosis- blackout or whiteout- 25%

Question 19

Which antiepileptic drugs make myoclonus jerks and absences worse?

Answer 19

Phenytoin
Pregabalin
Gaba pectin
Carbamazepine

Question 20

Who are you going to recommend a brain scan?

Answer 20

Jacksonian motor or sensory seizures
Patients with a focal neurological deficit

Alcohol withdrawal- only if subdural haemotoma suspected

Question 21

Which drug enhances slow inactivation of sodium channels?

Answer 21

Lacosamide

Question 22

AMPA receptor antagonist?

Answer 22

Perampanel, non competitive

Question 23

Which anticonvulsants work on the presynaptic voltage gated calcium channels?

Answer 23

Topiramate, gabapentin, pregabalin, iamotrigine and zonisamide

Question 24

Enhancers of GABA Eric synaptic transmissions?

Answer 24

Sodium valproate
Benzo
Barbiturates
Tiagabine (inhibits GABA reuptake)
Vigabatrin (inhibits gaba T breakdown)

Question 25

How does levetiracetam work?

Answer 25

High affinity synaptic vesicles protein 2a ligand Modulates glutamate release

Question 26

If its a primary generalised seizure?

Answer 26

Sodium valproate and iamotrigine

Question 27

If its a partial focal onset seizure then it is?

Answer 27

Carbamazepine, iamotrigine

Question 28

Sodium valproate side effects?

Answer 28

``` Sedation Tremor Hair thinning Weight gain Menstrual irregularities Parkinsonism ```

Question 29

Sodium valproate can cause what?

Answer 29

Impaired cognitive development 30%

Question 30

Sodium valproate is an?

Answer 30

Enzyme inhibitor

Question 31

Which enzyme induction happens due to antiepileptic drugs?

Answer 31

CYP3A4

Question 32

Na channelopathies?

Answer 32

Point mutation Na channel inactivation is too slow Reduced number of function Na in inhibitory neurons- missense mutation GEFS plus

Question 33

K channelopathies?

Answer 33

Benign familial neonatal convulsions Defect in KCNQ2/3 subunit impaired activation Action potential repolarisation impaired

Question 34

When aroused neuronal activity becomes?

Answer 34

Desynchronised

Question 35

What is the difference between spasticity and rigidity?

Answer 35

Spasticity- only agonist or antagonist Characteristic posture changes Sensitive to sensory input Clasp knife ``` Rigidity Both agonist and antagonist No static postural changes Not sensitive to sensory input Cogwheel lead pipe ```