Epilepsy

Question 1

T or F , 70 % of patients can be seizure free with treatment

Answer 1

true

Question 2

Epilepsy definition

Answer 2

Neurological condition with Tendency to recurrent spontaneous seizures

Question 3

What causes seizures

Answer 3

Brief disturbances in the electrical function of the brain

Question 4

Possible causes of seizure

Answer 4

Infections
Stroke
Head injuries
Genetic
Brian tumor
Brain damage
Unknown

Question 5

Mortality rate of epileptic compared to normal population

Answer 5

Twice more

Question 6

Main causes leading to more death in epileptic population

Answer 6

Status epilepticus
Burns
Drowning
Injury
SUDEP
Chest infection
Aspiration
Suicide

Question 7

Morbidities present in epilepsy

Answer 7

Injury
Drugs side effects
Aspiration
Cognitive decline
Depression
Psychosis
Employment discriminions
Driving impaired
Embarrassment
Social prejudice

Question 8

2 groups of seizures

Answer 8

Local
Generalized

Question 9

What is the treatment gap in epilepsy

Answer 9

Number of people who have epilepsy and do not receive treatment

Question 10

Treatment gap in Ghana

Answer 10

50-60%

Question 11

Reasons for treatment gap

Answer 11

Poverty
Lack of medications
Social stigma
No prioritization for treatment

Question 12

How should you take history in epilepsy

Answer 12

Need a third person to give history - events, surroundings, details of seizures

Question 13

Questions to ask in epilepsy history

Answer 13

First time occurrence >
Age of onset - adulthood ? Childhood ?
Warning signs ( aura ? Tastes, odors, visual, auditory , repetitive movement )
Frequency
Time of seizures
Step by step explanation
Progression of seizure
Loss of consciousness
Triggers
Medications
PMH

Question 14

Birth history

Answer 14

Pregnancy - alcohol , smoking, herbal
Antenatal care
Delivery issue - fall, vacuum, obstructed labour , TBA
Sucking, cry, jaundice., meningitis
Milestones
Cerebral palsy

Question 15

Pathophysiology of seizures

Answer 15

Imbalance between inhibitory ( GABA ) and excitatory ( glutamate and aspartate)

Question 16

Classification of seizures

Answer 16

Generalized
Focal
Unknown

Question 17

Types of generalized seizures

Answer 17

Tonic clonic
Absence
Myoclonic absence
Eyelid myoclonia
Myoclonic
Clonic
Tonic
Atonic

Question 18

Types of absence generalized seizures

Answer 18

Typical
Atypical
Absence with special features

Question 19

Types of Myoclonic generalized seizures

Answer 19

Myoclonic
Myoclonic atonic
Myoclonic tonic

Question 20

Types of focal seizures

Answer 20

No impairment of consciousness or awareness ( simple partial ) - focal motor or sensory

Impairment of consciousness or awareness ( complex partial )

Bilateral , convulsive seizure (secondarily geenralized seizure) - tonic, clonic, tonic clonic

Question 21

Types of unknown seizures

Answer 21

Epileptic spasms

Question 22

Some causes of focal epilepsy ( anything hat can disturb cortical architecture and function )

Answer 22

Focal infection
Tumour
Hamartoma
Trauma related scarring

Question 23

Percentage of generalized epilepsy form. All seizures

Answer 23

30%

Question 24

Trigger factors for seizures on

Answer 24

Sleep deprivation
Missed doses of anti epileptic drugs
Alcohol
Recreational drug misuse
Physical or mental exhaustion
Flickering lights
Intercurrent infections
Metabolic disturbances
Uncommon - Loud noises, music , reading , hot baths

Question 25

History taking

Answer 25

Attack type Age at onset Frequency Duration Typical features Triggers

Question 26

What type of seizure do you expect n a patient more than 30 yo

Answer 26

Focal type

Question 27

Causes of focal seizures

Answer 27

Benign Rolandic epilepsy of childhood (idiopathic ) Benign occipital epilepsy of childhood ( idiopathic ) Genetic Infantile hémiplégia Dysembroynic Cerebrovascular dx Tumors Infective Trauma Inflammatory

Question 28

Characteristics of tonic clonic seizures

Answer 28

Preceded by aura Rigid and unconscious Falls heavily if standing Breathing stops and central. Cyanosis Jerking for 2 mins at most Flaccid state of deep coma Regain awareness and is confused Urinary incontinence and tongue biting possible

Question 29

Causes of tonic clonic generalized seizures

Answer 29

From focal seizures Genetic Cerebral birth injury Hydrocephalus Cerebral anoxia Drugs (ATBs, anti malarials, cyclosporin, amphetamines , antiarrythmics , psychotropic ) Alcohol Toxins Metabolic dx (all the hypo..) Infective Inflammatory Diffuse degenerative dx

Question 30

Characteristics of absence seizures

Answer 30

Start in childhood Brief Frequent - 20 to 30times in a day Can be mistaken for daydreaming or poor concentration in school

Question 31

Myoclonic seizures characteristics

Answer 31

Brief jerking movements mostly in arms More prominent in morning or when waking up Provoked by fatigue alcohol and sleep deprivation

Question 32

Characteristic atonic seizures

Answer 32

Brief loss of muscle tone Heavy falls Occur in epilepsy sydrome

Question 33

Charcateriics of tonic seizures

Answer 33

Increase in tone and loss of awareness Seen in epilepsy sudrome

Question 34

Characteristic sof clonic seizures

Answer 34

Same as tonic clonic seizures but no preceding tonic pahse

Question 35

Common generalized epilepsy syndrome

Answer 35

Childhood absence epilepsy (4-8yo, frequent brief absence) Juvenile absence epilepsy (10-15 yo, brief absence) Juvenile Myoclonic epilepsy (15-20 yo, GTCS,absences, morning Myoclonus ) GTCS on awakening (10-25yo , GTCS, sometimes Myoclonus)

Question 36

Investigations for seizures

Answer 36

ECG Cranial imaging - CT or MRO EEG Other appropriate when signs of infections or metabolic etc

Question 37

Investigations for epilepsy

Answer 37

EEG Imaging